Coronary Heart Disease (10-year risk)

Coronary Heart Disease
(10-year risk)

Based on
Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998 May 12;97(18):1837-47. PMID:9603539.

Outcome
Coronary Heart Disease

Duration of follow-up
Maximum of 12 years, 10-year risk prediction

Population of interest
Individuals 30 to 74 years old and without overt CHD at the baseline examination

Predictors

  • Age
  • Diabetes
  • Smoking
  • JNC-V blood pressure categories
  • NCEP total cholesterol categories
  • LDL cholesterol categories

Estimating Risk of CHD in Men

Step 1
Age
Years LDL Pts Chol Pts
30-34 -1 [-1]
35-39 0 [0]
40-44 1 [1]
45-49 2 [2]
50-54 3 [3]
55-59 4 [4]
60-64 5 [5]
65-69 6 [6]
70-74 7 [7]
Step 2
LDL-C
(mg/dl) (mmol/L) LDL Pts
<100 <2.59 -3
100-129 2.60-3.36 0
130-159 3.37-4.14 0
160-190 4.15-4.92 1
≥190 ≥4.92 2
Cholesterol
(mg/dl) (mmol/L) Chol Pts
<160 <4.14 [-3]
160-199 4.15-5.17 [0]
200-239 5.18-6.21 [1]
240-279 6.22-7.24 [2]
≥280 ≥7.25 [3]
Step 3
HDL-C
(mg/dl) (mmol/L) LDL Pts Chol Pts
<35 <0.90 2 [2]
35-44 0.91-1.16 1 [1]
45-49 1.17-1.29 0 [0]
50-59 1.30-1.55 0 [0]
≥60 ≥1.56 -1 [-2]
Step 4
Blood Pressure
Systolic
(mm Hg)		 Diastolic (mm Hg)
<80 80-84 85-89 90-99 ≥100
<120 0 [0]pts
120-129 0 [0]pts
130-139 1 [1]pts
140-159 2 [2]pts
≥160 3 [3]pts

*Note: When systolic and diastolic pressures provide different estimates for point scores, use the higher number

Step 5
Diabetes
LDL Pts Chol Pts
No 0 [0]
Yes 2 [2]
Step 6
Smoker
LDL Pts Chol Pts
No 0 [0]
Yes 2 [2]
Step 7 (sum from Steps 1-6)
Adding up the points
Age
LDL-C or Chol
HDL-C
Blood Pressure
Diabetes
Smoker
Point total
Step 8 (determine CHD risk from point total)
CHD Risk
LDL Pts
Total		 10 Yr
CHD Risk		 Chol Pts
Total		 10 Yr
CHD Risk
<-3 1%
-2 2%
-1 2% [<-1] [2%]
0 3% [0] [3%]
1 4% [1] [3%]
2 4% [2] [4%]
3 6% [3] [5%]
4 7% [4] [7%]
5 9% [5] [8%]
6 11% [6] [10%]
7 14% [7] [13%]
8 18% [8] [16%]
9 22% [9] [20%]
10 27% [10] [25%]
11 33% [11] [31%]
12 40% [12] [37%]
13 47% [13] [45%]
≥14 ≥56% [≥14] [≥53%]
Step 9 (compare to average person your age)
Comparative Risk
Age
(years)		 Average
10 Yr CHD
Risk		 Average
10 Yr Hard* CHD
Risk		 Low**
10 Yr CHD
Risk
30-34 3% 1% 2%
35-39 5% 4% 3%
40-44 7% 4% 4%
45-49 11% 8% 4%
50-54 14% 10% 6%
55-59 16% 13% 7%
60-64 21% 20% 9%
65-69 25% 22% 11%
70-74 30% 25% 14%
Key
Color Relative Risk
green Very low
green-yellow Low
yellow Moderate
yellow-red High
red Very high

*Hard CHD events exclude angina pectoris

**Low risk was calculated for a person the same age, optimal blood pressure, LDL-C 100-129mg/dl or cholesterol 160-199 mg/dl, HDL-C 45 mg/dl for men or 55 mg/dl for women, non-smoker, no diabetes.

Risk estimates were derived from the experience of the Framingham Heart Study, a predominantly Caucasian population in Massachusetts, USA.

Estimating Risk of CHD in Women
Wilson, PWF, Circulation 1998;97:1837-1847

Step 1
Age
Years LDL Pts Chol Pts
30-34 -9 [-9]
35-39 -4 [-4]
40-44 0 [0]
45-49 3 [3]
50-54 6 [6]
55-59 7 [7]
60-64 8 [8]
65-69 8 [8]
70-74 8 [8]
Step 2
LDL-C
(mg/dl) (mmol/L) LDL Pts
<100 <2.59 -2
100-129 2.60-3.36 0
130-159 3.37-4.14 0
160-190 4.15-4.92 2
≥190 ≥4.92 2
Cholesterol
(mg/dl) (mmol/L) LDL Pts
<160 <4.14 [-2]
160-199 4.15-5.17 [0]
200-239 5.18-6.21 [1]
240-279 6.22-7.24 [1]
≥280 ≥7.25 [3]
Step 3
HDL-C
(mg/dl) (mmol/L) LDL Pts Chol Pts
<35 <0.90 5 [5]
35-44 0.91-1.16 2 [2]
45-49 1.17-1.29 1 [1]
50-59 1.30-1.55 0 [0]
≥60 ≥1.56 -2 [-3]
Step 4
Blood Pressure
Systolic
(mm Hg)		 Diastolic (mm Hg)
<80 80-84 85-89 90-99 ≥100
<120 -3 [-3]pts
120-129 0 [0]pts
130-139 0 [0]pts
140-159 2 [2]pts
≥160 3 [3]pts

