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Importance of a Patient's Personal Health History on Assessments of Future Risk of Coronary Heart Disease

Department of Family Medicine (AGM, CJE, MSP, DEK, VAD), Medical University of South Carolina, Charleston
Department of Biostatistics, Bioinformatics, and Epidemiology (AGM), Medical University of South Carolina, Charleston

Correspondence: Corresponding author: Arch G. Mainous, III, PhD, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, MSC 192, Charleston, SC 29425 (E-mail: mainouag{at}musc.edu)

Objective: Although many coronary heart disease (CHD) risk factors are known, the role of an individual's changing personal health history is unclear. We implemented this study to evaluate whether accounting for previous Framingham Risk Scores (FRSs) improves the predictive ability of a current FRS for future CHD in middle-aged adults.

Methods: We analyzed data from the Atherosclerosis Risk in Communities Study (ARIC), a longitudinal cohort of people 45 to 64 years old at entry (1986 to 1989 through 2001). FRSs were calculated for participants in the ARIC cohort (3901 men, 5406 women) at baseline (visit 3) and 3 and 6 years before. Using Cox regressions we evaluated the risk of CHD development for the FRS 6 years from baseline and then evaluated whether the addition of the change in FRS assessments from 3 and 6 years before the baseline improved the predictive ability of the FRS. Areas under the receiver operating characteristic (AUROC) curves were compared.

Results: The addition of the difference between the baseline FRS (eg, in 1995) and the FRS from 6 years earlier (eg, in 1989) to predict CHD development by 2001 for the entire cohort yielded an AUROC of 0.730, which was a significant improvement over just using the baseline FRS (P < .05). The effect was located primarily among women, with the AUROC curve improving from 0.667 to 0.709 (P < .05). There was no improvement for CHD risk prediction in men when the earlier FRS assessments were taken into account. Men seem to have less change in some risk factors over time.

Conclusions: Accounting for an individual's history improves risk assessments based on current measures.

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