High 10-year Coronary Heart Disease Risk Research Articles

Association of high-sensitivity C-reactive protein in middle-aged and elderly Chinese people with hyperuricaemia and risk of coronary heart disease: a cross-sectional study

ObjectivesPatients with hyperuricaemia are at relatively high risk of developing coronary heart disease (CHD). The purpose of this study was to examine the relationship between high-sensitivity C-reactive protein (hs-CRP) and...

White blood cell count: an independent predictor of coronary heart disease risk in middle-aged and elderly population with hyperuricemia.

Previous studies have shown that hyperuricemia is an independent risk factor for cardiovascular disease. The aim of the study was to examine the association between white blood cell (WBC) count and coronary heart disease (CHD) risk in middle-aged and elderly population with hyperuricemia.Data included in this analysis were from a population-based cross-sectional study, that is, the Xiangya Hospital Health Management Center Study. Hyperuricemia was defined as uric acid ≥416 μmol/L in male population and ≥360 μmol/L in female population. The WBC count was classified into 3 categories based on the tertile distribution of the study population. Framingham risk scores calculated by the Adult Treatment Panel III charts were used to estimate 10-year CHD risk for each participant. The relationship between WBC count and CHD risk in patients with hyperuricemia was examined using the multivariable logistic analysis.A total of 1148 hyperuricemia patients (855 males and 293 females) aged from 40 to 85 years were included and 418 (36.4%) of them were defined with relatively high 10-year CHD risk. Compared with the lowest tertile, the crude odds ratios (ORs) of high 10-year CHD risk were 1.43 (95% confidence interval [CI] 1.06–1.92) and 1.56 (95% CI 1.16–2.11) in the 2nd and 3rd tertiles of WBC count (P for trend = .004), and the multivariable adjusted ORs of high 10-year CHD risk were 1.39 (95% CI 1.03–1.89) and 1.47 (95% CI 1.08–2.00) in the 2nd and 3rd tertiles of WBC count (P for trend = .015).This study indicated that WBC count was associated with CHD risk in patients with hyperuricemia, suggesting that WBC count, an easily accessible biomarker, could probably predict CHD risk in middle-aged and elderly population with hyperuricemia.

Examination of a Nurse-led Community-based Education and Coaching Intervention for Coronary Heart Disease High-risk Individuals in China

PurposeEarly detection and management of coronary heart disease (CHD) are embedded into many community health service and primary care practices in western countries. The Framingham CHD risk score has been used to predict CHD and mortality for nearly 20 years, and it has predicted CHD event risk accurately in multiethnic populations. The aim of this study was to access the effect of a 6-month community-based intervention on CHD risk in individuals at high risk. MethodsA randomized controlled trial of individuals with a high 10-year CHD risk were recruited from two communities in China. Individuals in the intervention group (n = 53) received a 3-month group education and a 3-month coaching session. Physical examination and self-report questionnaires were used to collect both pre- and postintervention data on blood pressure, glucose, cholesterol, body mass index, smoking, depression, and health-related quality of life (HRQoL). ResultsA total of 102 participants (85.0%) completed the 6-month study. Compared with the usual care group, the intervention group had a 5 mmHg greater reduction in systolic blood pressure (t = 2.01, p = .047), larger declines in glucose (t = −2.49, p = .015), cholesterol (t = −2.44, p = .017), body mass index (t = −2.58, p = .011), and depression (t = −2.05, p = .043), and better reports of HRQoL (t = 3.36, p = .001). No significant group differences in smoking behaviors were reported. ConclusionA 6-month community-based intervention in a CHD high-risk population improved disease-related risk factors, depression, and HRQoL. Results provide preliminary evidence for primary prevention of cardiovascular disease risk in a community high-risk population.

Associations of fibroblast growth factor 21 with cardiovascular risk and β-cell function in patients who had no history of diabetes

BackgroundWe investigated the associations of fibroblast growth factor 21 (FGF-21) with cardiovascular risk and β-cell function in patients who had no history of diabetes. MethodsWe enrolled 269 outpatients who had been referred for an oral glucose tolerance test (OGTT). Plasma glucose, insulin, and FGF-21 were measured before and at 2h after the OGTT. β-cell function was assessed using the insulinogenic index, corrected for insulin resistance. Patients' 10-year coronary heart disease (CHD) risk was assessed using the Chinese Multi-provincial Cohort Study functions. ResultsOverall, there was a 10% decrease in FGF-21 after OGTT (p<0.001). The decrease of FGF-21 after OGTT in patients with normal glucose tolerance, prediabetes, and diabetes was 8%, 10%, and 21%, respectively (all p<0.05). Patients with a history of admission for coronary angiography had a higher 10-year CHD risk and fasting FGF-21 (both p<0.001). In multivariate regression analysis, fasting FGF-21 was positively associated with 10-year CHD risk, while FGF-21 relative change 2h after OGTT was positively associated with β-cell function. ConclusionsIn patients who had no history of diabetes, fasting FGF-21 was positively associated with 10-year CHD risk, while FGF-21 relative change 2h after OGTT was positively associated with β-cell function.

