Circulation. 1998;97:1876-1887
(Circulation. 1998;97:1876-1887.)
© 1998 American Heart Association, Inc.
Primary Prevention of Coronary Heart Disease: Guidance From Framingham
A Statement for Healthcare Professionals From the AHA Task Force on Risk Reduction
Scott M. Grundy, MD, PhD, Chair;
Gary J. Balady, MD;
Michael H. Criqui, MD;
Gerald Fletcher, MD;
Philip Greenland, MD;
Loren F. Hiratzka, MD;
Nancy Houston-Miller, BSN, RN;
Penny Kris-Etherton, PhD, RD;
Harlan M. Krumholz, MD;
John LaRosa, MD;
Ira S. Ockene, MD;
Thomas A. Pearson, MD;
James Reed, MD;
Reginald Washington, MD, Members;
; Sidney C. Smith, Jr, MD, Ex-Officio-Member
Key Words: AHA Medical/Scientific Statements • prevention • risk factors • coronary disease
The Framingham Heart
Study has contributed importantly to understanding of the causes of
coronary heart disease (CHD), stroke, and other
cardiovascular diseases. Framingham research has helped
define the quantitative and additive nature of these causes or, as they
are now called, "cardiovascular risk
factors."1 The National Cholesterol
Education Program (NCEP)2 3 has made extensive
use of Framingham data in developing its strategy for preventing CHD by
controlling high cholesterol levels. The NCEP
guidelines2 3 adjust the intensity of
cholesterol-lowering therapy with absolute risk as
determined by summation of risk factors. The National High Blood
Pressure Education Program (NHBPEP) has set forth a parallel approach
for blood pressure control. In contrast to the
NCEP,2 however, earlier NHBPEP reports issued through the Joint National Committee4
did not match the intensity of therapy to absolute risk for CHD.
"Normalization" of blood pressure is the essential goal of therapy
regardless of risk status. Blood pressure–lowering therapy is carried
out as much for prevention of stroke and other
cardiovascular complications as for reduction of CHD
risk. Nonetheless, risk assessment could be important for making
decisions about type and intensity of therapy for hypertension. Thus,
the most recent Joint National Committee report5
gives more attention to risk stratification for adjustment of therapy
for hypertension. Although Framingham data have already been
influential in the development of national guidelines for risk factor
management, the opportunity may exist for both cholesterol
and blood pressure programs to draw more extensively from Framingham
results when formulating improved risk assessment guidelines and
recommending more . . . [Full Text of this Article]
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22(11):
919 - 925.
[Abstract]
[PDF]
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S. M. Grundy
Coronary calcium as a risk factor: role in global risk assessment
J. Am. Coll. Cardiol.,
May 1, 2001;
37(6):
1512 - 1515.
[Full Text]
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P. Holvoet, A. Mertens, P. Verhamme, K. Bogaerts, G. Beyens, R. Verhaeghe, D. Collen, E. Muls, and F. Van de Werf
Circulating Oxidized LDL Is a Useful Marker for Identifying Patients With Coronary Artery Disease
Arterioscler Thromb Vasc Biol,
May 1, 2001;
21(5):
844 - 848.
[Abstract]
[Full Text]
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J. Muntwyler and T.F. Luscher
Assessment of cardiovascular risk: time to apply genetic risk factors?
Eur. Heart J.,
April 2, 2000;
21(8):
611 - 613.
[PDF]
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K. O. Akosah, E. Gower, L. Groon, B. L. Rooney, and A. Schaper
Mild hypercholesterolemia and premature heart disease: do the national criteria underestimate disease risk?
J. Am. Coll. Cardiol.,
April 1, 2000;
35(5):
1178 - 1184.
[Abstract]
[Full Text]
[PDF]
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A. J. Taylor, A. P. Burke, P. G. O’Malley, A. Farb, G. T. Malcom, J. Smialek, and R. Virmani
A Comparison of the Framingham Risk Index, Coronary Artery Calcification, and Culprit Plaque Morphology in Sudden Cardiac Death
Circulation,
March 21, 2000;
101(11):
1243 - 1248.
[Abstract]
[Full Text]
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J. A. Vita and J. F. Keaney
Exercise -- Toning up the Endothelium?
N. Engl. J. Med.,
February 17, 2000;
342(7):
503 - 505.
[Full Text]
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S. M. Grundy, T. Bazzarre, J. Cleeman, R. B. D’Agostino Sr, M. Hill, N. Houston-Miller, W. B. Kannel, R. Krauss, H. M. Krumholz, R. M. Lauer, et al.
Prevention Conference V : Beyond Secondary Prevention : Identifying the High-Risk Patient for Primary Prevention : Medical Office Assessment : Writing Group I
Circulation,
January 4, 2000;
101
(1):
e3 - e11.
[Full Text]
[PDF]
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S. M. Grundy, R. Pasternak, P. Greenland, S. Smith Jr, and V. Fuster
Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology
J. Am. Coll. Cardiol.,
October 1, 1999;
34(4):
1348 - 1359.
[Full Text]
[PDF]
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S. M. Grundy, R. Pasternak, P. Greenland, S. Smith Jr, and V. Fuster
Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations : A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology
Circulation,
September 28, 1999;
100(13):
1481 - 1492.
[Full Text]
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S. M. Grundy, I. J. Benjamin, G. L. Burke, A. Chait, R. H. Eckel, B. V. Howard, W. Mitch, S. C. Smith Jr, and J. R. Sowers
Diabetes and Cardiovascular Disease : A Statement for Healthcare Professionals From the American Heart Association
Circulation,
September 7, 1999;
100(10):
1134 - 1146.
[Full Text]
[PDF]
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S. M. Grundy
Primary Prevention of Coronary Heart Disease : Integrating Risk Assessment With Intervention
Circulation,
August 31, 1999;
100(9):
988 - 998.
[Full Text]
[PDF]
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I.U. Haq, L.E. Ramsay, P.R. Jackson, and E.J. Wallis
Prediction of coronary risk for primary prevention of coronary heart disease: a comparison of methods
QJM,
July 1, 1999;
92(7):
379 - 385.
[Abstract]
[Full Text]
[PDF]
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A. M. Gotto Jr
Lipid-lowering therapy for the primary prevention of coronary heart disease
J. Am. Coll. Cardiol.,
June 1, 1999;
33(7):
2078 - 2082.
[Full Text]
[PDF]
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P. Greenland, S. Grundy, R. C. Pasternak, and C. Lenfant
Problems on the Pathway From Risk Assessment to Risk Reduction
Circulation,
May 19, 1998;
97(18):
1761 - 1762.
[Full Text]
[PDF]
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S. Windecker, Y. Allemann, M. Billinger, T. Pohl, D. Hutter, T. Orsucci, L. Blaga, B. Meier, and C. Seiler
Effect of endurance training on coronary artery size and function in healthy men: an invasive followup study
Am J Physiol Heart Circ Physiol,
June 1, 2002;
282(6):
H2216 - H2223.
[Abstract]
[Full Text]
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