Framingham Risk Assessment for Men

[jkhh]

Can anyone offer any expertise or familiarity with the Framingham Risk Assessment for Men? I recieved it today in a Monograph for Slo-Niacin. At my age, 39, HDL 39, total cholesterol 250, nonsmoker and Systolic Blood Pressure 130-9, I score 8 points which means that I have a 10 year CHD risk of 4%. Does this mean that I'm 96 % safe if I do nothing (in terms of trying to alter my labs ?

[Mark1e]

Yip, you are 96% safe if you do nothing. And you can reduce your 4% risk to maybe 3% by taking a statin. That is a 25% reduction of relative risk, which the drug companies use to sell their statin products. But it is only a 1% improvement in absolute risk, improving your chances of not having a heart attack from 96% to 97%. And for that you have to take a statin every day for the next 10 years. The chances are pretty good that you will suffer debilitating side effects in the process. Hardly seems worthwhile, doesn't it?

Mark

[Lenin]

judge,

If I remember correctly, the Framingham Risk is for "hard" coronary events: death or heart attack.

So you are 39 and tthe chances are 4% you will suffer one of these by age 49...one in 25.
Assuming you'd like to live longer than 49, I think a practical assumption will be higher risk in the next decade, say 6% for sake of argument? Now these two numbers are additive meaning a 10% chance of heath or MI by age 59. Would 20 or 30% for age 69 seem out of the ordinary?

You then get to the "average man over a lifetime"...he probably WILL die of heart disease since it is the largest killer. Remeber the average man has AVERAGE risk factors...and STILL dies of heart disease.

Relative vs. absolute risk may seem trivial if you are talking about a low occurrence event like tetanus or typhus, but a 1% reduction in death from coronary heart disease affects MILLIONS of people. A 25 % reduction represents a medical miracle never before seen except maybe with penicillin.

[jkhh]

Lenin,

If you know, by reducing my risk factors and taking a statin, etc. what % can I bring it down (off the 25-30 %) by the time I'm 60-9? I guess that's the real point that you're making because the effect would seem relatively small in the short term???

[Mark1e]

Statistics can be used to support whichever arguement you choose to support. Numbers are very persuasive - just look at how extensively they are used in advertising. And they can be very misleading too. The only certainty is that you have a 100% chance of dying some time in the future. And your statistical chance of dying during the following 10 years increases every year, starting from the day you were born. Fiddling with marginal 1% absolute reductions here an there is really not going to make much difference to your life story.

The other thing to remember is that, while you might be able to reduce your risk of dying from a heart attack by 10+% during the next 20 years by taking a statin every day, you would increase your chances of dying from something else by a similar amount. Studies show that, while the use of statins reduces deaths from CHD events, it doesn't reduce total mortality at all. CHD survivors go on to die of something else within a similar timeframe within which they would have died if they had done nothing. The only winners here are the pharmaceutical companies and the doctors who prescribed the drugs.

There is bound to be some downside to anything you do that changes the way your body works. The human body is a highly sophisticated and delicately balanced set of inter-dependant systems. And you mess with their equilibrium at your peril! Cholesterol gets used in various important processes. And there must be lots of downsides to disrupting its production for 20+ years non-stop. For example, both cholesterol and ubiquinone are powerful anti-oxidants. And reducing your body's production of them, especially as you get older, must surely make you more susceptible to cancer. Which, as we all know is , is the other big killer.

Go figure

Mark