Timeline for Framingham risk scales

Timeline for Framingham risk scales

Before reviewing the available validation studies for Framingham risk scales, it is important to have a basic understanding of the timeline for these scales. This is because each Framingham scale is designed to measure a different and specific CVD outcome or is generated using different statistical methods and there is therefore a need for studies addressing validation or making comparisons of scales to clearly identify which Framingham scales they are referring to. Unfortunately, through the course of this research, it was found that validation studies often overlook this need and the generic name “Framingham scale” is used indiscriminately across both the original Framingham scale and its derivative. This section of the Wiki therefore aims to clarify the confusion created by the different scales for primary prediction of CVD developed by the Framingham Heart Study Group by specifying dates for scale development. For more information on each scale and how scales differ from one other, please click on the names of the scales listed on the previous page. Note also the distinction below between total and hard CHD,

1991 – Framingham-Anderson scale: earliest Framingham coronary heart disease scale currently in use

1994 – European Society of Cardiology recommends a risk chart based on the Framingham-Anderson model

1998 – Framingham-Wilson scale: LDL cholesterol introduced as additional factor

2002 – Framingham/ATPIII scale: Adult Treatment Panel III (ATP III) from the National Cholesterol Education Program (NCEP) in US, develop a new version of Framingham CHD prediction scale, based on Framingham-Wilson scale, excluding diabetes as a factor and including age range, dyslipidemia, hypertension treatment, smoking, and total cholesterol as new factors, while targeting “hard CHD (myocardial infarction + CHD death)” as the primary outcome as opposed to the previous “total CHD (stable angina, unstable angina, myocardial infarction, and CHD death)”.

2003 – Framingham-REGICOR scale: Framingham-Wilson scale calibrated specifically for the Spanish province of Gerona as the target population

2003 – European society of cardiology generate their own prediction scale, SCORE, independently of the Framingham Heart Study Group

2008 – Framingham-D’Agostino scale (Framingham General Cardiovascular Risk Profile): the Framingham Heart Study Group introduce this new prediction scale to estimate the risk of an individual developing all cardiovascular events (inclusive of CHD, cerebrovascular events, peripheral arterial disease and heart failure)

2010 – NICE withdraws its recommendation of universal use of Framingham equation but recognizes it in a list of recommended scales for clinicians to use at their own discretion

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Cardiovascular Health Measurement Scales