*Note: When systolic and diastolic pressures provide different estimates for point scores, use the higher number

Step 5
Diabetes
LDL Pts Chol Pts
No 0 [0]
Yes 4 [4]
Step 6
Smoker
LDL Pts Chol Pts
No 0 [0]
Yes 2 [2]
Step 7 (sum from Steps 1-6)
Adding up the points
Age
LDL-C or Chol
HDL-C
Blood Pressure
Diabetes
Smoker
Point total
Step 8 (determine CHD risk from point total)
CHD Risk
LDL Pts
Total		 10 Yr
CHD Risk		 Chol Pts
Total		 10 Yr
CHD Risk
≤-2 1% [≤-2] [1%]
-1 2% [-1] [2%]
0 2% [0] [2%]
1 2% [1] [2%]
2 3% [2] [3%]
3 3% [3] [3%]
4 4% [4] [4%]
5 5% [5] [4%]
6 6% [6] [5%]
7 7% [7] [6%]
8 8% [8] [7%]
9 9% [9] [8%]
10 11% [10] [10%]
11 13% [11] [11%]
12 15% [12] [13%]
13 17% [13] [15%]
13 17% [13] [15%]
14 20% [14] [18%]
15 24% [15] [20%]
16 27% [16] [24%]
≥17 ≥32% [≥17] [≥27%]
Step 9 (compare to average person your age)
Comparative Risk
Age
(years)		 Average
10 Yr CHD
Risk		 Average
10 Yr Hard* CHD
Risk		 Low**
10 Yr CHD
Risk
30-34 <1% <1% <1%
35-39 <1% <1%% 1%
40-44 2% 1% 2%
45-49 5% 2% 3%
50-54 8% 3% 5%
55-59 12% 7% 7%
60-64 12% 8% 8%
65-69 13% 8% 8%
70-74 14% 11% 8%
Key
Color Relative Risk
green Very low
green-yellow Low
yellow Moderate
yellow-red High
red Very high

*Hard CHD events exclude angina pectoris

**Low risk was calculated for a person the same age, optimal blood pressure, LDL-C 100-129mg/dl or cholesterol 160-199 mg/dl, HDL-C 45 mg/dl for men or 55 mg/dl for women, non-smoker, no diabetes.

Risk estimates were derived from the experience of the Framingham Heart Study, a predominantly Caucasian population in Massachusetts, USA.

Functions for Men and Women

Estimated Coefficients Underlying CHD
Prediction Sheets Using Total Cholesterol Categories
Variable Men Women
Age,-y 0.04826 0.33766
Age-squared,-y -0.00268
TC,-mg/dL
<160 -0.65945 -0.26138
160-199 Referent Referent
200-239 0.17692 0.20771
240-279 0.50539 0.24385
>=280 0.65713 0.53513
HDL-C,-mg/dL
<35 0.49744 0.84312
35-44 0.2431 0.37796
45-49 Referent 0.19785
50-59 -0.05107 Referent
>=60 -0.4866 -0.42951
Blood-pressure
Optimal -0.00226 -0.53363
Normal Referent Referent
High-normal 0.2832 -0.06773
Stage-I-hypertension 0.52168 0.26288
Stage-II-IV-hypertension 0.61859 0.46573
Diabetes 0.42839 0.59626
Smoker 0.52337 0.29246
Baseline-survival-function-at-10-years, S0(10) 0.90015 0.96246
Linear predictor at risk factor means 3.09750 9.92545
Estimated Coefficients Underlying CHD
Prediction Sheets Using LDL Cholesterol Categories
Variable Men Women
Age,-y 0.04808 0.33994
Age-squared,-y -0.0027
LDL-C,-mg/dL
<100 -0.69281 -0.42616
100-129 Referent Referent
130-159 0.00389 0.01366
160-189 0.26755 0.26948
≥190 0.56705 0.33251
HDL-C,-mg/dL
<35 0.48598 0.88121
35-44 0.21643 0.36312
45-49 Referent 0.19247
50-59 -0.0471 Referent
≥60 -0.3419 -0.35404
Blood-pressure
Optimal -0.02642 -0.51204
Normal Referent Referent
High-normal 0.30104 -0.03484
Stage-I-hypertension 0.55714 0.28533
Stage-II-IV hypertension 0.65107 0.50403
Diabetes 0.42146 0.61313
Smoker 0.54377 0.29737
Baseline-survival-function-at-10-years, S0(10) 0.90017 0.9628
Linear predictor at risk factor means 3.00069 9.91414