The increasing absolute risk that accompanies advancing age attests to the opportunity for reducing absolute short-term risk by an immediate aggressive reduction of risk factors in older people. The report notes that the best candidates for aggressive risk reduction among older patients may be those with a moderately high or a high relative risk. Percentages show 10-year absolute risk for total CHD end points. The number of Framingham points is derived from the information in the table on scoring. Average risk refers to that observed in the Framingham population.
Absolute risk is expressed as the percentage likelihood of developing CHD per decade.
Hard CHD estimates are approximated from the Framingham data. For example, NCEP guidelines identify patients with coronary disease and other atherosclerotic disease at very high risk and recommend aggressive therapy in these patients. For primary prevention, LDL goals were established in the NCEP guidelines by counting risk factors, but absolute risk is not defined in precise, quantitative terms. For example, a 20-year projection of absolute risk may be of interest when patients are 50 to 54 years of age. The scoring does not adequately account for severe abnormalities in risk factors, such as severe hypertension, severe hypercholesterolemia and heavy smoking.