Traditional Scoring Misses One-Third of Women -- MEDICA - World Forum for Medicine

The Framingham Risk Estimate (FRE) is a total estimate of how likely a person is to suffer a heart attack within 10 years, and it is based on a summary estimate of major risk factors, such as age, blood pressure, blood cholesterol levels and smoking. However, cardiologist Roger Blumenthal, M.D. of the Ciccarone Preventive Cardiology Center at The Johns Hopkins University School of Medicine and its Heart Institute.says, many women with cardiovascular problems go undetected despite use of the Framingham score.

In their latest report, the Hopkins researchers examined the risk of premature CHD in women whose average age was 50 and who were participating in the Sibling and Family Heart Study, a long-term study of how heart disease develops among family members. Study subjects had no symptoms of heart disease, but had a sibling who had been hospitalized for a coronary event, such as a heart attack before age 60.

The researchers calculated each woman's Framingham score and found that 98 percent were gauged to be at very low risk for future CHD, with an FRE of less than 6 percent, while only 2 percent of participants were judged to be at intermediate risk for future CHD, with an FRE between 10 percent and 20 percent.

When the results were contrasted with evidence gleaned from CT-scan measurements of calcium build-up in the arteries, the researchers found that one-third of women originally classified as very low risk actually had coronary atherosclerosis.

According to the researchers, performing cardiac CT scans on everyone with a low Framingham score is not a practical option. They found that people with two or more risk factors, such as obesity, smoking or metabolic syndrome, plus a family history for heart disease were those most likely to have a high calcium score. It is this group, the researchers say, who should be considered for a fast cardiac CT scan regardless of low Framingham scores.; Source: Johns Hopkins Medical Institutions