Utility of Framingham Coronary Heart Disease Risk Score for Predicting Cardiac Risk After Stroke

Abstract

Background and Purpose— Coronary heart disease (CHD) is a major cause of mortality among stroke patients after the acute period. Simple risk stratification of stroke patients without known CHD may permit prompt implementation of CHD-specific management strategies for those who are at high risk for cardiac events. We assessed the utility of the Framingham Coronary Heart Disease Risk Score (FCRS) as a prognosticator in stroke patients without known CHD. Methods— Post hoc analysis of a trial dataset of 3509 recent ischemic stroke patients who were aged 35 years or older, recruited from 56 centers, and followed-up for 2 years. Patients were categorized as having known CHD, high FCRS (≥20%), and low/intermediate FCRS (<20%). The predictive values between baseline FCRS and primary (myocardial infarction [MI]), secondary (MI or vascular death), and tertiary (recurrent stroke) outcomes were assessed in multivariate analyses. Results— Rates of first MI at 2 years were 6.34%, 4.65%, and 1.44% for the known CHD, high FCRS, and low/intermediate FCRS groups. Compared with stroke patients with low/intermediate FCRS, individuals with high FCRS had a higher risk of MI (adjusted hazard ratio, 3.70; 95% confidence interval, 2.14–6.38) and MI or vascular death (adjusted hazard ratio, 2.21; 95% confidence interval, 1.48–3.28). High FCRS did not predict recurrent stroke. Conclusion— Among patients with a recent ischemic stroke without known CHD, high FCRS was associated with a higher risk of MI and vascular death, but not stroke. FCRS could be a simple way to identify recent stroke patients who may benefit from additional CHD-specific management.