Infarct, atherosclerosis, stroke, thrombosis… These terms are causing more and more fear, and justifiably so. They can all be grouped into one term: cardiovascular diseases (CVD), which cause more than 36 percent of all deaths in North America, ahead of cancer (29 percent), car crashes, murders, etc. Efforts are being intensified to prevent these diseases, through medical and pharmaceutical research, as well as public awareness raising campaigns.
You can determine the level of CVD risk to which you are personally exposed, using the Framingham tables, a relatively simple calculation that can be performed by your pharmacist or physician. Your score makes it possible to set more effective goals to help further reduce the problems associated with these diseases.
THE FRAMINGHAM TABLES: A VALUABLE TOOL
Framingham is the name of an American town where a study of CVD risk factors was conducted over the course of more than 50 years. The study helped identify the main elements that influence the risk of developing these diseases and it also helped determine their relative importance. These factors were also statistically analyzed in order to render them quantifiable.
The Framingham risk score therefore helps assess your risk of developing a CVD, whether fatal or not, over the next ten years. There are online tools for calculating your Framingham risk score (e.g. at Risk calculator).
HOW TO CALCULATE YOUR SCORE
The Framingham score is basically obtained by attributing points based on the quantity and importance of your personal CVD risk factors. The calculation is different for men and women. It assesses the following factors:
Your age Your CVD risk increases with age. On the Framingham table, a certain number of points is attributed based on your age group.
Total cholesterol and HDL cholesterol levels While it is not the only guilty party in CVD, blood cholesterol is a very important element in calculating the Framingham score. Here the number of points attributed to you increases as your total cholesterol level (which reflects all your “bad” cholesterol) increases. However, this level is also analyzed according to your age. For example, the younger you are when your total cholesterol level starts to increase, the more you are at risk for CVD and the number of points attributed to you tends to increase.
The Framingham tables also take your “good” (HDL) cholesterol into consideration. The lower your HDL blood cholesterol level, the more points you are given.
Your systolic blood pressure When you take your blood pressure, the results include two numbers; the first is your systolic blood pressure, and the second is your diastolic blood pressure. While both are important in determining your CVD risk, only the systolic figure is used in the Framingham calculation. Points are also attributed differently depending on whether you are already being treated for hypertension. You therefore get more points as your systolic blood pressure increases, and even more if you are already taking medication to reduce your blood pressure.
Your smoking status You probably already know that there is a direct relationship between smoking and CVD. This important risk factor is also included in the Framingham score. If you are a smoker, you will be allotted points, and the number will be higher the younger you are.
INTERPRETING THE RESULTS OBTAINED
The total number of points obtained is converted into a percentage based on the Framingham tables; this reflects your risk of developing a CVD in the coming ten years. It therefore indicates a medium-term risk.
You could fall into one of the following three risk categories:
1. Low risk: your 10-year CVD risk is 10 percent or lower. 2. Moderate risk: your risk level is between 11 and 19 percent. 3. High risk: you have a 20 percent or higher risk. However, there are certain situations that place you in this category automatically regardless of the score you get. This is the case, for example, if you have diabetes or atherosclerosis, a disease of the blood vessels.
Bear in mind that this calculation does not assess all risk factors. For example, if you have a family history of CVD, you have a higher risk of developing it also. In addition, the Framingham score does not take into account lifestyle-related factors such as your alcohol consumption or how physically active you are – factors that can also influence your CVD risk.
The Heart and Stroke Foundation offers an online CVD risk assessment tool that also takes lifestyle and other risk factors into consideration (HSF-calculator).
Lastly, preventing CVD also means ensuring better control of your health, for example by respecting any pharmacological treatment, especially when it comes to treating chronic diseases.
WHAT YOU CAN CONTRIBUTE TO THE SCORE
In order for your pharmacist or physician to be able to determine your CVD risk level, it is up to you to make sure you provide them with the most accurate and representative information possible on the state of your health. These figures are very important, as they are true gauges of your health. You should therefore religiously jot down these figures, for example by keeping a notebook in which you compile your blood pressure readings. Your doctor or pharmacist will then be able to establish a representative blood pressure average for you. Accurate blood cholesterol values are also necessary for calculating your risk, so if you haven’t undergone a lipid profile recently, your doctor may ask you to get these lab tests done. Don’t forget to ask for the results of this profile so that you can bring the information next time you see your pharmacist. Based on these values and your blood pressure readings, your pharmacist will be able to calculate your CVD risk and to act accordingly, together with your doctor.
The Framingham score is not a panacea; it is one aspect of managing your overall health. But don’t forget that your health is first and foremost your responsibility, so take action now!