The Framingham Risk Score: An Appraisal of Its Benefits and Limitations

The concepts of risk assessment and reduction are the cornerstones of preventive cardiology practice. The Framingham Heart Study is a landmark achievement that has provided valuable insights into coronary heart disease risk prediction. Through this cohort study, risk calculators have been generated to predict the risk of cardiac disease in asymptomatic patients. These risk predictors are practical, clinically relevant, and modestly accurate. Their accuracy is somewhat limited in applicability among certain specific populations, however, and some well-known risk factors are not incorporated. These are recognized limitations of the Framingham Risk Score, but it is important to keep in mind that the Framingham Heart Study is an ongoing project and that there are new risk prediction models forthcoming to incorporate additional risk factors. The emergence of subclinical atherosclerosis testing offers promise to refine the assessment of global risk, specifically identifying subjects assessed as intermediate risk by the standard Framingham Risk Score.