Framingham Risk Calculator: 10-Year Hard CHD Risk (ATP III Points and Equation)

How it works

Point score: points for age + total cholesterol (by age group) + HDL + systolic BP (treated or untreated) + smoking (by age group) → sex-specific table of 10-year risk · Equation (men): L = 52.00961·ln(age) + 20.014077·ln(TC) − 0.905964·ln(HDL) + 1.305784·ln(SBP) + 0.241549·BPtreated + 12.096316·smoker − 4.605038·ln(age)·ln(TC) − 2.84367·ln(age*)·smoker − 2.93323·ln(age)², risk = 1 − 0.9402^exp(L − 172.300168), age* = min(age, 70) · Equation (women): L = 31.764001·ln(age) + 22.465206·ln(TC) − 1.187731·ln(HDL) + 2.552905·ln(SBP) + 0.420251·BPtreated + 13.07543·smoker − 5.060998·ln(age)·ln(TC) − 2.996945·ln(age*)·smoker, risk = 1 − 0.98767^exp(L − 146.5933061), age* = min(age, 78) · cholesterol in mg/dL (mmol/L × 38.67)

The Framingham score used by the NCEP Adult Treatment Panel III (2001) estimates the chance of "hard" coronary heart disease, meaning a heart attack or coronary death, over the next 10 years. It was built from the Framingham Heart Study cohorts and uses six inputs: age, sex, total cholesterol, HDL cholesterol, systolic blood pressure (with or without treatment) and current smoking. The point version assigns points to each factor, with cholesterol and smoking weighted more heavily at younger ages, then converts the total to a risk using a separate table for men and women. The equation version is the Cox model behind the points: it uses the exact values, so it gives a smooth percentage that can differ by a few points from the banded table. Results under 10% are usually called low, 10% to 20% intermediate and above 20% high. The score is for primary prevention in adults without diabetes or known cardiovascular disease, was derived in a mostly white US population, and does not include family history, diabetes, kidney function or other risk enhancers. Newer US tools (the Pooled Cohort Equations and the AHA PREVENT equations) estimate broader cardiovascular risk and are preferred for treatment decisions today.

Worked example

A 55-year-old man with total cholesterol 213 mg/dL, HDL 50 mg/dL, untreated systolic BP 130 mmHg and no smoking: age 55–59 = 8 points, total cholesterol 200–239 at age 50–59 = 3, HDL 50–59 = 0, untreated SBP 130–139 = 1, non-smoker = 0. Total 12 points, which the men's table converts to a 10% 10-year risk, the intermediate tier. The full Framingham equation with the same values gives 7.2%, which is in the low tier: the 12-point band covers a range of risks.

Sources: NHLBI, ATP III At-A-Glance: estimate of 10-year risk for men and women (Framingham point scores) · Framingham Heart Study: hard coronary heart disease 10-year risk function (coefficients, means, baseline survival) · MDCalc: Framingham Risk Score for Hard Coronary Heart Disease

Frequently asked questions