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Studies Challenge Framingham Risk Score
Date:1/8/2009

to do CT artery scans.

"But one thing they shouldn't do is what the American College of Cardiology and the American Heart Association suggested in 2007, that if someone has a low Framingham Risk Score, you shouldn't do imaging of coronary arteries," he said. "This study suggests that that might be a mistake."

The second report, by researchers at Leiden University Medical Center and published online Jan. 9 in the journal BMJ, concerned a specific group of people not covered by the Framingham guidelines: those 85 and older.

The Framingham Risk Score did no better than chance in predicting the 108 deaths that occurred among the 215 women and 87 men who were followed for five years, said Dr. Wouter de Ruijter, a clinical researcher at Leiden and lead author of the report.

"The key word here is age," de Ruijter said. "The Framingham Risk Score is validated up to age 75. There have been signs in the medical literature that the classic risk factors such as hypertension and hypercholesterolemia [high cholesterol levels] were not performing that well for people with advanced age."

The new study "indicates that the traditional risk factors become blurred or wane with age," he said.

The only accurate predictor of cardiovascular death in the Dutch study was the blood level of homocysteine, an amino acid that is related to formation of fatty deposits in the arteries, the study found.

"At this point, many questions would have to be answered before we recommend measuring homocysteine in people at this advanced age," de Ruijter said. "And I do not know what kind of intervention we could offer these people. The results of homocysteine-lowering trials have been disappointing."

What the study does show is "a 10-year gap here" in the effectiveness of the Framingham Risk Score, he said. "The primary preventive strategy for people at an advanced age is unknown," de Ruijter said. "Measuring blood pressu
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