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Framingham Risk Calculators

 

 

These are not Palm applications.  They will run from the web, or they can be downloaded to your own computer and run from there as a web page.  There are 3 calculator versions, each based on Canadian Cardiovascular Society (CCS) algorithms, as these have the most relevance to Canadian patients.  The algorithms derive the Framingham Risk Score (FRS).  Decision support based on this score varies considerably between calculators:

 

The Standard CCS Calculator

 

Based on the latest guideline update in 2012.  This is the best choice for those who wish to adhere to the most recent Canadian guidelines.  The LDL targets and thresholds are poorly based in evidence, but are widely followed.

 

The CCS Calculator with Decision Support for Mixed Dyslipidemias

 

Many people in primary prevention who have events are not identified by risk score, and may have normal LDL levels.  Most of these people are obese, and may have diabetes or metabolic syndrome, and have many novel risk factors which put them at increased long term risk.  Their numbers are increasing in our patient mix.  Non-HDL cholesterol is helpful in establishing risk in these people.  Recommended for obese and diabetic patients.

 

The AHA/ACC Framingham Calculator (Recommended)

 

The Nov. 2013 guidelines on lipids from AHA/ACC were a long time coming, but at last there are evidence based directives.  Treatment is predicated on risk rather than LDL levels, and the only drug therapy recommended is the statins.  Finally some attention is given to quantifying the effect on risk of proven diet and exercise interventions, which can be as effective as statin therapy.  Treatment thresholds are low, but not carved in stone, and can be negotiated with an informed patient.  The calculator includes assessment of influence of changes in exercise, diet and statin dosage with a continuous graphical interface and calculation of cardiovascular age.  This is a large departure from previous lipid management, but is very much in line with the evidence, and is recommended.