Assessment of Asymptomatic Coronary Heart Disease in Type 2 Diabetics with Treadmill Test and Framingham 10-Year CHD Risk Scoring System

Background and objectives: Coronary Heart Disease (CHD) has a high prevalence in Asian Indians & is the leading cause of morbidity & mortality in patients with type 2 diabetes due to silent myocardial ischemia. This needs early cardio vascular assessment through non invasive tests e.g. Treadmill Test (TMT) & Framingham 10-year CHD risk in addition to periodical clinical examination & resting electrocardiogram. Methods: 102 known north Indian diabetics without clinical & electrocardiographic evidence of CHD were evaluated for smoking, blood pressure, glycosylated hemoglobin, fasting & post-prandial blood sugar & lipid profile to calculate Framingham score system for 10-year CHD risk assessment along with exercise treadmill test. Results: Among 102 diabetic patients, TMT was positive in 32 (31.37%) patients; more in males (59.73%). Mean cholesterol (189.81 mg %), triglycerides (135.19 mg %) and LDL (116.28 mg %) levels were significantly high in TMT positive cases (P 20%), 28 intermediate (≥10-19.9%) & 51 low ( Conclusion: A 6-fold higher incidence between low & intermediate, 2.4-fold between intermediate & high and 14-fold between low & high Framingham 10-year CHD risk groups is suggestive of higher incidence of TMT positive cases correlates with higher Framingham 10-year CHD risk & are more prone for asymptomatic CHD in north Indian diabetics. Key words: Coronary heart disease, Electrocardiogram, Framingham 10-year CHD risk, Treadmill test, Type 2 diabetes.

Association of Cardiorespiratory Fitness With Coronary Heart Disease in Asymptomatic Men

ObjectiveTo examine the association of cardiorespiratory fitness (CRF) with risk of coronary heart disease (CHD) while controlling for an individual's Framingham Risk Score (FRS)–predicted CHD risk. Patients and MethodsThe study included 29,854 men from the Aerobics Center Longitudinal Study, who received a baseline examination from January 1, 1979, to December 31, 2002. Coronary heart disease events included self-reported myocardial infarction or revascularization or CHD death. Multivariable survival analysis investigated the association between CRF, FRS, and CHD. Cardiorespiratory fitness was analyzed as both a continuous and a categorical variable. The population was stratified by “low” and “moderate or high” risk of CHD to test for differences in the FRS stratified by CRF. ResultsCompared with men without incident CHD, men with incident CHD were older (mean age, 51.6 years vs 44.6 years), had lower average maximally achieved fitness (10.9 metabolic equivalent of tasks vs 12.0 metabolic equivalent of tasks [METs]), and were more likely to have moderate or high 10-year CHD risk (P<.001). Cardiorespiratory fitness, defined as maximal METs, exhibited a 20% lower risk of CHD (hazard ratio, 0.80; 95% CI, 0.77-0.83) for each 1-unit MET increase. Among men in the low CRF strata, individuals with moderate or high 10-year CHD risk, according to the FRS, had a higher CHD risk (hazard ratio, 6.55; 95% CI, 3.64-11.82) than men with low CHD risk according to the FRS. ConclusionClinicians should promote physical activity to improve CRF so as to reduce CHD risk, even to patients with otherwise low CHD risk.

