Representativeness of the Framingham risk model for coronary heart disease mortality: A comparison with a national cohort study

doi:10.1016/0021-9681(87)90129-9

Journal of Chronic Diseases

Volume 40, Issue 8, 1987, Pages 775-784

Journal of Chronic D...

https://doi.org/10.1016/0021-9681(87)90129-9 Get rights and content

Abstract

The Framingham Heart Study has been the foundation upon which several national policies regarding risk factors for coronary heart disease mortality are based. The NHANES I Epidemiologic Followup Study is the first national cohort study based upon a comprehensive medical examination of a probability sample of United States adults. The average follow-up time was 10 years. This study afforded an opportunity to evaluate the generalizability of the Framingham risk model, using systolic blood pressure, total cholesterol, and cigarette smoking, to the U.S. population with respect to predicting death from coronary heart disease. The Framingham model predicts remarkably well for this national sample. The major risk factors for coronary heart disease mortality described in previous Framingham analyses are applicable to the United States white adult population.

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Cardiovascular disease (CVD) is among the leading causes of death and disability worldwide. Since its beginning, the Framingham study has been a leader in identifying CVD risk factors. Clinical trials have demonstrated that when the modifiable risk factors are treated and corrected, the chances of CVD occurring can be reduced. The Framingham study also recognized that CVD risk factors are multifactorial and interact over time to produce CVD. In response, Framingham investigators developed the Framingham Risk Functions (also called Framingham Risk Scores) to evaluate the chance or likelihood of developing CVD in individuals. These functions are multivariate functions (algorithms) that combine the information in CVD risk factors such as sex, age, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking behavior, and diabetes status to produce an estimate (or risk) of developing CVD or a component of CVD (such as coronary heart disease, stroke, peripheral vascular disease, or heart failure) over a fixed time, for example, the next 10 years. These estimates of CVD risk are often major inputs in recommending drug treatments such as cholesterol-lowering drugs.
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Dietary carbohydrate intake is associated with cardiovascular disease risk in Korean: Analysis of the third Korea National Health and Nutrition Examination Survey (KNHANES III)
2010, International Journal of Cardiology
Citation Excerpt :
Cardiovascular disease (CVD) has become a leading cause of morbidity and mortality in Korea, as it is in most developed countries [1,2]. CVD results from complex interactions of multiple genetic and environmental factors, including diabetes mellitus, cigarette smoking, total cholesterol, blood pressure, and physical activity [3–5]. Dietary patterns are also a major factor contributing to the development of CVD.
It is widely recognized that dietary factors play important roles in the development of cardiovascular disease (CVD). We evaluated the association between carbohydrate intake and CVD risk factors, using data from the third Korea National Health and Nutrition Examination Survey (KNHANES III).
A nationally representative sample of Korean adults (1536 men, 2235 women), aged 20 to 69 years, was divided into three groups according to carbohydrate intake (% of energy), based on the Dietary Reference Intakes (DRI, 55–70% of energy) for Koreans. Then, we examined whether excessive carbohydrate intake was related to CVD risk factors.
Mean carbohydrate intake (% of energy) was 72.8% (321 g/day), above the DRI for Korean adults (55–70%). A high carbohydrate intake (> 70% of energy) was associated with higher BMI, blood pressure, fasting glucose, triglycerides, and LDL-cholesterol levels in women. After adjusting for covariates, such as age, energy intake, alcohol consumption, smoking status, and physical activity, high carbohydrate intakes (> 70% of energy) were significantly associated with diabetes mellitus and low HDL-cholesterol (HDL-C) in women. In men, however, only total cholesterol was inversely associated with high carbohydrate intake.
Higher carbohydrate intakes than the DRI for Koreans were significantly associated with diabetes mellitus and low HDL-C levels in women. These results suggest that improvement of dietary patterns may be an important approach to the prevention of CVD in Korean women.
Fruit and vegetable consumption and risk factors for cardiovascular disease
2009, Metabolism: Clinical and Experimental
Citation Excerpt :
Cardiovascular diseases (CVDs) are among the most common causes of death and disability worldwide [1]. The risk of CVD rises with increasing age, body weight, blood pressure, cigarette smoking, alcohol intake, and dyslipidemia [2,3]. Epidemiologic studies have shown that elevated concentrations of serum total cholesterol and low-density lipoprotein cholesterol (LDL-C) are independent risk factors for CVD [4,5].
