Framingham Risk Calculator (10-year heart attack risk, ATP III points)

Understanding the Framingham risk calculator — concept and principle

This calculator uses the Framingham point score from the US ATP III cholesterol guidelines (2001) to estimate the 10-year risk of "hard" coronary heart disease, meaning a heart attack or coronary death, in adults aged 20–79 without heart disease or diabetes. It was widely used to decide how intensively to treat cholesterol.

Points add up: with the default inputs the result is 13 → 12% (10-year hard CHD risk).

How it is calculated

Total points = age points + total cholesterol points + HDL points + blood pressure points + smoking points

Age points rise steeply with age and differ by sex.
Total cholesterol and smoking points depend on the age band (20–39, 40–49, 50–59, 60–69, 70–79) and are weighted less at older ages.
HDL: 60 mg/dL or more −1, 50–59 0, 40–49 +1, under 40 +2.
Systolic pressure points are higher if blood pressure is treated.

The total is converted to a 10-year risk with the sex-specific ATP III table. mmol/L × 38.67 = mg/dL.

The principle

The Framingham Heart Study followed residents of one US town for decades and modelled how each risk factor predicted heart attacks. ATP III turned that model into a point table so it could be used without a computer. The risk factors add on the log scale, which is why they become additive points, and the table then maps each total back to a probability.

Worked example

Default inputs: male, 55, total cholesterol 210 mg/dL, HDL 48, systolic 135 untreated, non-smoker.

Age 55–59 → 8 points.
Cholesterol 200–239 at age 50–59 → 3 points.
HDL 40–49 → 1 point.
Systolic 130–139 untreated → 1 point.
Non-smoker → 0 points.
Total 13 → 10-year risk 12% → moderate (10–20%).

Each point is the calculator re-run with only “Total cholesterol” changed; the gold point is the default example. Change the inputs above and this chart follows your numbers.

Total cholesterol	10-year hard CHD risk
52.5	6%
105	6%
158	6%
210	12%
262	16%
315	20%
420	20%

How to read the result

ATP III groups were under 10%, 10–20% and over 20%, the last being treated like existing heart disease. Newer guidelines often use other calculators (for example the US Pooled Cohort Equations or European SCORE2), which estimate a broader set of events and may give different numbers.

Common mistakes

Using it for people with diabetes or known heart disease, who are already high risk.
Entering mmol/L values while the unit is set to mg/dL.
Assuming a low 10-year risk means low lifetime risk in a young adult.

Keep in mind: This is not a diagnosis or treatment advice. Discuss your cardiovascular risk and any treatment with a doctor.

Frequently asked questions

What does "hard CHD" mean?

Heart attack (myocardial infarction) or death from coronary heart disease.

Is the Framingham score still used?

It is still widely known, but many current guidelines prefer newer risk equations calibrated to today's populations.

Why does cholesterol count less at older ages?

In the Framingham data, the extra risk linked to cholesterol and smoking was relatively smaller in older people, whose risk is driven more by age.

Sources: National Cholesterol Education Program, Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III), NIH Publication 02-5215 (2002) · Executive Summary of ATP III, JAMA 2001;285:2486–2497

Checked 9 Nov 2026. National Cholesterol Education Program, Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III), NIH Publication 02-5215 (2002), Section III and Appendix III-A (Framingham point scores, Tables for men and women); Executive Summary, JAMA 2001;285:2486–2497.

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