Laboratory-based Calculation of Coronary Heart Disease Risk

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Abstract
Guidelines for the use of cholesterol-lowering drugs in the primary prevention of coronary heart disease (CHD) now recommend that both the serum cholesterol concentration of the patient and an estimate of future risk of CHD for the patient are considered before treatment is initiated. CHD risk (CHDR) is judged semiquantitatively in the National Cholesterol Education Program guidelines by counting the number of additional nonlipid risk factors ( 1). In guidelines in the United Kingdom ( 2), Europe ( 3), and New Zealand ( 4), risk is projected in a quantitative manner using a predictive equation derived from the Framingham Heart Study ( 5). This uses eight weighted risk factors (age, sex, systolic or diastolic blood pressure, total and HDL-cholesterol, and the presence or absence of cigarette smoking, diabetes mellitus, and left ventricular hypertrophy) to calculate an absolute CHDR. The Framingham formula is mathematically complex, and for routine clinical practice, it has been converted into several risk tables ( 2)( 3)( 4)( 6) that may be inaccurate ( 7). We previously developed a Framingham-based CHDR calculation system using the laboratory computer ( 8) and now report our experience of the first 2 years of this program.

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