Abstract P180: Ten-Year and Lifetime Cardiovascular Risk and Subclinical Cardiovascular Disease in Mexican Women

Introduction: Estimates of Lifetime Cardiovascular Risk may identify individuals with different levels of cardiovascular disease (CVD) risk within the low short-term risk (10-year risk) for coronary heart disease (CHD) category defined by the Framingham Risk Score. Evidence of the applicability of this risk stratification in relatively young people is limited, especially among Hispanics. Hypothesis: We assessed the hypothesis that the risk categories from the combination of these two risk stratification scales are positively associated with subclinical CVD in Mexican women. Methods: We calculated 10-year CHD risk using the Framingham Risk Score and lifetime CVD risk based on risk factor burden in 759 women in Southern Mexico from the Mexican Teachers’ Cohort and evaluated the presence of subclinical CVD. We evaluated common carotid intima-media thickness (IMT), ankle-brachial index (ABI), and inter-arm blood pressure difference (IAD) using standard protocols and performed laboratory analyses from a fasting blood draw. We defined three risk strata: Low 10-year (&lt;10%)/Low lifetime risk, Low 10-year (&lt;10%)/High lifetime risk, and High 10-year risk (≥10%). We evaluated outcome measures continuously and estimated the prevalence of subclinical CVD for each risk strata. We defined subclinical CVD as IMT ≥0.8 mm or atheromatous plaque, ABI &lt;0.90, systolic IAD ≥20 mmHg or diastolic IAD ≥10 mmHg. We calculated the sensibility and specificity of the predicted risk categories to detect subclinical CVD. Results: Women evaluated had a mean age of 48.4 years, 22.5% (n=171) were classified as High 10-year CHD Risk, 58.8% (n=446) as Low 10-year/High lifetime risk and 18.7% (n=142) as Low 10-year/Low lifetime risk. We observed significant increase in IMT measurement according to increasing risk categories: 0.656 mm (±0.062), 0.704mm (±0.085), and 0.739mm (±0.089) (p= &lt;0.001). We found similar significant trends in ABI (p= 0.001), systolic IAD (p= &lt;0.001), and diastolic IAD (p= &lt;0.001). We observed a significant higher prevalence of at least one subclinical CVD as the risk category increased: 10.6%, 26.9%, and 45.6% (p= &lt;0.001). The sensitivity and specificity of the combination of these scores to detect subclinical CVD was of 93% and 23%, whereas only considering the high vs. low 10-year risk categories these parameters were 37% and 83% respectively. Conclusion: The combination of these short-term and lifetime risk scores accurately identify differences in objective measurements of subclinical cardiovascular disease in Mexican women. Further calibration of these risk scores is needed to incorporate them in the risk assessment tools to identify individuals at risk for the implementation of preventive strategies in the Mexican population.

Education and coronary heart disease risk: potential mechanisms such as literacy, perceived constraints, and depressive symptoms.

Education is inversely associated with coronary heart disease (CHD) risk; however the mechanisms are poorly understood. The study objectives were to evaluate the extent to which rarely measured factors (literacy, time preference, sense of control) and more commonly measured factors (income, depressive symptomatology, body mass index) in the education-CHD literature explain the associations between education and CHD risk. The study sample included 346 participants, aged 38 to 47 years (59.5% women), of the New England Family Study birth cohort. Ten-year CHD risk was calculated using the validated Framingham risk algorithm that utilizes diabetes, smoking, blood pressure, total cholesterol, high-density lipoprotein cholesterol, age, and gender. Multivariable regression and mediation analyses were performed. Regression analyses adjusting for age, race/ethnicity, and childhood confounders (e.g., parental socioeconomic status, intelligence) demonstrated that relative to those with greater than or equal to college education, men and women with less than high school had 73.7% (95% confidence interval [CI; 29.5, 133.0]) and 48.2% (95% CI [17.5, 86.8]) higher 10-year CHD risk, respectively. Mediation analyses demonstrated significant indirect effects for reading comprehension in women (7.2%; 95% CI [0.7, 19.4]) and men (7.2%; 95% CI [0.8, 19.1]), and depressive symptoms (11.8%; 95% CI [2.5, 26.6]) and perceived constraint (6.7%, 95% CI [0.7, 19.1]) in women. Evidence suggested that reading comprehension in women and men, and depressive symptoms and perceived constraint in women, may mediate some of the association between education and CHD risk. If these mediated effects are interpreted causally, interventions targeting reading, depressive symptoms, and perceived constraint could reduce educational inequalities in CHD.

