Original Article

Comparison of Framingham Cardiovascular Risk Criteria and ASCVD Score in Iranian Obese Patients


Background: Calculating and predicting the risk of disease plays an important role in preventive medicine. Today, some risk scores have been designed to estimate the risk of cardiovascular diseases (CVDs) by assessing different factors. Obesity is associated with an increased risk of cardiovascular disease, so we decided to calculate the possible risk of heart disease in obese Iranian people to suggest a more accurate calculator.

Methods: In this cross-sectional study, we compared the data of 289 people from Framingham Risk Score and ASCVD Risk Score calculations who had been referred to Shariati Hospital Obesity Clinic, Tehran, Iran from 2016 to 2019. In the form of sub-goals, we examined other factors such as blood pressure and hepatic aminotransferases, etc.

Results: The mean age of participants was 51.20±7.58 years, 86.2% being women. Of the whole, 19.72%, 31.83%, 21.11%, and 27.34% were categorized as overweight, Obese I, II, and III, respectively. According to the ASCVD score 80.3%, 4.8%, and 14.9%, and according to the Framingham score 95.5%, 3.5%, and 1% were classified as low-risk, intermediate-risk, and high-risk. Moreover, a fair agreement was observed between the two-risk score in the whole (Kappa=0.236; P<0.001), overweight (Kappa=0.304; P=0.028), Obese I (Kappa=0.210; P=0.048), Obese II (Kappa=0.268; P=0.015), and obese III (Kappa=0.202; P=0.023).

Conclusion: Despite its age limit, ASCVD has a higher risk of CVDs, causing statin care (which has a protective role for cardiovascular disease) to be given to a larger population.

1. Hulten EA, Bittencourt MS, Preston R, et al (2017). Obesity, metabolic syndrome and cardiovascular prognosis: from the Partners coronary computed tomography angiography registry. Cardiovasc Diabetol,16:14.
2. Rosengren A, Hawken S, Ounpuu S, et al (2004). Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet;364(9438):953-62.
3. Ford ES, Mokdad AH (2008). Epidemiology of obesity in the Western Hemisphere. The J Clin Endocrinol Metab, 93 Suppl, (1):S1-8.
4. Wharton S, Lau DCW, Vallis M, et al (2020). Obesity in adults: a clinical practice guide-line. CMAJ, 192(31):E875-E91.
5. Whiting DR, Guariguata L, Weil C, et al (2011). IDF diabetes atlas: global esti-mates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract, 94(3):311-21.
6. Arnett DK, Blumenthal RS, Albert MA, et al (2019). ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 140(11):e563-e95.
7. D'Agostino RB Sr., Vasan RS, Pencina MJ, et al (2008). General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation, 117(6):743-53.
8. Arsenault BJ, Pibarot P, Després JP (2009). The Quest for the Optimal Assessment of Global Cardiovascular Risk: Are Traditional Risk Factors and Metabolic Syndrome Partners in Crime? Cardiology, 113:35–49.
9. Bove AA, Santamore WP, Homko C, et al (2011). Treatment of patients with inter-mediate cardiovascular risk: Are clinical measures enough? J Nucl Cardiol, 18(6):1021-5.
10. Koopman RJ, Swofford SJ, Beard MN, et al (2009). Obesity and metabolic disease. Prim Care, 36(2):257-70.
11. Aghasi M, Matinfar A, Golzarand M, et al (2020). Internet Use in Relation to Over-weight and Obesity: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Adv Nutr, 11(2):349-356.
12. Ge L, Sadeghirad B, Ball GDC, et al (2020). Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascu-lar risk factor reduction in adults: system-atic review and network meta-analysis of randomised trials. BMJ, 1; 369:m696.
13. Homaie Rad E, Khodadady-Hasankiadeh N, Kouchakinejad-Eramsadati L, et al (2020). The relationship between weight indices and injuries and mortalities caused by the motor vehicle accidents: a system-atic review and meta-analysis. J Inj Violence Res, 12(1):85-101.
14. Koochakpoor G, Hosseini-Esfahani F, Daneshpour MS, (2016). Effect of inter-actions of polymorphisms in the Mela-nocortin-4 receptor gene with dietary fac-tors on the risk of obesity and Type 2 di-abetes: a systematic review. Diabet Med, 33(8):1026-34.
15. Litwin SE, Coles A, Hill CL, et al (2020). Discordances between predicted and actual risk in obese patients with suspected cardiac ischaemia. Heart ,106(4):273-9.
16. Pearson F, Huangfu P, Abu-Hijleh FM, et al (2020). Effect of subsidies on healthful consumption: a protocol for a systematic review update. BMJ Open, 20; 10(8):e036031
17. Poorolajal J, Sahraei F, Mohamdadi Y, et al (2020). Behavioral factors influencing childhood obesity: a systematic review and meta-analysis. Obes Res Clin Pract, 14(2):109-118.
18. Garg N, Muduli SK, Kapoor A, et al (2017). Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline recom-mended statin uses. Indian Heart J, 69(4):458-63.
19. Rahmani M, Jeddi S, Ghanbari M, et al (2019). Reference Values for Serum Lipid Profiles in Iranian Adults: Tehran Lipid and Glucose Study. Arch Iran Med, 1; 22(1):24-3.
20. Yuan-Lung Cheng J-HS, Hsiu-Chuan Hsu, Ying Liang, et al (2018). High health literacy is associated with less obesity and lower Framingham risk score: Sub-study of the VGH-HEALTHCARE trial. PloS One, 13(3):e0194813.
21. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med, 22(3):276-82.
22. Aminorroaya A, Janghorbani M, Amini M, et al (2009). The prevalence of thyroid dysfunction in an iodine-sufficient area in Iran. Arch Iran Med, 12(3):262-70.
23. Guerra-Silva NM, Santucci FS, Moreira RC, et al(2017). Coronary disease risk assess-ment in men: Comparison between ASCVD Risk versus Framingham. Int J Cardiol, 1; 228:481-487.
24. Ulbrich AZ, Bertin RL, Bozza R, et al (2012). Probability of arterial hypertension from anthropometric measures in adults. Arq Bras Endocrinol Metabol, 56(6):351-7.
25. Motamed N, Rabiee B, Perumal D, et al (2017). Comparison of cardiovascular risk assessment tools and their guidelines in evaluation of 10-year CVD risk and preventive recommendations: A popula-tion based study. Int J Cardiol, 1; 228:52-57.
IssueVol 52 No 2 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v52i2.11895
Obesity Cardiovascular disease Guidelines Framingham

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Hasani-Ranjbar S, Razmandeh R, Ghodssi-Ghassemabadi R, Khodabakhshi M, Ebrahimpour M. Comparison of Framingham Cardiovascular Risk Criteria and ASCVD Score in Iranian Obese Patients. Iran J Public Health. 2023;52(2):420-426.