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Framingham Risk Calculator
Using Canadian Lipid Guidelines

Instructions

 

From the initial screen, select the units to be used for input of lipid values.  Most countries, including Canada have adopted SI units, and this should be selected.  If your values are derived in the USA, select US units.  Either selection will take you to the calculator screen.  The screen will initially come up for women.  Be sure to select the appropriate gender using the radio buttons.  Gender will be colour coded as a reminder.

 

Data Input:

  1. Data input is via either drop-down lists or radio buttons.  Data for all categories except c-reactive protein (hsCRP) is required for accurate calculation.
  2. Data can be entered in any order, except that hsCRP and Family History (FHx) require all other data to be entered before their calculations can be done.  If you have not entered the other values, you will be reminded to do so.
  3. Family History (FHx) will require all values except hsCRP to be entered.  This is considered positive only if there is coronary artery disease in a first-degree relative onset before age 60.
  4. hsCRP will require all values including FHx to be entered.  Patients in the moderate (10-19%) risk category over age 50 for men and age 60 for women with normal lipids should be tested, and a result over 2 may change their 10-year risk status.  Patients requiring this test for evaluation will be flagged after all other data input is complete.
  5. The course of data entry may be stopped by a message in diabetics if they become high risk by virtue of age alone or the presence of one risk factor which has already been entered.  No other data should be entered, as it will not influence treatment recommendations.  Bear in mind that diabetics may have risk factors which have no calculator input such as metabolic syndrome or truncal obesity.
  6. Generally, if the course of data entry has not been interrupted by a message assigning the patient to high-risk, data values can be changed to see what the influence of the change has upon risk status.  For example, changing to non-smoking status may reduce risk from high to moderate, with the possibility that statin therapy could be avoided depending on baseline lipid status.
  7. Inappropriate data entry will not be accepted for hsCRP.  The appropriate age and risk level status must be present before this calculation will be run.  There will otherwise be an explanatory message.  This can be a way of determining whether hsCRP needs to be done, as utility of the test lies within a narrow range of age and risk.  If data entry is complete and this test is indicated, a “Yes” recommendation will appear for this test.
  8. The only optional data entry is hsCRP.

 

Result Display:

  1. The first box indicates the percentage risk over 10 years of developing any cardiovascular disease.  This now includes not only MI and cardiovascular death, but also stroke, coronary artery disease, peripheral arterial disease and congestive heart failure.  Previous Framingham tables tended to underestimate risk by not including all cardiovascular disease.
  2. The second box simply assigns risk levels.  1-9% is low, 10-19% is moderate, and 20%+ is high.  Each level has specific lipid and ASA recommendations.
  3. The third box gives a “Yes” recommendation for ASA if it is indicated for men.  Since this is now a rather complex algorithm dependent upon age and relative risk of GI bleed, the decision incorporates age and 10-year risk percentage, and will only be valid when data entry is complete and if ASA therapy is indicated.  For women, the risk score algorithm is likely to be reliable over age 65.  Prior to age 65, stroke rather than MI is the most common event for women, and Framingham cardiovascular disease scores can only be used as a rough guide.  Individual consideration of risk and benefit is important in all ASA decisions.  No recommendation will be made where younger age confers no benefit.
  4. The fourth box gives the most recent LDL targets for the individual level of risk.
  5. The fifth box indicates the threshold at which treatment to lower LDL should begin.  This should be compared to the patient’s present level of LDL or total cholesterol/HDL ratio. 

 

Installing the Calculator:

The calculator may be run from the website, however it will probably be faster to have the application run from your hard drive.  The source files can be downloaded as Framingham Risk Calculator.zip from the website title page or from here.

  1. It is suggested that you unzip these files to a newly created folder.  All the files must be in the same folder otherwise hyperlinks will not function.
  2. Run the application from the file titled Framingham Risk Calculator.htm.  This file has hyperlinks to the calculator and allows you to change units for lipid measurement.  Documentation can be accessed from here as well.
  3. Create an icon for your desktop if you wish by right-clicking on Framingham Risk Calculator.htm and select Send to > Desktop (create shortcut).  Double clicking on this icon will then open the calculator application.
  4. If you are only going to use SI units, you can bring the calculator up by creating a desktop icon in the same way to the 2009 CCS Framingham.htm file.  If you do this, you will not be able to access instructions or calculators using US units.  Similarly, an icon to 2009 CCS Framingham_US.htm will bring up a calculator in US units.  The main menu button will not function.
  5. This is a javascript based application, so javascript must be enabled in your browser.  So far it is only tested in Firefox and Internet Explorer.