Coronary age as a risk factor in the modified Framingham risk score

In this paper we discuss a new and simple method for incorporating the coronary calcium score (CCS) to modify the Framingham Risk Assessment (FRA). Using this method, a coronary artery calcium (CAC) age equivalent is generated that replaces chronological age in Framingham scoring.Using a percentile table of CCS scores by age group and sex, individuals are matched to the age group whose calcium score most closely approximates their own individual score. The original 10-year absolute risk score of a 65-year old man with a CCS of 6 based on chronological age is 10%, whereas the modified absolute risk score based on CAC age equivalents is 2%.Our approach of replacing chronological age with CAC age equivalents in the Framingham equations possesses simplicity of application combined with precision. Physicians can easily derive adjusted Framingham risk scores and prescribe intervention methods based on patients' ten-year risks. The adjusted ten-year risks are likely to be more accurate than unadjusted risks since they are based on coronary calcium score information. The modified FRA approach not only may increase the predicted risk for some patients, but also may decrease the predicted risk for others, making it a more precise adjustment than other methods.Effective medical interventions to reduce risk for coronary heart disease (CHD) have brought the issue of primary prevention with drug therapies to the fore. There is growing evidence that both cholesterol-lowering drugs and anti-platelet drugs will reduce risk for new onset CHD in otherwise asymptomatic persons. The selection of patients for medical intervention for primary prevention therefore has assumed increasing importance in clinical practice. Current clinical guidelines stress risk assessment as the key to selection of persons for medical primary prevention. Unfortunately, current risk assessment tools are limited in their power to predict further major coronary events. The most widely accepted tool in the United