A health risk appraisal function has been developed for the prediction of stroke using the Framingham Study cohort. The stroke risk factors included in the profile are age, systolic blood pressure, the use of antihypertensive therapy, diabetes mellitus, cigarette smoking, prior cardiovascular disease (coronary heart disease, cardiac failure, or intermittent claudication), atrial fibrillation, and left ventricular hypertrophy by electrocardiogram. Based on 472 stroke events occurring during 10 years' follow-up from biennial examinations 9 and 14, stroke probabilities were computed using the Cox proportional hazards model for each sex based on a point system. On the basis of the risk factors in the profile, which can be readily determined on routine physical examination in a physician's office, stroke risk can be estimated. An individual's risk can be related to the average risk of stroke for persons of the same age and sex. The information that one's risk of stroke is several times higher than average may provide the impetus for risk factor modification. It may also help to identify persons at substantially increased stroke risk resulting from borderline levels of multiple risk factors such as those with mild or borderline hypertension and facilitate multifactorial risk factor modification. (Stroke 1991;22:312-318) S troke is the third leading cause of death in the United States and is a major source of disability in persons older than age 60 years. In the face of an elderly population of increasing size, stroke is likely to be responsible for even greater disability and death. Epidemiologic study has identified key risk factors for stroke and has provided an estimate of the relative impact of these factors. Using data collected over 36 years of follow-up in the general population sample at Framingham, Mass., a stroke risk profile or health risk appraisal function has been developed. This profile contains a number of ingredients not available at the time of the previous stroke risk handbook, which was based on 16 years of follow-up. 1 The inclusion of previously diagnosed cardiovascular disease (coronary heart disease Received October 15, 1990; accepted November 27, 1990. [includes history of myocardial infarction, angina pectoris, and coronary insufficiency], cardiac failure, and intermittent claudication), atrial fibrillation, and left ventricular hypertrophy by electrocardiogram as ingredients in the profile has improved the efficiency of the risk prediction and gives a more realistic assessment of the importance of the stroke risk factors. Key to the usefulness of determining the likelihood of stroke by means of a risk profile is evidence that modification of several potent risk factors will reduce stroke probability. Epidemiologic study and clinical trial results have shown that reduction of elevated blood pressure and cessation of cigarette smoking can reduce stroke incidence. Warfarin (and perhaps aspirin) therapy in persons with atrial fibrillation, reversal of left ventricular hypertrophy by electrocardiogram, and treatment of cardiac failure and coronary heart disease may also effect a reduction in stroke incidence. Probability of stroke was determined in subjects aged 55-84 years and free of stroke at the time of two examination cycles, examinations 9 and 14, and is based on 10 years of follow-up from each of these examinations. Stroke risk factors included age, systolic blood pressure, use of antihypertensive therapy, and the presence of diabetes mellitus or cigarette by guest on April 12, 2017 http://stroke.ahajournals.org/ Downloaded from
Cox proportional hazards regression is one technique used to develop a statistical model, where the use of the Framingham Study cohort forms one such application REF .
Probability of stroke: a risk profile from the Framingham Study
Stroke
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