Abstract P320: Discordance of Framingham Risk Score and Reynolds Risk Score to Global Vascular Risk Score: Results from the Hispanic Community Health Study/Study of Latinos

Introduction: The Framingham Risk Score (FRS) is a coronary heart disease (CHD) risk model established using an ethnically homogeneous population that predicts 10-year hard CHD events, myocardial infarction (MI) and coronary death. The Reynolds Risk Score (RRS) and Global Vascular Risk Score (GVRS) are validated CHD risk models that, in addition to hard CHD events, predict stroke and other CHD outcomes. In addition to major CHD risk factors, RRS adds systemic inflammation and family history of MI as GVRS adds behavioral and anthropometric measures. This study aims to compare agreement of RRS and GVRS with FRS among Hispanic/Latino adults and to describe discordance in RRS and GVRS with FRS categories, by socio-demographic characteristics. Methods: HCHS/SOL is a population-based cohort study of Hispanics/Latinos in four US communities. The analytic sample includes 6,058 non-diabetic participants 45-74 years of age with no past history of CHD and stroke who underwent comprehensive baseline examination. 10-year hard CHD risk score was calculated; participants were categorized as low (&lt;10%), moderate (10-&lt;20%), and high (≥20%) risk. Kappa scores were calculated to compare agreement of RRS and GVRS with FRS. Socio-demographic characteristics of concordance and discordance were characterized overall; multinomial logistic regression models was used to examine age-sex-adjusted likelihood of in discordance by these factors. Results: Mean age of the participants was 55 (SE=0.15) years, 54.3% were women, 41% had family history of CHD, and 90% were foreign born. Overall, 4,805 (74%) had low FRS, 1,143 (24%) had moderate FRS, and 110 (2%) had high FRS. There was poor agreement between RRS and FRS (Kappa=0.16, P&lt;0.01) and fair agreement between GVRS and FRS (Kappa=0.36, P&lt;0.01). In age-sex-adjusted analyses, RRS and GVRS were both more likely to classify persons of moderate and high risk who are between the ages of 60-74; GVRS classified more moderate and high risk women than the FRS. RRS and GVRS discordance with FRS was not associated with nativity and length of time in US. Conclusion: Significant discordance was observed between RRS and GVRS compared to FRS. Among Hispanic/Latino adults, use of RRS or GVRS may be more inclusive in classifying older age adults and women at high 10-year CHD risk.

Abstract MP43: The Population Impact and Cost-Effectiveness of Statins for Primary Prevention in Adults 75 and Older in the United States

Introduction: Several investigations have evaluated the cost effectiveness of a low density lipoprotein (LDL) cholesterol “threshold” treatment strategy compared with a “risk-based” strategy based on a person’s 10-year risk of coronary heart disease (CHD). No studies to date have focused on adults 75 years and older. Methods: Based on the Cardiovascular Disease Policy Model, a Markov model of the U.S. population, we forecasted the population impact of statin therapy over 10 years in adults aged 75-94 years. We compared two strategies for statin therapy in adults 75-94 years free of prevalent CHD and stroke: 1) treatment in anyone with LDL cholesterol &gt;100 mg/dL in diabetics, and &gt;130 mg/dL in non-diabetics, and 2) high intensity statins for persons with a 10-year CHD risk of &gt;20% and low intensity statin for persons with a risk of 10-20%, independent of LDL cholesterol level. We assumed the use of low-cost statins ($4 per month), 100% adherence, 3% discounting/year, and costs from a healthcare perspective. Results: The threshold strategy would treat an additional 50 million elders and prevent 99,000 incident myocardial infarctions and 55,000 CHD deaths at a cost of $ 1.4 billion, whereas the risk-based strategy would treat 103 million and prevent 143,000 incident myocardial infarctions and 97,000 CHD deaths at a cost of $ 7.8 billion. The threshold strategy is more cost-effective than the risk-based strategy ($4,300 vs. $18,000 per quality-adjusted life year gained). Conclusions: A risk-based strategy prevents more events compared with a threshold strategy due to the large proportion of older adults who have high 10-year CHD risk scores, but is less efficient than a threshold strategy in adults 75 years and older.

Prevalence rates and cardiometabolic determinants of diabetes mellitus and pre-diabetes with projected coronary heart disease at bank site of Brazzaville

