Framingham Risk Score (CHD)
Estimates 10-year risk of coronary heart disease events
Calculator
Why use it
Foundation of cardiovascular preventive care. Guides decisions on statin therapy, aspirin prophylaxis, lifestyle counseling, and intensive hypertension management. Forms the basis for ACC/AHA pooled cohort equations. Required for primary prevention decision-making.
About
The Framingham Risk Score estimates the 10-year risk of developing a first major coronary heart disease (CHD) event (angina, MI, or CHD death) based on sex, age, total cholesterol, HDL cholesterol, systolic blood pressure, antihypertensive treatment, smoking, and diabetes. It was one of the first validated multivariable cardiovascular risk scores and remains the foundation of most subsequent CVD risk tools. Different point systems are used for men and women.
When to use
- Primary prevention cardiovascular risk assessment
- Statin therapy eligibility assessment
- Blood pressure treatment target determination
- Shared decision-making for preventive interventions
- Patients aged 30–74 without pre-existing CHD
Formula
Pearls & pitfalls
- Framingham score was developed primarily in white European populations — may underestimate risk in South Asian patients and overestimate in African American patients.
- The ACC/AHA Pooled Cohort Equations (2013) replaced Framingham for many clinical decisions — they include total CVD events (not just CHD) and include African American-specific equations.
- A Framingham score > 20% is equivalent to having established coronary artery disease for treatment intensity purposes.
- Diabetes is one of the highest weighted factors in the score — treat aggressively.
- Smoking cessation is the single most impactful modifiable risk factor in most patients.
- Coronary artery calcium (CAC) score can reclassify intermediate-risk patients when treatment decisions are uncertain.
Next steps
Low risk (< 10%): Lifestyle modification; reassess in 4–6 years. Intermediate risk (10–20%): Discuss statin therapy if LDL-C ≥ 130 mg/dL; intensive lifestyle intervention. High risk (> 20%): Statin therapy recommended; aggressive risk factor modification; aspirin consideration in select patients.
Evidence
Wilson PW et al. (Circulation 1998) derived from 5,345 Framingham Heart Study participants. Validated extensively in diverse populations. Endorsed by ATP III, ACC/AHA. Note: ACC/AHA 2013 guidelines now recommend Pooled Cohort Equations as primary tool for 10-year ASCVD risk.