The Framingham risk estimation (FRE) is often used to assess risk of coronary heart disease (CHD), the leading cause of death among women in this country. But the FRE does not take into account family history and thus may underestimate the risk in women from families with a history of CHD.

Researchers assessed the FRE scores of 102 women (average age, 51 years; 60% were black) who had no symptoms of heart disease and had siblings hospitalized with premature CHD. They then compared the FRE scores with the women's coronary artery calcium scores (determined by computed tomography), a method reported to be useful in detecting the presence and extent of coronary artery calcification.

Despite high rates of smoking, obesity, and high blood pressure among the participants, almost all of them had FRE scores that classified them as being at low risk for CHD. But 40% had detectable coronary artery calcification, with 6% showing severe calcification. In total, 32% had "significant subclinical atherosclerosis."

These findings indicate that adding an assessment of family history to the screening procedures for women may help to identify at an earlier stage those at risk for CHD and those who might benefit from preventive measures such as weight loss, low-dose aspirin, or lipid-lowering medications.

Michos ED, et al. Am Heart J 2005;150(6):1276-81.