Does the Framingham Risk Score Predict Risk in Women as Well as It Does in Men?
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Does the Framingham Risk Score Predict Risk in Women as Well as It Does in Men? Lewis H. Kuller
Published online: 23 March 2010 # Springer Science+Business Media, LLC 2010
Abstract The current guidelines for classifying women into high, intermediate and low risk based on the Framingham Risk Score and National Cholesterol Education Program guidelines are biased against women, deprive many women at risk of coronary heart disease of potentially effective lipidlowering drug therapy, and likely contribute to a very high prevalence of vascular disease, cognitive disorders, disability, and reduced active life expectancy for women. Prevalence of atherosclerosis beginning early in life, use of noninvasive imaging of atherosclerosis, better measurement of lipoprotein levels, awareness of importance of diseases that increase risk of coronary heart disease among women, and earlier and more frequent use of effective therapies to prevent cardiovascular disease are necessary to greatly improve women’s cardiovascular health. Keywords Risk factors . Women . Cardiovascular disease . Coronary calcium . Lipid lowering
Introduction We and others have documented that women can be identified with very low levels of risk factors for coronary heart disease (CHD). Such women have an extremely low incidence of and mortality due to CHD even to very old age, suggesting that if risk factor levels are reduced to these low levels then CHD would be preventable in other women [1•, 2•].
A major question is how to maximize preventive therapies to reduce incidence and disability due to CHD among women. The current guidelines for identification of women at high risk of cardiovascular disease (CVD) who are candidates for pharmacologic therapies, especially lipidlowering drug therapies, are biased against women and contribute to the continued high incidence of CHD and substantial morbidity and disability, especially among women later in life [3]. First, the risk score focuses only on hard CHD end points, not CVD. Women have a lower incidence of myocardial infarction (MI) and sudden CHD death than men but have a high prevalence of other manifestations of CVD. Second, guidelines focus on short-term risk of disease (ie, end stage of disease) and not on the prevention of atherosclerosis. Third, risk scores do not take into account the very high prevalence of subclinical vascular disease among older women and the importance of vascular disease in the brain, which is a determinant of dementia and disability. Fourth, the risk scores focus on low-density lipoprotein cholesterol (LDL-C). Many women are overweight, obese, have dyslipidemia (a combination of high apolipoprotein-B [ApoB], LDL particles, and high triglycerides), and have low high-density lipoprotein cholesterol (HDL-C) [4]. Fifth, risk scores presume that nonpharmacologic therapies to lower blood lipids, blood pressure (BP), body weight, and diabetes risk are very effective and therefore a good substitute for drug therapies. Unfortunately, for most women, this is incorrect.
Risk Scores L. H. Kulle
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