Framingham and National Cholesterol Education Program tools do not accurately predict coronary heart disease

The Framingham and National Cholesterol Education Program tools, NCEP, do not accurately predict coronary heart disease, according to a study performed at the Yale University School of Medicine in New Haven, CT.

The study included 1,653 patients who had no history of coronary heart disease; although 738 patients were taking statins (cholesterol lowering drugs like Lipitor) because of increased risk of developing coronary heart disease. All 1,653 patients underwent a coronary CT angiogram and doctors compared their risk of coronary heart disease, determined by the Framingham and NCEP risk assessment tools, to the amount of plaque actually found in their arteries as a result of the scan. Results showed that 21% of the patients who were thought to need statin drugs before the scan (because of the Framingham and NCEP assessment tools) did not require them; "26% of the patients who were already taking statins (because of the risk factor assessment tools) had no detectable plaque at all," said Kevin M. Johnson, MD, lead author of the study.

"Risk assessment tools are used by physicians implicitly. Physicians use them as a way to separate and treat patients accordingly. Ultimately, the Framingham influences what every physician does, but I feel it is not good enough to show what is happening with each individual patient," said Dr. Johnson.

"The average person tends to put a lot of weight on family history, but the association between that and coronary heart disease is only modest," said Dr. Johnson. "We are living in an era where genetic research is in the headlines, but reality is a lot more complicated than that," he said.

"There are still 400,000 people a year who die from heart attacks and have no warning signs at all; doctors want to be able to find those people before that happens and I hope this study gets people interested in finding out better predictors for coronary heart disease," said Dr. Johnson.