Background: Aim: Congolese Bank employees are often inactive without valid information on the burden of dysglycemia and cardiometabolic risk. This study aims to assess the prevalence rates of diabetes mellitus (DM) and pre-diabetes and to identify the environmental, genetic and cardiometabolic risk factors associated with Type 2 diabetes mellitus (T2DM) and pre-diabetes among Congolese bank employees. Methods: In representative 126 bank employees from Brazzaville, Congo, Central Africa, Abdominal obesity, dyslipidemia and metabolic syndrome (MetS) were defined by IDF for Europe, NCEP-ATPIII and IDF criteria modified for Central Africa. Projected high 10-year total risk of coronary heart disease (CHD) ≥20% was calculated using Framingham scores. Results: Out of the employees, 16% and 21.4% had DM and pre-diabetes, respectively. The rate of T2DM among diabetics was estimated 90%. Aging, high total cholesterol, high LDL-cholesterol, high conicity index and longer urban residence after migration were significantly associated with pre-diabetes. Physical inactivity, smoking, excessive alcohol intake, abdominal obesity, female gender, low HDL-C, hypertension, CHD, projected high 10-year total CHD risk, age ≥ 55 years, urban residence, Southern area residence, high socioeconomic status, non married status, MetS/NCEP, MetS/IDF for Europe and MetS/IDF for Africa were significantly associated with T2DM.MetS/IDF for Africa was the only independent determinant of T2DM. Conclusion: Urgent prevention and intervention programme are needed to curb the alarming increase in DM, T2DM, pre-diabetes.

Community pharmacist assessment of 10-year risk of coronary heart disease for union workers and their dependents

Objective:To determine 10-year coronary heart disease (CHD) risk for union workers and their dependents in a pharmacist-managed health screening program. Methods:Two local unions of plumbers and electricians contracted with a community pharmacy to provide health screening services for union workers and their dependents. Patients chose any one or any combination of three clinical tests: blood pressure, total cholesterol, and HDL cholesterol. At the end of the screening, which took approximately 35 minutes, the participants received brief patient education from pharmacists and a printout of their results. Pharmacists provided the services based on their in-store screening experience and, before the screening, received training on 10-year CHD risk calculation and guidelines regarding cholesterol treatment. Framingham scoring was applied to calculate 10-year CHD risk for participants who chose all three clinical tests. Results:265 patients (55.8% men, average age 57.7 years) participated in the screening program. Frequency of cardiovascular disease (CVD) risk factors ranged from 25.5% (diastolic blood pressure) to 52.5% (total cholesterol). Using Framing- ham scoring, 10-year CHD risk was calculated for 226 patients, with 119 (52.7%) patients having less than 10% risk with zero to one CVD risk factor, 73 (32.3%) having 10% to 20% risk with two or more CVD risk factors, and 34 (15%) having greater than 20% risk with two or more risk factors. Conclusion:Pharmacists provided intermediate- and high- risk participants with guideline-based recommendations such as referring them to physicians for further assessment, therapeutic lifestyle changes, and medication treatment. Community pharmacists were able to identify individuals with intermediate or high 10-year CHD risk. Based on 10-year CHD risk assessment, further pharmacist-managed interventions, such as a cardiovascular risk management program, can be conducted.

Current coronary heart disease risk assessment tools may underestimate risk in community-dwelling persons with chronic spinal cord injury

Cross-sectional, observational study. To quantify, in adults with chronic spinal cord injury (SCI): (1) presence of metabolic syndrome versus the general North American population (GP) and (2) 10-year coronary heart disease (CHD) risk using Framingham risk scoring (FRS). Ontario, Canada. Fasting anthropometric and biochemical data were collected from 75 adults with chronic SCI. Metabolic syndrome was determined using four internationally recognized definitions and FRS using the most recent (2001) algorithm. Prevalence of metabolic syndrome was up to 5.4 times lower in SCI participants compared to GP, and FRS categorized 3.1% of participants as being at high 10-year CHD risk. However, high-sensitivity C-reactive protein (CRP) values indicated 36.7% of participants as being at high CHD risk. Current metabolic syndrome definitions and FRS may underestimate true CHD risk in people with SCI. Tools that better identify CHD risk require validation in the SCI population. CRP may be a potential factor to consider in the development of SCI-specific screening tools.

Comparative performance of subclinical atherosclerosis tests in predicting coronary heart disease in asymptomatic individuals

The prognostic performance of subclinical atherosclerosis in predicting coronary heart disease (CHD) needs to be clarified because of the existence of many non-invasive tests available for its detection in the clinical setting: ultrasound measurement of carotid intima-media thickness (IMT) and plaque, cardiac computed tomography assessment of coronary artery calcium, Doppler stethoscope measurement of ankle-arm index pressure (AAI), and mechanographic or Doppler determination of aortic pulse wave velocity (PWV). Data analysis of the main prospective studies in asymptomatic populations allows the establishment of a dose-response relationship between subclinical atherosclerosis burden and cumulative incidence of future CHD event (absolute risk). Negative subclinical atherosclerosis testing conveys a low 10-year CHD risk inferior to 10% whatever the test considered, i.e. IMT less than the 1st tertile or 1st quintile, AAI > or = 0.90, PWV less than the first tertile, no discernible carotid plaque, or zero coronary calcium score. Positive testing for IMT (>95th percentile or 5th quintile), AAI (<0.90), or PWV (>3rd tertile) conveys a moderately high 10-year CHD risk between 10 and 20%. Positive testing for carotid plaque (focal protrusion >1.5 mm or mineralization) or coronary calcium (total score >300 or 400 units) conveys a high 10-year CHD risk superior to 20%. Therefore, positive subclinical atherosclerosis measurement seems to have its place in the context of existing prediction models, namely for intermediate risk classification. It also remains to be established whether individuals with negative subclinical atherosclerosis may be considered at low CHD risk and receive conservative management.

