Framingham Cardiovascular Risk

Framingham 10-year cardiovascular risk score

The Framingham Risk Score estimates the probability of a major cardiovascular event (coronary heart disease, stroke, peripheral artery disease, heart failure) over the next 10 years. The current model (D'Agostino, Circulation 2008) extends the classical Wilson 1998 equation and combines seven variables: age (30–74), sex, total cholesterol, HDL-c, systolic blood pressure (treated vs untreated), current smoking and diabetes. The result follows a Cox proportional-hazards form: P = 1 − S₀(t)^exp(Σ βᵢXᵢ − M), where S₀(10) is the 10-year baseline survival and M is the mean linear predictor.

Risk strata: low <10%, intermediate 10–20%, high >20%. The Brazilian Society of Cardiology adapted the calibration in the ER-Brasil score (Update 2017); SCORE2 is preferred in Europe, and ASCVD (Pooled Cohort Equations, AHA/ACC 2013) in the United States. None of the equations are validated <30 or >74 years.

Applications

Stratifying primary prevention to decide statin therapy, antihypertensive intensity and aspirin use; guiding shared decision making with the patient; selecting people for advanced imaging (coronary calcium score) when risk is intermediate; reassessment every 4–6 years or after significant risk factor changes.

FAQ

Why does Framingham overestimate in Brazil? The original cohort was overwhelmingly white American; in Brazilian and Latin American populations the absolute event rate is lower. ER-Brasil and SCORE2 recalibrate to local incidence.

What about people under 30? Use lifetime risk tools or family-history flags. Short-term equations underestimate young patients with severe single risk factors (e.g., familial hypercholesterolemia).

Does this tool replace a doctor? No. It is an educational implementation of the Framingham equation and does not substitute medical evaluation, complementary tests or treatment by a qualified professional.