AHA/ACC Scientific Statement:Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations

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GRUNDY ET AL., Assessment of Cardiovascular Risk
J Am Coll Cardiol 1999;34:1348--59

AHA/ACC Scientific Statement: 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

IV. Definition of CHD

Interpretation of risk estimates for CHD requires a precise definition of CHD. Framingham estimates traditionally predict total CHD, which includes angina pectoris, recognized and unrecognized myocardial infarction, coronary insufficiency (unstable angina), and CHD deaths. In contrast, many clinical trials^11–14 that have evaluated specific risk-reducing therapies have specified major coronary events (recognized acute myocardial infarction and CHD deaths) as the primary coronary end points. In accord, the recent Framingham report² also provided estimates for "hard" CHD, excluding angina pectoris. The inclusion of coronary insufficiency (unstable angina) and unrecognized myocardial infarction (defined by electrocardiography) probably gives estimates of hard CHD that are somewhat higher than combined end points reported in several clinical trials.^11–14 A recent clinical trial, the Air Force/Texas Coronary Artery Prevention Study (AFCAPS/TexCAPS),¹⁵ specified acute coronary events, including unstable angina, acute myocardial infarction, and coronary death, as the primary end point. This combined end point probably corresponds closely to the Framingham study's definition of hard CHD. Definitions of coronary end points assume critical importance when risk cutpoints are defined to select patients for specific therapies.

American College of Cardiology

Helping Cardiovascular Professionals Learn. Advance. Heal.

GRUNDY ET AL., Assessment of Cardiovascular Risk J Am Coll Cardiol 1999;34:1348--59