Updating the assessment of cardiac risk: beyond Framingham.

Identification of the widely accepted cardiovascular risk factors of age, sex, hypertension, hyperlipidemia, smoking, obesity, diabetes, and physical inactivity from the Framingham Heart Study have led to dramatic reductions in cardiovascular morbidity and mortality. The Framingham estimation of coronary heart disease remains the mainstay of clinical risk assessment. However, novel risk predictors present opportunities to identify more patients at risk and to more accurately define that risk. Such predictors include lipoprotein analysis, measurement of lipoprotein-associated phospholipase A(2) and C-reactive protein, and assessment of hyperglycemia, liver function, and central obesity. Vascular imaging can also provide useful risk information. Using Framingham as a basis, several international groups have developed risks-coring systems that more closely reflect their individual populations and the clinical practicalities of their countries. When used accordingly, the newer risk predictors build upon the Framingham framework to allow physicians and their patients to effectively minimize, or even avoid, the burden of cardiovascular disease.