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Predicting the 30-year risk of cardiovascular disease: the framingham heart study.

Publication ,  Journal Article
Pencina, MJ; D'Agostino, RB; Larson, MG; Massaro, JM; Vasan, RS
Published in: Circulation
June 23, 2009

BACKGROUND: Present cardiovascular disease (CVD) risk prediction algorithms were developed for a < or =10-year follow up period. Clustering of risk factors at younger ages and increasing life expectancy suggest the need for longer-term risk prediction tools. METHODS AND RESULTS: We prospectively followed 4506 participants (2333 women) of the Framingham Offspring cohort aged 20 to 59 years and free of CVD and cancer at baseline examination in 1971-1974 for the development of "hard" CVD events (coronary death, myocardial infarction, stroke). We used a modified Cox model that allows adjustment for competing risk of noncardiovascular death to construct a prediction algorithm for 30-year risk of hard CVD. Cross-validated survival C statistic and calibration chi2 were used to assess model performance. The 30-year hard CVD event rates adjusted for the competing risk of death were 7.6% for women and 18.3% for men. Standard risk factors (male sex, systolic blood pressure, antihypertensive treatment, total and high-density lipoprotein cholesterol, smoking, and diabetes mellitus), measured at baseline, were significantly related to the incidence of hard CVD and remained significant when updated regularly on follow-up. Body mass index was associated positively with 30-year risk of hard CVD only in models that did not update risk factors. Model performance was excellent as indicated by cross-validated discrimination C=0.803 and calibration chi2=4.25 (P=0.894). In contrast, 30-year risk predictions based on different applications of 10-year functions proved inadequate. CONCLUSIONS: Standard risk factors remain strong predictors of hard CVD over extended follow-up. Thirty-year risk prediction functions offer additional risk burden information that complements that of 10-year functions.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

June 23, 2009

Volume

119

Issue

24

Start / End Page

3078 / 3084

Location

United States

Related Subject Headings

  • Time Factors
  • Sex Factors
  • Risk Factors
  • Predictive Value of Tests
  • Models, Theoretical
  • Middle Aged
  • Massachusetts
  • Male
  • Life Expectancy
  • Incidence
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pencina, M. J., D’Agostino, R. B., Larson, M. G., Massaro, J. M., & Vasan, R. S. (2009). Predicting the 30-year risk of cardiovascular disease: the framingham heart study. Circulation, 119(24), 3078–3084. https://doi.org/10.1161/CIRCULATIONAHA.108.816694
Pencina, Michael J., Ralph B. D’Agostino, Martin G. Larson, Joseph M. Massaro, and Ramachandran S. Vasan. “Predicting the 30-year risk of cardiovascular disease: the framingham heart study.Circulation 119, no. 24 (June 23, 2009): 3078–84. https://doi.org/10.1161/CIRCULATIONAHA.108.816694.
Pencina MJ, D’Agostino RB, Larson MG, Massaro JM, Vasan RS. Predicting the 30-year risk of cardiovascular disease: the framingham heart study. Circulation. 2009 Jun 23;119(24):3078–84.
Pencina, Michael J., et al. “Predicting the 30-year risk of cardiovascular disease: the framingham heart study.Circulation, vol. 119, no. 24, June 2009, pp. 3078–84. Pubmed, doi:10.1161/CIRCULATIONAHA.108.816694.
Pencina MJ, D’Agostino RB, Larson MG, Massaro JM, Vasan RS. Predicting the 30-year risk of cardiovascular disease: the framingham heart study. Circulation. 2009 Jun 23;119(24):3078–3084.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

June 23, 2009

Volume

119

Issue

24

Start / End Page

3078 / 3084

Location

United States

Related Subject Headings

  • Time Factors
  • Sex Factors
  • Risk Factors
  • Predictive Value of Tests
  • Models, Theoretical
  • Middle Aged
  • Massachusetts
  • Male
  • Life Expectancy
  • Incidence