title: Framingham risk score inadequately predicts cardiac risk in young patients presenting with a first myocardial infarction.
abstract: BACKGROUND
  The Framingham Risk Score (FRS) is a well-validated epidemiologic tool used to assess the risk for a fi rst cardiac event. Because young patients presenting with a fi rst myocardial infarction (MI) tend to have less significant risk profiles compared with older patients, we hypothesized that FRS may underestimate cardiac risk in these patients.
  
  
  METHODS
  We studied 1267 patients between January 2002 and November 2007 presenting with a fi rst MI. Patients with pre-existing diabetes mellitus and vascular disease were excluded. FRS was calculated for each patient. Patients were divided based on their age: group A (<40 years), group B (40 to 64 years) and group C (> or =65 years).
  
  
  RESULTS
  The mean age was 54.7 +/- 11 years, 88.4% of the patients were males. Younger patients were more likely to be assigned with lower scores. Based on FRS, 63.0%, 29.3% and 14.2% of group A, B and C patients were classified as low risk (10-year risk for cardiac events<10%) respectively, P <0.001. The sensitivity of FRS in identifying at least intermediate risk subjects (10-year risk for cardiac events >10%) was 37.0% in group A vs 85.8% in group C (P <0.001). The incidence of newly diagnosed diabetes mellitus was higher in younger patients (12.0% vs 13.2% vs 7.1 % in groups A, B and C respectively, P = 0.027).
  
  
  CONCLUSIONS
  FRS inadequately predicts cardiac risk in young patients presenting with a fi rst MI. This could be because a significant proportion of these young patients have undiagnosed diabetes mellitus, a coronary artery disease risk equivalent.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Glenn K M
authors.initials: GK
authors.lastname: Lee
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Lee
authors.forename: Christopher W Y
authors.initials: CW
authors.lastname: Liu
authors.forename: Shir Lynn
authors.initials: SL
authors.lastname: Lim
authors.forename: Lu-Ming
authors.initials: LM
authors.lastname: Shi
authors.forename: Hean-Yee
authors.initials: HY
authors.lastname: Ong
authors.forename: Yean-Teng
authors.initials: YT
authors.lastname: Lim
authors.forename: Tiong-Cheng
authors.initials: TC
authors.lastname: Yeo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors