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Framingham Risk Score (ATP III, 10-Year Hard CHD)

The ATP III Framingham equation estimates 10-year risk of hard coronary heart disease (MI or coronary death) in adults 30–79 without diabetes or CHD, from age, sex, total and HDL cholesterol, systolic BP, BP treatment and smoking. <10% low, 10–20% intermediate, >20% high (CHD risk equivalent).

  • Age (years)
  • Sex: Male; Female
  • Total cholesterol (mg/dL or mmol/L)
  • HDL cholesterol (mg/dL or mmol/L)
  • Systolic blood pressure (mmHg or kPa)
  • On blood-pressure medication (yes/no, +1)
  • Current smoker (yes/no, +1)
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Interpretation

ResultMeaning
< 10%Low
10–20%Intermediate
> 20%High (CHD risk equivalent)

Formula

Risk = 1 − S₀^exp(Σβx). Men (S₀ 0.9402): 52.00961·ln(age) + 20.014077·ln(TC) − 0.905964·ln(HDL) + 1.305784·ln(SBP) + 0.241549·BPtx + 12.096316·smoker − 4.605038·ln(age)·ln(TC) − 2.84367·ln(age*)·smoker − 2.93323·ln(age)² − 172.300168. Women (S₀ 0.98767): 31.764001·ln(age) + 22.465206·ln(TC) − 1.187731·ln(HDL) + 2.552905·ln(SBP) + 0.420251·BPtx + 13.07543·smoker − 5.060998·ln(age)·ln(TC) − 2.996945·ln(age*)·smoker − 146.5933061. age* = age capped at 70 (men) or 78 (women); TC, HDL in mg/dL.

Clinical pearls

  • Not for patients with diabetes or known CHD (already high risk under ATP III).
  • Predicts hard CHD only (MI, coronary death). Current US guidelines use the Pooled Cohort Equations for total ASCVD; Canada uses the Framingham CVD (2008) model.
  • Uses the continuous ATP III Framingham equation exactly as implemented in MedCalc-Bench (framingham_risk_score.py); results track but are smoother than the ATP III point tables.

Examples

framingham risk 55 yo male tc 213 hdl 50 sbp 120 nonsmokerframingham 60M smoker on bp meds, total chol 250, hdl 35, sbp 15010 year CHD risk for 60 year old woman, cholesterol 220, HDL 55, SBP 130

FAQ

What Framingham risk is high?

Under ATP III, a 10-year hard CHD risk above 20% is high (a CHD risk equivalent); 10–20% is intermediate and below 10% is low.

Framingham or the Pooled Cohort Equations?

US guidelines since 2013 recommend the Pooled Cohort Equations, which predict stroke as well as CHD; ATP III Framingham remains common in older protocols and benchmarks.

Evidence

  1. NCEP Expert Panel. Third Report of the NCEP Adult Treatment Panel III (ATP III) final report. Circulation 2002;106:3143–421.
  2. Wilson PW et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837–47.
  3. MedCalc-Bench reference implementation (framingham_risk_score.py).

Cardiology · Reviewed 2026-10-14 · Methodology