Framingham Risk Score
10-Year CHD Risk

Framingham Risk Score — Clinical Guide

The Framingham Risk Score was developed from the Framingham Heart Study, a landmark prospective cohort study initiated in 1948 in Framingham, Massachusetts. The 1998 Wilson et al. equations (JAMA) use age, total cholesterol, HDL cholesterol, systolic blood pressure, antihypertensive treatment, smoking, and diabetes to predict 10-year risk of coronary heart disease events (MI, coronary death, unstable angina, coronary insufficiency) in adults aged 30–79 without existing CHD.

Risk Categories

• Low (<10%): Lifestyle counselling. Statin not routinely indicated unless LDL ≥190 mg/dL
• Intermediate (10–19%): Consider statin; individualise based on risk factors and patient preference
• High (≥20%): Statin therapy recommended — high-intensity preferred (atorvastatin 40–80 mg or rosuvastatin 20–40 mg)

Framingham vs ASCVD — Key Differences

• Framingham predicts CHD events only; ASCVD (Pooled Cohort Equations) predicts both MI and stroke — broader endpoint
• Framingham is validated for ages 30–79; ASCVD for 40–79
• Both validated primarily in White populations; apply with caution in South Asian and other populations
• For South Asian patients (including Indian subcontinent), multiply risk by 1.4–1.5 to account for higher intrinsic risk

Lifestyle Risk Reduction — Evidence-Based

• Smoking cessation: reduces CHD risk by 50% within 1 year — most impactful single intervention
• Diet: Mediterranean or DASH diet — reduces LDL by 10–15%, lowers BP, reduces inflammation
• Physical activity: 150 min/week moderate aerobic exercise — reduces CHD risk by 30–35%
• BP control to <130/80 mmHg: each 10 mmHg SBP reduction reduces CHD risk by 25%
• Diabetes control: HbA1c <7% — reduces microvascular risk; SGLT2 inhibitors reduce MACE in T2DM

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