Skip to main content
Log in

Peripheral and cerebral atherothrombosis and cardiovascular events in different vascular territories: Insights from the framingham study

  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Major risk factors for clinical atherosclerosis include dyslipidemia, hypertension, glucose intolerance, adiposity, cigarette smoking, hemostatic factors, inflammatory markers, and sedentary lifestyle. Sets of some of these and evidence of vascular damage such as left ventricular hypertrophy and atrial fibrillation are used to formulate multivariable risk profiles for peripheral artery disease and stroke. These global risk formulations facilitate office estimation of the risk of these disabling diseases, which often indicate diffuse systemic atherosclerosis. Because predisposing risk factors usually cluster, and the risk each imposes varies widely, global risk assessment is a necessity, especially now that average risk factor levels are recommended for treatment. Novel risk factors deserve attention, but the standard cardiovascular risk factors account for as much as 85% of the cardiovascular disease arising within the population. Further improvement in detection, evaluation, and control of the major risk factors by implementation of guidelines for primary and secondary prevention of stroke and peripheral artery disease is needed, particularly in the high-risk segment of the population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Cupples LA, D’Agostino RB: Survival Following Initial Cardiovascular Events. The Framingham Study. 30-year follow-up. Section 35. NIH Publication No. 88-2909, 1988.

  2. Kannel WB: Global cardiovascular risk evaluation. In Preventive Cardiology. A Practical Approach, edn 2. Edited by Wong ND, Black HR, Gardin JM. New York: McGraw-Hill; 2005:1–21.

    Google Scholar 

  3. 2002 NHLBI Chart Book on Cardiovascular Lung and Blood Diseases.

  4. Hiatt WR: Medical treatment of peripheral arterial disease. N Engl J Med 2001, 344:1608–1621.

    Article  PubMed  CAS  Google Scholar 

  5. Thom TJ: Stroke mortality trends: an international perspective. Ann Epidemiol 1993, 3:509–518.

    Article  PubMed  CAS  Google Scholar 

  6. American heart Association 2004 Heart Disease and Stroke Statistics-2004 Update. Dallax, TX: American Heart Association; 2004.

  7. Hylek EM, Go AS, Chang Y, et al.: Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 2003, 349:1019–1026.

    Article  PubMed  CAS  Google Scholar 

  8. Kannel WB, McGee DL: Update on some epidemiologic features of intermittent claudication. J Am Geriatr Soc 1985, 33:13–18.

    PubMed  CAS  Google Scholar 

  9. Kannel WB: Risk factors for atherosclerotic cardiovascular outcomes in different vascular territories. J Cardiovasc Risk 1994, 1:1–7.

    Article  Google Scholar 

  10. Murabito JM, Evans JC, D’Agostino RB, et al.: Temporal trends of intermittent claudication from 1950–1999. Am J Epidemiol 2005, 162:430–437.

    Article  PubMed  Google Scholar 

  11. Hackam DG, Goodman SG, Annand SS: Management of risk in peripheral artery disease: Recent therapeutic advances. Am Heart J 2005, 150:35–40.

    Article  PubMed  Google Scholar 

  12. Sacco RL, Benjamin EJ, Broderick JP, et al.: Risk factors. Stroke 1997, 28:1507–1517.

    PubMed  CAS  Google Scholar 

  13. Wolf PA, Abbott RD, Kannel WB: Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991, 22:983–988.

    PubMed  CAS  Google Scholar 

  14. Benjamin EJ, Plehn JF, D’Agostino RB, et al.: Mitral annular calcification and risk of stroke in an elderly cohort. N Engl J Med 1992, 327:374–379.

    Article  PubMed  CAS  Google Scholar 

  15. Kannel WB, Wolf PA, Verter J: Manifestations of coronary disease predisposing to stroke. JAMA 1983, 250:2942–2946.

    Article  PubMed  CAS  Google Scholar 

  16. Sacco RL, Foulkes MA, Mohr JP, et al.: Determinants of early recurrence of cerebral infarction: the Stroke Data Bank. Stroke 1989, 20:983–989.

    PubMed  CAS  Google Scholar 

  17. Sacco RL, Wolf PA, Kannel WB, McNamara PM: Survival and recurrence following stroke: the Framingham Study. Stroke 1982, 13:290–295.

    PubMed  CAS  Google Scholar 

  18. Sacco RL, Shi T, Zamanillo MC, Kargman DE: Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stoke Study. Neurology 1994, 44:626–634.

    PubMed  CAS  Google Scholar 

  19. Kannel WB: Epidemiologic relation of cardiovascular disease among different vascular territories. In Atherothrombosis and Coronary Artery Disease, edn 2. Edited by Fuster V, Topol EJ, Nabel EG: Philadelphia: Lippincott Williams & Wilkins; 2005:1493–1496.

    Google Scholar 

  20. Wolf PA, Kannel WB, Sorlie P, McNamara P: Asymptomatic carotid bruit and risk of stroke. The Framingham Study. JAMA 1981, 245:1442–1445.

