Distribution of lifestyle and emerging risk factors by 10-year risk for coronary heart disease

  1. Umed A. Ajani1
  2. Earl S. Ford1
  3. Lisa C. McGuire1
  1. 1Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence and requests for reprints to Umed A. Ajani, MBBS, MPH, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS-K66, Atlanta, GA 30341, USA. Tel: +1 770 488 2426; fax: +1 770 488 8150; e-mail: uajani@cdc.gov


Background The Framingham risk score has been used for coronary heart disease (CHD) risk assessment. Recently, additional risk factors not included in the Framingham algorithm have received much attention and may help improve risk assessment. We examined the distributions of lifestyle and emerging risk factors by 10-year risk of CHD.

Methods We calculated 10-year CHD risk (<10%, 10–20%, and >20%) for 8355 participants in the National Health and Nutrition Examination Survey (NHANES) 1999–2002 using the Framingham risk score as modified by the National Cholesterol Education Program Adult Treatment Panel III guidelines. We examined the prevalence of lifestyle risk factors [body mass index (BMI) and waist circumference] and various emerging risk factors [C-reactive protein (CRP), white blood cell count, fibrinogen, homocysteine, glycosylated hemoglobin, and albuminuria] as well as prevalence of high CHD risk by levels of these risk factors.

Results All examined CHD risk factors were significantly associated with increasing 10-year CHD risk among men and women. Odds of being in the highest CHD risk group were greater at higher levels of examined risk factors. Means for most risk factors were slightly higher for women than the means for men. Sizeable proportions of participants with lower 10-year CHD risk had high levels of lifestyle and emerging risk factors: 60.8% were overweight, 33.8% had high CRP concentrations, 24.1% had serum fibrinogen >400 mg/dl and 6% had an albumin/creatinine ratio ≥ 30.

Conclusions Lifestyle and emerging risk factors, in addition to those included in the Framingham risk score, may be important in CHD risk assessment.


  • Received October 5, 2005.
  • Accepted May 26, 2006.


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