The international guidelines issued by the World Health Organization recommend reduction in dietary saturated fat and cholesterol intakes as means to prevent hypercholesterolemia and cardiovascular disease (CVD); however, only limited data are available on the benefits of fruit and vegetable consumption on CVD risk factors in a community-based population. The aim of this study was to examine whether, and to what extent, intake of fruits and vegetables is inversely associated with CVD risk factors in adults. In this population-based cross-sectional study, a representative sample of 840 Tehranian adults (male and female) aged 18 to 74 years was randomly selected in 1998. Multivariate logistic regression adjusted for lifestyle and nutritional confounders was used in 2 models. After adjusting for confounders, dietary fruit and vegetable were found to be significantly and inversely associated with CVD risk factors. Adjusted odds ratio for high low-density lipoprotein concentrations were 1.00, 0.88, 0.81, and 0.75 (P for trend < .01) in the first model, which was adjusted for age, sex, keys score, body mass index, energy intake, smoking status, dietary cholesterol, and history of diabetes mellitus and coronary artery disease, a trend which was not appreciably altered by additional adjustment for education, physical activity, and saturated, polyunsaturated, and total fat intakes. This association was observed across categories of smoking status, physical activity, and tertiles of the Keys score. Exclusion of subjects with prevalent diabetes mellitus or coronary artery disease did not alter these results significantly. Consumption of fruits and vegetables is associated with lower concentrations of total and low-density lipoprotein cholesterol and with the risk of CVD per se in a dose-response manner.
Anàlisi descriptiva de les variables: Nivell d'activitat física, depressió i riscos cardiovasculars en treballadors i docents d'una institució universitària a Medellín (Colòmbia)
2008, Apunts Medicina de l'Esport
Identificar los niveles de actividad física, depresión y riesgos cardiovasculares de los empleados y docentes de una Institución Universitaria en Medellín, Colombia (Politécnico Colombiano Jaime Isaza Cadavid).
De la población de docentes y empleados nacidos desde 1955, se seleccionó una muestra aleatoria estratificada según escala de edad de Framingham a la cual se practicaron: exámenes de laboratorio para medir perfil lipídico y glucemia; evaluación médica y antropométrica; Cuestionario Internacional de Actividad Física (IPAQ Corto) y escala de depresión de Hamilton.
El 45,4% de los evaluados eran sedentarios; el 40,5% presentaron depresión leve o moderada; el 10,5% consumían 22 o más gramos de alcohol a la semana; el 7% eran hipertensos; el 75,6% tenían dislipemia; el 3,5% eran diabéticos; el 18,6% eran obesos; el 19,8% tenían el hábito de fumar; según la calificación del colesterol unido a lipoproteínas de baja densidad (cLDL) y de alta densidad (cHDL), el 79,1% estaban en el límite o riesgo alto y el 75,6% se encontraban en el límite o con riesgo alto o moderado, respectivamente; el 43% tenían riesgo en la calificación del índice arterial; el 31,4% presentaron riesgo medio, moderado o alto de padecer infarto en los próximos 10 años según la escala Framingham.
Del análisis descriptivo se concluyó que las dislipemias y el sedentarismo eran los principales factores de riesgo cardiovascular encontrados en la población. Además, los valores menores de cLDL y de depresión se encontraron en personas físicamente activas o muy activas.
To identify levels of physical activity, depression and cardiovascular risk in the teaching and other staff of a university in Medellin, Colombia (Politécnico Colombiano Jaime Isaza Cadavid).
A random sample was selected of teachers and other staff born since 1955, stratified by the Framingham age range. Lipid profile and glycemia levels were measured and medical and anthropometric evaluations were carried out. The International Physical Activity Questionnaire (Short-IPAQ) and the Hamilton depression scale were administered.
A total of 45.4% of the participants were sedentary, 40.5% had mild or moderate depression, 10.5% consumed 22 or more grams of alcohol per week, 7% were hypertensive, 75.6% had dyslipidemia, 3.5% had diabetes, 18.6% were obese, and 19.8% were smokers. Low-density lipoprotein cholesterol (LDL-C) levels were classified as borderline or high risk in 79.1% and high-density lipoprotein cholesterol (HDL-C) as borderline, high or moderate risk, respectively, in 75.6%. The total/HDL cholesterol ratio showed risk in 43% of the participants. According to the Framingham scale, 31.4% had a medium, moderate or high risk of having a heart attack within the next 10 years.
This descriptive analysis reveals that the main cardiovascular risk factors in this population were lipid disorders and physical inactivity. Lower levels of LDL-C and depression were found in physically active or highly active participants.

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Original articleRepresentativeness of the Framingham risk model for coronary heart disease mortality: A comparison with a national cohort study

Abstract

Atherosclerosis

Am J Cardiol

The Framingham, Massachusetts Study twenty years later

Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final report of the Pooling Project

J Chron Dis

The results of the Framingham Study applied to four other U.S.-based epidemiologic studies of cardiovascular disease

Plan and Operation of the Health and Nutrition Examination Survey, United States, 1971–1973

Recommendations for Human Blood Pressure Determination by Sphygmomanometers

Original article
Representativeness of the Framingham risk model for coronary heart disease mortality: A comparison with a national cohort study