The Effect of the Change in the Framingham Risk Score Calculator Between the 2006 and 2009 Canadian Lipid Guidelines

Abstract

Background Recent Canadian lipid guidelines changed the methodology used for calculating the Framingham Risk Score (FRS). We assessed the impact this would have on management when related to baseline lipid profiles and the possible need for statin drug therapy. Methods Patients with their FRS calculated between November 2006 and March 2010 were considered. There were 247 patients categorized as either low or intermediate risk. Results The study population consisted of 91 men and 156 women with a mean (SD) age of 52.7 ± 15.0 years. The average FRS was 5.6 ± 4.8 vs 11.5 ± 8.3 (2006 vs 2009) ( P < .00010). The number of FRS patients categorized as low and intermediate risk requiring some form of lipid-lowering treatment increased from 35 (14.2%) to 81 (32.8%), a 2.3-fold increase. Of 41 high-risk patients, 40 had a baseline low-density lipoprotein cholesterol of ≥2.0 mmol/L and would qualify for not only health behaviour interventions but also statin drug treatment. Conclusions The new FRS increases the number of 2006 patients with low and intermediate scores who move from low to high risk (n = 11, 5.9%), from low to intermediate risk (n = 50, 26.9%), and from intermediate to high risk (n = 30, 49.2%), leading to a 2.3-fold increase in the need for lipid-lowering treatment. Therapies intended to improve lipid profiles and potentially patient outcomes include both health behaviour interventions alone or in combination with lipid-lowering drug therapy. Given the relationship between low-density lipoprotein cholesterol and cardiovascular events is linear, treating more patients is likely to lead to a further reduction in cardiovascular events.