BMJ: Framingham Risk Score might be outdated to assess CV disease risk

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The Framingham Risk Score system for assessing the risk of cardiovascular disease among older people should be replaced with something more accurate, according to a study published Jan. 8 in the British Medical Journal (BMJ).

Wouter de Ruijter, MD, and colleagues at the Leiden University Medical Center in Leiden, Netherlands, looked at 215 women and 87 men with no history of cardiovascular disease aged 85 over a five-year period to assess mortality from cardiovascular disease (such as stroke and heart disease), and whether different ways of assessing their risk of such disease at the start proved to be more accurate. The people were taking part in the existing Leiden 85-plus Study.

The Framingham Risk Score system has been used for decades to predict the 10-year risk of developing heart disease in people with no history of such disease. It uses classic risk factors including sex, systolic blood pressure, cholesterol, diabetes and smoking.

As well as using the Framingham Risk Score, the researchers also measured plasma levels of the new biomarkers homocysteine, folic acid, C-reactive protein and interleukin-6 in the study.
During the follow-up period, the researchers said that 108 of the 302 participants died, and 32 percent of the deaths were from cardiovascular disease.

De Ruijter and colleagues found that classic risk factors were unable to predict cardiovascular deaths accurately, neither by using the Framingham Risk Score nor by using the classic risk factors in a newly calibrated model.

From the new biomarkers used, homocysteine had the best ability to predict deaths, according to the authors. Of the 35 people who died from cardiovascular disease during the five years studied, the Framingham Risk Score had classified just 12 people as being at high risk. However, the homocysteine-based model had classified 20 people as being high risk—nearly a quarter more of all individuals who died from cardiovascular disease.

The authors concluded that a single homocysteine measurement can accurately identify very elderly people who are at high risk of dying from cardiovascular disease. They called for a larger study to be carried out as their findings could lead to a change to current guidelines.

“Possibly, plasma homocysteine, and not classic risk factors, could be used to select very elderly people for primary preventive interventions,” the authors wrote.