Wolf et al developed a risk appraisal function for predicting the risk of stroke using data from the Framingham study. The following is a table driven point system for estimating probability of stroke within 10 years for a middle aged to elderly adult.
NOTE: An updated version based on adjustment for antihypertensive therapy is given below (17.10.09).
Patient selection:
(1) both male and female
(2) ages 55 – 84
(3) free of previous stroke
(4) systolic blood pressure 95 – 213 mm Hg for men and 95 – 204 mm Hg in women
Parameters used for risk appraisal:
(1) age in years
(2) systolic blood pressure
(3) taking antihypertensive medications (in women there is an interaction with the systolic blood pressure)
(4) diabetes mellitus
(5) cigarette smoking
(6) history of cardiovascular disease (as intermittent claudication or CHF in Table 5 and 6 footnotes; also referred to include myocardial infarction, angina pectoris and coronary insufficiency elsewhere)
(7) history of atrial fibrillation
(8) evidence of left ventricular hypertrophy on electrocardiogram (ECG)
|
Parameters for Men |
Finding |
Points |
|---|---|---|
|
age in years |
54 – 56 |
0 |
|
|
57 – 59 |
1 |
|
|
60 – 62 |
2 |
|
|
63 – 65 |
3 |
|
|
66 – 68 |
4 |
|
|
69 – 71 |
5 |
|
|
72 – 74 |
6 |
|
|
75 – 77 |
7 |
|
|
78 – 80 |
8 |
|
|
81 – 83 |
9 |
|
|
84 - 86 |
10 |
|
systolic blood pressure in mm Hg |
95 – 105 |
0 |
|
|
106 – 116 |
1 |
|
|
117 – 126 |
2 |
|
|
127 – 137 |
3 |
|
|
138 – 148 |
4 |
|
|
149 – 159 |
5 |
|
|
160 – 170 |
6 |
|
|
171 – 181 |
7 |
|
|
182 – 191 |
8 |
|
|
192 – 202 |
9 |
|
|
203 –213 |
10 |
|
under antihypertensive therapy |
no |
0 |
|
|
yes |
2 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
2 |
|
cigarette smoking |
no |
0 |
|
|
yes |
3 |
|
history of cardiovascular disease |
no |
0 |
|
|
yes |
3 |
|
history of atrial fibrillation |
no |
0 |
|
|
yes |
4 |
|
left ventricular hypertrophy on ECG |
no |
0 |
|
|
yes |
6 |
|
Parameters for Women |
Finding |
Points |
|---|---|---|
|
age in years |
54 – 56 |
0 |
|
|
57 – 59 |
1 |
|
|
60 – 62 |
2 |
|
|
63 – 65 |
3 |
|
|
66 – 68 |
4 |
|
|
69 – 71 |
5 |
|
|
72 – 74 |
6 |
|
|
75 – 77 |
7 |
|
|
78 – 80 |
8 |
|
|
81 – 83 |
9 |
|
|
84 - 86 |
10 |
|
systolic blood pressure (SBP) in mm Hg |
95 – 104 |
0 |
|
|
105 – 114 |
1 |
|
|
115 – 124 |
2 |
|
|
125 – 134 |
3 |
|
|
135 – 144 |
4 |
|
|
145 – 154 |
5 |
|
|
155 – 164 |
6 |
|
|
165 – 174 |
7 |
|
|
175 – 184 |
8 |
|
|
185 – 194 |
9 |
|
|
195 –204 |
10 |
|
under antihypertensive therapy |
no |
0 |
|
|
yes and SBP 185 - 204 |
0 |
|
|
yes and SBP 165 – 184 |
1 |
|
|
yes and SBP 155 – 164 |
2 |
|
|
yes and SBP 135 – 154 |
3 |
|
|
yes and SBP 125 – 134 |
4 |
|
|
yes and SBP 105 – 124 |
5 |
|
|
yes and SBP 95 – 104 |
6 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
3 |
|
cigarette smoking |
no |
0 |
|
|
yes |
3 |
|
history of cardiovascular disease |
no |
0 |
|
|
yes |
2 |
|
history of atrial fibrillation |
no |
0 |
|
|
yes |
6 |
|
left ventricular hypertrophy on ECG |
no |
0 |
|
|
yes |
4 |
risk score =
= SUM(points for all parameters)
Interpretation:
• minimum score: 0
• maximum score for men: 40
• maximum score for women: 44
|
Risk Score |
10 Year Probability for Men |
10 Year Probability for Women |
|---|---|---|
|
1 |
2.6% |
1.1% |
|
2 |
3.0% |
1.3% |
|
3 |
3.5% |
1.6% |
|
4 |
4.0% |
2.0% |
|
5 |
4.7% |
2.4% |
|
6 |
5.4% |
2.9% |
|
7 |
6.3% |
3.5% |
|
8 |
7.3% |
4.3% |
|
9 |
8.4% |
5.2% |
|
10 |
9.7% |
6.3% |
|
11 |
11.2% |
7.6% |
|
12 |
12.9% |
9.2% |
|
13 |
14.8% |
11.1% |
|
14 |
17.0% |
13.3% |
|
15 |
19.5% |
16.0% |
|
16 |
22.4% |
19.1% |
|
17 |
25.5% |
22.8% |
|
18 |
29.0% |
27.0% |
|
19 |
32.9% |
31.9% |
|
20 |
37.1% |
37.3% |
|
21 |
41.7% |
43.4% |
|
22 |
46.6% |
50.0% |
|
23 |
51.8% |
57.0% |
|
24 |
57.3% |
64.2% |
|
25 |
62.8% |
71.4% |
|
26 |
68.4% |
78.2% |
|
27 |
73.8% |
84.4% |
|
28 |
79.0% |
> 84.4% |
|
29 |
83.7% |
> 84.4% |
|
30 |
87.9% |
> 84.4% |
|
31 |
> 87.9% |
> 84.4% |
Specialty: Neurology
ICD-10: ,