Haemorheological, platelet and endothelial indices in relation to global measures of cardiovascular risk in hypertensive patients: a substudy of the Anglo‐Scandinavian Cardiac Outcomes Trial

We tested the hypothesis that there was a significant relationship between haemorheological markers [white blood cell count (WCC), plasma viscosity (PV), haematocrit (HCT) and fibrinogen], as well as plasma von Willebrand factor (vWf, an index of endothelial damage/dysfunction) and soluble P-selectin (sP-sel, an index of platelet activation), to five global measures of cardiovascular risk [i.e. Framingham coronary heart disease (CHD), stroke and cardiovascular death score, the Pocock cardiovascular risk score and the sum of individual risk factors]. Men with a high (> or = median, n = 156) Framingham 10-year CHD risk score had higher levels of WBC (P = 0.027), fibrinogen (P = 0.012) and vWF (P = 0.002) than 153 men with results < median. Men with a high 10-year stroke risk score had significantly higher levels of fibrinogen (P = 0.01) and vWF (P < 0.0001). In stepwise linear regression analysis in men, vWF and fibrinogen were independent predictors of the number of risk factors (P < 0.0001), whilst WCC, vWF and fibrinogen emerged as independent predictors of Framingham CHD risk (P < 0.0001), and fibrinogen and vWF predicted Framingham stroke risk (R(2) = 0.089, P < 0.0001). vWF, PV and fibrinogen were predictors of Pocock cardiovascular death risk (P < 0.0001) but vWF was the only independent predictor of Framingham cardiovascular death risk (P = 0.001). Abnormal haemorheological factors (particularly high plasma fibrinogen levels) and endothelial damage/dysfunction (high vWF), but not platelet activation (sP-sel), are related to established cardiovascular and death risk scores. This relationship was most evident amongst male 'high-risk' hypertensive subjects.

A Pen-and-Paper Coronary Risk Estimator for Office Use With Patients With Type 2 Diabetes

To develop a pen-and-paper coronary heart disease (CHD) 10-year risk estimator for patients with type 2 diabetes based on the United Kingdom Prospective Diabetes Study (UKPDS) risk equation (based on 4000 patients with diabetes but only available electronically). We used data collected from adults with type 2 diabetes from 6 primary care practices that participated in a randomized trial in Rochester, Minn; patients were enrolled in the study from July 2001 to December 2003, with follow-up through June 2004. We used multivariable linear regression of the CHD risk estimate to formulate prediction equations to estimate average (<15%), elevated, or high (>30%) 10-year CHD risk according to sex, age, diabetes duration, smoking, hemoglobin A1c level, systolic blood pressure, ratio of total cholesterol to high-density lipoprotein cholesterol, and microalbuminuria categories. We selected cut points for the predicted score, seeking to (1) maximize the number of patients with total agreement between our estimator and the UKPDS risk equation, (2) avoid any patient's risk being either overestimated or underestimated by 2 risk categories, and (3) overestimate rather than underestimate coronary risk. A total of 535 patients with type 2 diabetes participated in this study, 400 in the generation cohort and 135 in the validation cohort. Of the 400 patients in the generation cohort, our estimator had an 82% total agreement with the UKPDS calculation, 11% overestimated risk, and 7% underestimated UKPDS coronary risk (weighted kappa=0.77). Results were similar in the 135 patients in the validation cohort (kappa=0.79) and in an independent validation cohort of 52 patients attending a referral diabetes clinic (kappa=0.68). The pen-and-paper estimator facilitates the point-of-care estimation of coronary risk in situations in which use of a desktop or handheld version of the electronic UKPDS risk engine is not practical or feasible. In our experience, estimation of risk using this tool, when done with patients, can further patients' insight into their risk of coronary events, often leading to enlightened discussions about modification of Individual risk factors.