Lloyd-Jones Donald M, Wilson Peter W F, Larson Martin G, Beiser Alexa, Leip Eric P, D'Agostino Ralph B, Levy Daniel
Department of Preventive Medicine and Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois,
Am J Cardiol. 2004 Jul 1;94(1):20-4. doi: 10.1016/j.amjcard.2004.03.023.
We investigated whether the Framingham risk score, which was designed to estimate the 10-year risk of coronary heart disease (CHD), differentiates lifetime risk for CHD. All subjects in the Framingham Heart Study examined from 1971 to 1996 who were free of CHD were included. Subjects were stratified into age- and gender-specific tertiles of Framingham risk score, and lifetime risk for CHD was estimated. We followed 2,716 men and 3,500 women; 939 developed CHD and 1,363 died free of CHD. At age 40 years, in risk score tertiles 1, 2, and 3, respectively, the lifetime risks for CHD were 38.4%, 41.7%, and 50.7% for men and 12.2%, 25.4%, and 33.2% for women. At age 80 years, risks were 16.4%, 17.4%, and 38.8% for men and 12.8%, 22.4%, and 27.4% for women. The Framingham risk score stratified lifetime risk well for women at all ages. It performed less well in younger men but improved at older ages as remaining life expectancy approached 10 years. Lifetime risks contrasted sharply with shorter term risks: at age 40 years, the 10-year risks of CHD in tertiles 1, 2, and 3, respectively, were 0%, 2.2%, and 11.6% for men and 0%, 0.7%, and 2.3% for women. The Framingham 10-year CHD risk prediction model discriminated short-term risk well for men and women. However, it may not identify subjects with low short-term but high lifetime risk for CHD, likely due to changes in risk factor status over time. Further work is needed to generate multivariate risk models that can reliably predict lifetime risk for CHD.
我们研究了旨在评估冠心病（CHD）10年风险的弗雷明汉风险评分是否能区分冠心病的终生风险。纳入了弗雷明汉心脏研究中1971年至1996年间接受检查且无冠心病的所有受试者。受试者按弗雷明汉风险评分的年龄和性别特异性三分位数分层，并估算冠心病的终生风险。我们随访了2716名男性和3500名女性；939人患冠心病，1363人无冠心病死亡。在40岁时，风险评分三分位数1、2和3中，男性冠心病终生风险分别为38.4%、41.7%和50.7%，女性分别为12.2%、25.4%和33.2%。在80岁时，男性风险分别为16.4%、17.4%和38.8%，女性分别为12.8%、22.4%和27.4%。弗雷明汉风险评分在各年龄段对女性终生风险的分层效果良好。在年轻男性中表现较差，但随着预期剩余寿命接近10年，在老年男性中表现有所改善。终生风险与短期风险形成鲜明对比：在40岁时，风险评分三分位数1、2和3中，男性冠心病10年风险分别为0%、2.2%和11.6%，女性分别为0%、0.7%和2.3%。弗雷明汉10年冠心病风险预测模型对男性和女性短期风险的区分效果良好。然而，它可能无法识别短期风险低但冠心病终生风险高的受试者，这可能是由于风险因素状态随时间变化所致。需要进一步开展工作以生成能够可靠预测冠心病终生风险的多变量风险模型。