    Article  PubMed  CAS  Google Scholar 

  21. Kase CS, Wolf PA, Chodosh EH, et al.: Prevalence of silent stroke in patients presenting with initial stroke: the Framingham Study. Stroke 1989, 20:850–852.

    PubMed  CAS  Google Scholar 

  22. Chodosh EH, Foulkes MA, Kase CS, et al.: Silent stroke in the NINCDS Stroke Data Bank. Neurology 1998, 38:1674–1679.

    Google Scholar 

  23. Manolio TA, Kronmal RA, Burke GL, et al.: Magnetic resonance abnormalities and cardiovascular disease in older adults. Stroke 1994, 25:318–327.

    PubMed  CAS  Google Scholar 

  24. Vermeer SF, Prins ND, Den Heijer T, et al.: Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med 2003, 348:1215–1222.

    Article  PubMed  Google Scholar 

  25. Giele JL, Witkamp TD, Mali WP, van der Graaf Y: Silent brain infarcts in patients with manifest vascular disease. Stroke 2004, 35:742.

    Article  PubMed  Google Scholar 

  26. Murabito JM, Evans JC, Larson MG, et al.: The Ankle-Brachial Index in the elderly and risk of stroke, coronary disease and death. The Framingham Study. Arch Intern Med 2003, 163:1939–1942.

    Article  PubMed  Google Scholar 

  27. Franklin SS, Kahn SA, Wong ND, et al.: Is pulse pressure useful in predicting risk for coronary heart disease? Circulation 1999, 100:354–360.

    PubMed  CAS  Google Scholar 

  28. O’Leary DH, Anderson KM, Wolf PA, et al.: Cholesterol and carotid atherosclerosis. The Framingham Study. Ann Epidemiol 1992, 2:147–153.

    Article  PubMed  CAS  Google Scholar 

  29. Sacks FM, Pfeffer MA, Moye LA, et al.: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels: Cholesterol and Recurrent Events trial investigators. N Engl J Med 1996, 335:1001–1029.

    Article  PubMed  CAS  Google Scholar 

  30. Wolf PA, D’Agostino RB, Bonita R, Belanger AJ: Cigarette smoking as a risk factor for stroke. The Framingham study. JAMA 1988, 259:1025–1029.

    Article  PubMed  CAS  Google Scholar 

  31. Fowler B, Jamrozik K, Norman P, Allen Y: Prevalence of peripheral arterial disease; persistence of excess risk in former smokers. Aust NZ J Pub Health 2002, 26:219–224.

    Article  Google Scholar 

  32. Reaven GM: Syndrome X: 6 years later. J Intern Med 1995, 736:13–22.

    Google Scholar 

  33. Moller DE, Kaufman KD: Metabolic syndrome: a clinical and molecular perspective. Annu Rev Med 2005, 56:45–62.

    Article  PubMed  CAS  Google Scholar 

  34. Najarian RM, Sullivan LM, Wilson PW, et al.: Impact of the metabolic syndrome compared to diabetes as a risk factor for stroke. Arch Intern Med 2006, 166:106–111.

    Article  PubMed  Google Scholar 

  35. Wilson PW, D’Agostino RB, Levy D, et al.: Prediction of coronary heart disease using risk factor categories. Circulation 1998, 97:1837–1847.

    PubMed  CAS  Google Scholar 

  36. Brand RJ, Rosenman RH, Sholtz RI, Friedman M: Multivariate prediction of coronary heart disease in the Western Collaborative Group Study compared to the findings of the Framingham Study. Circulation 1976, 53:348–355.

    PubMed  CAS  Google Scholar 

  37. Leaverton PE, Sorlie PD, Kleinman JC, et al.: Representativeness of the Framingham risk model for coronary heart disease mortality: a comparison with a national cohort study. J Chronic Dis 1987, 40:775–784.

    Article  PubMed  CAS  Google Scholar 

  38. McGee D, Gordon T: The results of the Framingham Study applied to four other US-based studies of cardiovascular disease. In The Framingham Study: An Epidemiological Investigation of Cardiovascular Disease, section 31. Edited by Kannel WB, Gordon T. US Dept of Health Education and Welfare publication No. 76-1083. Bethesda, MD: US Government Printing Office; 1976.

    Google Scholar 

  39. Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB: Probability of stroke: a risk profile from the Framingham Study. Stroke 1991, 22:312–318.

    PubMed  CAS  Google Scholar 

  40. Murabito JM, D’Agostino RB, Silbershatz H, Wilson PW: Intermittent claudication: a risk profile from the Framingham Study. Circulation 1997, 96:44–49.

    PubMed  CAS  Google Scholar 

  41. Murabito JM, Evans JC, Nieto K, et al.: Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. Am Heart J 2002, 143:961–965.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kannel, W.B., Wolf, P.A. Peripheral and cerebral atherothrombosis and cardiovascular events in different vascular territories: Insights from the framingham study. Curr Atheroscler Rep 8, 317–323 (2006). https://doi.org/10.1007/s11883-006-0010-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-006-0010-3

Keywords

Navigation