An estimated adjustment is usually made for this. Framingham risk tables already fail to take account of other significant features, especially family history. I am not sure that an adjustment will be as simple as a ‘bolt on’ formula. I am grateful to Dr Law for his thoughtful and stimulating letter. It would be a great shame if GPs were discouraged from carrying out risk prediction and consequently primary prevention whether through lifestyle changes or medication. However, risk prediction can be a useful clinical management tool. I fully recognise that we should never lose sight of the major benefits of lifestyle changes, and that we are limited to providing only the prevention that our system can afford. The society’s recommendation for the high-risk cut-off point is likely to be well below the >=30% Framingham equivalent and it is likely to urge us to provide intervention, including statins, for ever larger numbers of patients. The European Society of Cardiology is in the advanced stages of developing a risk calculator that will give us a European evidence-based prediction tool (see ). With our new ‘modified’ equation we could reduce the arbitrary cut-off to, say, >=25% 10-year risk. This value was selected mainly to limit statin prescribing. We could have a ‘modified-for-Britain’ Framingham equation which would produce proportionately lower absolute 10-year risks those who currently fall into the high risk (>=30%) group would have the highest values with the new equation.īased on Framingham scores, an arbitrary cut-off of >=30% 10-year risk was chosen to signify high risk. When determining who should receive primary prevention we want to be able to select those at the highest absolute risk of coronary events. After making this adjustment, the predicted risk became close to the observed rate at all levels of risk. 1 which demonstrates an overestimation of the 10-year CHD risk in British men.Īs you point out in your news story ( Guidelines in Practice December 2003), the authors say that the accuracy can be improved by a simple calculation. In his letter ( Guidelines in Practice January 2004), Dr Lockyer cites the paper by Brindle et al. I write to contribute to the ongoing debate about the use of Framingham risk calculations in the British population. Osteoarthritis resource hub by Pfizer Ltd.
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