Relative importance of borderline and elevated levels of coronary heart disease risk factors

Ann Intern Med. 2005 Mar 15;142(6):393-402. doi: 10.7326/0003-4819-142-6-200503150-00005.


Background: Clinical trials indicate that a sizable proportion of adults have multiple borderline coronary risk factors and may benefit from treatment.

Objective: To estimate the relative and absolute contributions of borderline and elevated risk factors to the population burden of coronary heart disease (CHD) events.

Design: A prospective cohort study and a national cross-sectional survey.

Setting: The Framingham Study and the Third National Health and Nutrition Examination Survey (NHANES III).

Participants: White non-Hispanic persons in the Framingham Study and in NHANES III who were between 35 to 74 years of age and had no CHD.

Measurements: Occurrence of first CHD events according to 5 major CHD risk factors: blood pressure, low-density lipoprotein and high-density lipoprotein cholesterol levels, glucose intolerance, and smoking. Three categories-optimal, borderline, and elevated-were defined for each risk factor per national guidelines. Sex-specific 10-year CHD event rates from the Framingham Study were applied to numbers of at-risk individuals estimated from NHANES III and the 2000 U.S. Census.

Results: Twenty-six percent of men and 41% of women had at least 1 borderline risk factor in NHANES III. According to estimates, more than 90% of CHD events will occur in individuals with at least 1 elevated risk factor, and approximately 8% will occur in people with only borderline levels of multiple risk factors. Absolute 10-year CHD risk exceeded 10% in men older than age 45 years who had 1 elevated risk factor and 4 or more borderline risk factors and in those who had at least 2 elevated risk factors. In women, absolute CHD risk exceeded 10% only in those older than age 55 years who had at least 3 elevated risk factors.

Limitations: The generalizability of the findings to persons of other ethnic backgrounds is unknown.

Conclusions: Borderline CHD risk factors alone account for a small proportion of CHD events.

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Blood Pressure / physiology
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Coronary Disease / epidemiology*
  • Coronary Disease / etiology
  • Coronary Disease / physiopathology
  • Cross-Sectional Studies
  • Female
  • Glucose Intolerance / complications
  • Humans
  • Hypertension / complications
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Sex Distribution
  • Smoking / adverse effects
  • United States / epidemiology


  • Cholesterol, HDL
  • Cholesterol, LDL