Heart Healthy Women

Reynolds Risk Score

About the Reynolds Risk Score

The Reynolds risk score is new risk calculator that is designed especially for women. It was developed in response to problems with the Framingham risk score, which underestimates risk in women.

The Reynolds risk score uses a formula that, like the Framingham score, includes age, blood pressure, smoking, total cholesterol, and HDL (good) cholesterol. The Reynolds score adds two additional numbers: your level of a blood marker called hsCRP (a measure of inflammation), and whether your mother or father had a heart attack before age 60 (a measure of genetic risk).

For now, the Reynolds risk score is much less widely used than the standard Framingham risk score. This is partly because is so new, and also because unlike blood pressure and cholesterol, the hsCRP blood test is not a routine test that is given to everyone.

What does the Reynolds risk calculator measure?

The Reynolds risk calculator measures your risk of having a heart attack or stroke, dying of heart disease, or needing heart procedure such as bypass surgery or angioplasty, within the next 10 years. The risk levels are:

  • Low risk = less than 5% chance
  • Low to Moderate Risk = 5% to 10% chance
  • Moderate to High Risk = 10% to 20% chance
  • High risk = 20% or higher chance

Who can use the Reynolds risk calculator?

Like the Framingham risk calculator, the Reynolds risk calculator does not work for women who already have heart disease, have had a heart attack or stroke, or have diabetes, because these women are automatically considered at high risk for future heart problems.

In order to calculate your Reynolds risk, you will need to know your standard blood pressure and cholesterol numbers. If you don’t know your numbers, make an appointment with a healthcare provider as soon as possible to get them. You will also need to have a CRP test, a simple blood test that is not routine, but usually used as a “tiebreaker” test in people who are at intermediate risk. The test is simple and can be performed on the same blood sample that is used to measure cholesterol. If you are interested, ask your doctor if this test is appropriate for you. See our C-Reactive Protein (CRP) article to learn more.

If you have not had your CRP tested, you can still use the Framingham Risk Calculator.

How accurate is the Reynolds risk score?

The Reynolds risk score appears to be better than the Framingham risk score at predicting the risk of women. It was developed in a study of almost 25,000 initially healthy U.S. women (aged 45 or older) who were followed for 10 years.10 Between 30% and 40% of the women who had intermediate (10% to 20%) risk according to Framingham were reclassified as lower or high risk when analyzed with the Reynolds risk score.10

It is still not known how accurate the Reynolds risk score is in minority populations.

Can I believe it if the calculator says I’m low risk?

Risk calculators are useful for getting an idea of your overall risk for heart disease, and the results help your doctor decide how aggressively to treat your risk factors and whether you need to undergo any diagnostic tests. However, keep in mind that they are only a rough estimate: there are many factors that affect your heart risk that the calculators don’t take into account, for example your diet. You cannot assume that if you have a low risk score that you will never develop heart disease.

Another key distinction is that risk scores are a measure of your absolute risk. You may have a low absolute risk, but a higher relative risk. For example, a young woman who smokes may have a low risk of developing heart problems in 10 years, but her risk is much higher than a woman her age who doesn’t smoke. A low risk score is not an excuse to ignore risk factors such as smoking or high blood pressure. Because heart disease generally develops later in women, a 10-year projection may underestimate the true long-term risk. Doubling the 10-year score gives an estimate of your 20-year risk; for example, if your 10-year risk is 10% (low to moderate), that is roughly equal to a 20% risk over 20 years (high). In reality, this is probably an underestimate—risk increases with age and risk factors tend to worsen over time if you do not take steps to reduce them.

Now that I know my risk, what can I do about it?

Firstly, you should know what risk factors you have. Nearly a third of people with high blood pressure and about half of the people with high cholesterol do not know it.11, 12 It is estimated that more than 2 million American women have undiagnosed diabetes.13 According to current guidelines, all adults should be screened for heart disease risk factors at age 20.14 You should have your blood pressure, weight, and waist measurements recorded every 2 years, and your fasting blood sugar and lipid levels should be tested every 5 years. A Framingham risk score should be calculated for all adults 40 years and older.

You can lower your risk of heart disease by adopting a heart-healthy lifestyle that includes not smoking, eating a healthy diet, and getting regular exercise.15 These measures will reduce your risk of heart problems even if you have already been diagnosed with heart disease, or have major risk factors.7 Heart disease patients who quit smoking lower their risk of dying early by 36%.15 In addition, a heart-healthy lifestyle lowers your risk of dying early from any cause including cancer.16

See the next section, The Major Contributors to Your Heart Disease Risk, for a primer on the most important determinants of your heart risk. Then check out the other articles in our Risk Factors section to learn more about these and other risk factors that put you at risk, and what you can do about them.

See also

The Major Contributors to Your Heart Disease Risk

What are the major factors that determine my risk for heart disease?

The most important modifiable factors that determine your risk of heart disease are:

  • Cigarette smoking
  • High blood pressure
  • High total and LDL (bad) cholesterol
  • Diabetes
  • Not being physically active
  • Being overweight

Modifiable risk factors are those you can change, as opposed to ones you can’t change such as a family history of heart disease or a genetic predisposition to high cholesterol. The major modifiable risk factors explain most heart attacks and deaths from heart disease in men and women.15, 17 Combined results of two major studies that included more than 17,000 women found that 87% of women aged 40 to 59 who suffered a heart attack, and more than 90% who died after 30 years, had at least 1 of the following risk factors: smoking, diabetes, high blood pressure, or high cholesterol.18


What about people who die suddenly from heart disease?

We’ve all heard stories of an apparently healthy person who suddenly dropped dead of a heart attack. In the original Framingham study, 32% of the 292 women who died from heart disease, died suddenly.19 Many people who die suddenly from heart disease may not be aware of their risk factors—what you don’t know can hurt you. Some people also mistakenly believe that if their cholesterol levels are normal, they are in the clear. Up to 50% of people with heart disease have normal cholesterol levels.20 It is important to control your risk factors even if your cholesterol is not high.


If I control my risk factors, will I reduce my risk?

The good news is that you are unlikely to suffer a heart attack if you do not have any of the major risk factors for heart disease. Men and women with healthy blood pressure and cholesterol levels who do not smoke or have diabetes and are a healthy weight live longer than people with one or more of these risk factors. Having this healthy profile adds nearly 6 years to the life expectancy of a woman aged 40 to 59 years.16

If I have major risk factors, will I have a heart attack?

Many people have major risk factors for heart disease but not all of them end up having a heart attack or dying from heart disease. The goal of risk evaluation and diagnostic testing is to identify the women who are most likely to suffer heart problems, and who may therefore need more treatment. One thing to consider is the number of risk factors. If you have high cholesterol and high blood pressure, you are more at risk than if you had only one of these risk factors.21 The scale is also a factor: if your blood pressure is very high, you are more at risk than if it was only slightly high. Even a modest increase in blood pressure or cholesterol may be worrisome in a woman with a strong family history of heart disease (defined as having a first degree male relative diagnosed before age 55, or first-degree female relative diagnosed before age 65).1

References

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3. Stensvold I, Tverdal A, Urdal P, Graff-Iversen S. Non-fasting serum triglyceride concentration and mortality from coronary heart disease and any cause in middle aged Norwegian women. BMJ. Nov 20 1993;307(6915):1318-1322.
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17. Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA. Nov 28 1986;256(20):2823-2828.
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