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Johns Hopkins DNP student works to identify those overlooked by FRS


The Framingham Risk Score is a widely used and accepted predictor of heart disease, but it does not take in account family health history, which means some patients might not see cardiovascular disease coming.

Mariam Kashani, RN, MS, CRNP, a DNP student at the Johns Hopkins University School of Nursing in Baltimore, is working to identify and warn those overlooked by FRS and get them started on an aggressive program to limit the danger.

“Cardiovascular disease is the No. 1 cause of death and disability in the United States,” Kashani said in a news release. “Being categorized as low-risk when you are, in fact, truly high-risk could leave patients unaware and unarmed to take action to protect themselves.”

Kashani, working at Walter Reed National Military Medical Center in Bethesda, Md., created a clinical-decision support tool to re-analyze 239 patients out of 493 in the Integrative Cardiac Health Project who were labeled low- or intermediate-risk by FRS. Of the 239, 48% were found to have a family history of premature heart disease and were immediately reclassified as high-risk. The FRS bases the probability of cardiovascular disease within the next 10 years on age, sex, cholesterol levels, blood pressure and whether or not the person is a smoker, not family history.

Within the reclassified group, ultrasound of the carotid artery showed that 61% had atherosclerotic plaque, a precursor to heart disease. Those newly labeled high-risk begin a treatment plan that includes meeting cholesterol and blood pressure goals as well as advice on diet, exercise, stress and sleep management.

Women comprised 60% of that population, and the average patient was 48 years old. Kashani said in the release that early detection is extremely important for women, who “begin to lose their cardiovascular protective factors, like HDL, during middle age.”


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