Journal of General Internal Medicine

, Volume 18, Issue 12, pp 1039–1052

Framingham-based tools to calculate the global risk of coronary heart disease

A systematic review of tools for clinicians

DOI: 10.1111/j.1525-1497.2003.30107.x

Cite this article as:
Sheridan, S., Pignone, M. & Mulrow, C. J GEN INTERN MED (2003) 18: 1039. doi:10.1111/j.1525-1497.2003.30107.x


PURPOSE: To examine the features of available Framingham-based risk calculation tools and review their accuracy and feasibility in clinical practice.

DATA SOURCES:medline, 1966–April 2003, and the google search engine on the Internet.

TOOL AND STUDY SELECTION: We included risk calculation tools that used the Framingham risk equations to generate a global coronary heart disease (CHD) risk. To determine tool accuracy, we reviewed all articles that compared the performance of various Framingham-based risk tools to that of the continuous Framingham risk equations. To determine the feasibility of tool use in clinical practice, we reviewed articles on the availability of the risk factor information required for risk calculation, subjective preference for 1 risk calculator over another, or subjective ease of use.

DATA EXTRACTION: Two reviewers independently reviewed the results of the literature search, all websites, and abstracted all articles for relevant information.

DATA SYNTHESIS: Multiple CHD risk calculation tools are available, including risk charts and computerized calculators for personal digital assistants, personal computers, and web-based use. Most are easy to use and available without cost. They require information on age, smoking status, blood pressure, total and HDL cholesterol, and the presence or absence of diabetes. Compared to the full Framingham equations, accuracy for identifying patients at increased risk was generally quite high. Data on the feasibility of tool use was limited.

CONCLUSIONS: Several easy-to-use tools are available for estimating patients’ CHD risk. Use of such tools could facilitate better decision making about interventions for primary prevention of CHD, but further research about their actual effect on clinical practice and patient outcomes is required.

DISCLOSURE: Drs. Sheridan and Pignone have participated in the development of Heart-to-Heart, one of the risk tools evaluated within. They have also received speaking and consulting fees from Bayer, Inc. Bayer, Inc. has licensed the Heart-to-Heart tool.

Key words

risk assessment coronary heart disease Framingham Heart Study 

Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  • Stacey Sheridan
    • 2
  • Michael Pignone
    • 2
  • Cynthia Mulrow
    • 1
  1. 1.Division of General MedicineUniversity of Texas Health Sciences CenterSan Antonio
  2. 2.Division of General Medicine and Clinical EpidemiologyUNC HospitalChapel Hill

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