Letter to the Editor on “Traditional Cardiovascular Risk Factors Strongly Underestimate the 5-Year Occurrence of Cardiovascular Morbidity and Mortality in Spinal Cord Injured Individuals”

Barton et al's article studies cardiovascular risk in a cohort of individuals with a spinal cord injury. As the authors noted, the Framingham Risk Score (FRS) was derived to identify risk factors for cardiovascular disease. It is important to note, however, that the outcome measure for this risk score is defined as a “composite of coronary heart disease (coronary death, myocardial infarction, coronary insufficiency, and angina), cerebrovascular events (including ischemic stroke, hemorrhagic stroke, and transient ischemic attack), peripheral artery disease (intermittent claudication), and heart failure.” ^(p744) This composite outcome does not include pulmonary embolism, chronic venous insufficiency, deep venous thrombosis, atrial fibrillation/flutter, aortic aneurysms, valve diseases, or dissection, as was used in Barton et al's study. These other outcomes, which are not meant to be predicted by the FRS, encompassed 22 of the 39 outcomes that were reported. Additionally, there were 7 deaths in this study from “other cardiovascular death” and it is unclear whether the etiology of these would fall with the composite outcome for the FRS. There were also 2 instances of peripheral vascular disease, an entity that includes, but is not specific to, peripheral artery disease, so it is unclear whether these outcomes fall within the FRS composite outcome.