Ajani UA, Ford ES, McGuire LC
Eur J Cardiovasc Prev Rehabil. 2006;13:745-752.
Background
The Framingham risk score has been used for coronary heart disease (CHD) risk assessment. Recently, additional risk factors not included in the Framingham algorithm have received much attention and may help improve risk assessment. We examined the distributions of lifestyle and emerging risk factors by 10-year risk of CHD.
Methods.
We calculated 10-year CHD risk (<10%, 10-20%, and >20%) for 8,355 participants in the National Health and Nutrition Examination Survey 1999-2002 using the Framingham risk score as modified by the National Cholesterol Education Program Adult Treatment Panel III guidelines. We examined the prevalence of lifestyle risk factors (body mass index and waist circumference) and various emerging risk factors (C-reactive protein, white blood cell count, fibrinogen, homocysteine, glycosylated hemoglobin, and albuminuria) as well as the prevalence of high CHD risk by levels of these risk factors.
Results.
All examined CHD risk factors were significantly associated with increasing 10-year CHD risk among men and women. Odds of being in the highest CHD risk group were greater at higher levels of examined risk factors. Means for most risk factors were slightly higher for women than the means for men. Sizeable proportions of participants with lower 10-year CHD risk had high levels of lifestyle and emerging risk factors: 60.8% were overweight, 33.8% had high C-reactive protein concentrations, 24.1% had serum fibrinogen >400 mg/dL, and 6% had an albumin/creatinine ratio >=30.
Conclusions.
Lifestyle and emerging risk factors, in addition to those included in the Framingham risk score, may be important in CHD risk assessment.
Comment.
This article was selected because of a connection to the article above by Lavie and Milani. Lavie and Milani demonstrate that younger patients may have risk profiles that not only differ from, but that they are also at higher risk levels than older patients entering cardiac rehabilitation programs. Ajani examines the risk profiles of almost 8,000 individuals with CHD according to the Framingham risk assessment. Ajani, et al coupled assessment of lifestyle (body mass index and waist circumference) and emerging risk factors (C-reactive protein, white blood cells, fibrinogen, homocysteine, and HbA1c) and found that within the risk categories, as defined in Framingham (eg, <10%, 10-20%, and >20%), each cohort demonstrates separate risk profiles with respect to both lifestyle and emerging risk factors. Even within the lowest-risk group, there are significant numbers of individuals at higher risk with respect to lifestyle and emerging risk factors. Therefore, some individuals in this group may be considered at high risk with respect to 1 or more of those risk factors. Coupled with the Lavie study, this study has implications for younger, lower-risk (by Framingham or other risk assessments) patients entering cardiac rehabilitation programs. Risk assessment with particular attention to lifestyle and emerging risk factors should be completed on each patient. Special attention to those higher risk lifestyle and emerging risk factors may increase efficacy of the program.
JR