The Framingham Risk Score
The Framingham Heart Study has tracked residents of Framingham, Massachusetts since 1948. The risk equation derived from this cohort was one of the first tools to translate individual risk factors into a 10-year probability of cardiovascular events (coronary heart disease, stroke, peripheral artery disease).
It uses age, sex, total cholesterol, HDL cholesterol, systolic BP (and whether it's treated), diabetes, and smoking. Each factor is scored using sex-specific coefficients, summed, and mapped to a 10-year event probability.
Risk categories and treatment thresholds
| 10-Year Risk | Category | Treatment Approach |
|---|---|---|
| <10% | Low | Lifestyle modification. Statins if LDL very high or familial hypercholesterolaemia suspected. |
| 10-20% | Intermediate | Lifestyle modification strongly recommended. Statin if LDL >3.0 mmol/L or other high-risk features (CKD, family history). |
| >20% | High | Statin therapy recommended for most. BP treatment target <130/80 mmHg. Aspirin low-dose in selected patients. |
Framingham vs QRISK vs ACC/AHA Pooled Cohort Equations
The Framingham equation was derived from a predominantly white, middle-class US cohort. QRISK3 (used in UK NHS) includes additional factors like deprivation, ethnicity, atrial fibrillation, and systemic autoimmune disease. The ACC/AHA Pooled Cohort Equations are recommended in current US guidelines. All three tools produce broadly similar risk estimates but differ in population representativeness.
Related tools
For anticoagulation decisions in AF detected during CVD screening, see CHA2DS2-VASc Score. For ACS risk in chest pain presentation, see TIMI Score and HEART Score. For QTc monitoring on statins or antihypertensives, see QTc Calculator. For cholesterol unit conversion, see Lab Values Converter.
References
- Wilson PW, et al. "Prediction of coronary heart disease using risk factor categories." Circulation. 1998;97(18):1837-1847.
- D'Agostino RB, et al. "General cardiovascular risk profile for use in primary care." Circulation. 2008;117(6):743-753.
- Grundy SM, et al. "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol." JACC. 2019;73(24):e285-350.