10-Year Stroke Risk Calculator

What the Framingham Stroke Risk Profile measures

The Framingham Stroke Risk Profile grew out of the Framingham Heart Study, the Massachusetts cohort that researchers have followed since 1948. Wolf and colleagues published the original profile in 1991, fitting it to 472 strokes that occurred over 10 years of follow-up. In 1994, D'Agostino, Wolf, Belanger and Kannel adjusted the profile for people taking blood pressure medicine, and that 1994 point system is the one the National Institute of Neurological Disorders and Stroke prints on its stroke prevention worksheet.

The profile estimates the chance of a first stroke within 10 years. It takes eight inputs you can collect at an ordinary office visit: age, systolic blood pressure, blood pressure medicine, diabetes, cigarette smoking, prior cardiovascular disease, atrial fibrillation, and left ventricular hypertrophy seen on an ECG. Cholesterol is not one of them. Each answer converts to points, the points add up, and the total reads across to a probability. Every table sits below, so you can follow the arithmetic line by line instead of trusting a black box.

Two features separate this score from a heart risk score. It ends in stroke only, and it gives atrial fibrillation the same standing as smoking or diabetes.

The point table for men

Find your age row and your systolic pressure row. If you take blood pressure medicine, use the treated row; if you do not, use the untreated row. Then add the fixed values for the yes or no items on the right.

Prior cardiovascular disease here means a previous heart attack, angina, coronary insufficiency, heart failure or intermittent claudication. Atrial fibrillation and prior cardiovascular disease both land at 4 points for men, and left ventricular hypertrophy on the ECG adds 5.

Notice how fast the pressure rows climb: a man aged 66 to 68 starts at 4 points before any history enters the picture, and each 10 mm Hg step up the untreated column adds a point.

The point table for women

The women's table uses different age bands and different pressure bands, and the fixed values do not match the men's. Diabetes is worth 3 points for women against 2 for men. Prior cardiovascular disease is worth 2 points against 4. Atrial fibrillation is worth 6, the heaviest single item in either table.

Because the two tables differ, a man and a woman with identical numbers will not land on the same total. That is deliberate: the 1991 model was fitted separately for each sex, and the coefficients behind the points were not the same.

Turning a point total into a 10-year probability

Add the points, then read the total in the matching table. The two sexes convert on separate scales, and the gap is wide at the low end: 8 points means 7 percent for a man and 4 percent for a woman.

Average 10-year probability for people free of stroke at the start, by age band, from the same worksheet:

That last table is the one most people skip and the one that makes a score readable. Twelve points sounds alarming on its own. For a man of 67 it means 13 percent, against an 11.0 percent average for his age group, so he sits slightly above average rather than in a rare zone.

Two worked examples, step by step

Example 1: a 67-year-old man who smokes, untreated pressure 152. Age 66 to 68 gives 4 points. Untreated pressure in the 146 to 155 band gives 5 points. Current smoker adds 3. No diabetes, no prior heart disease, no atrial fibrillation, no LVH, so the total is 4 + 5 + 3 = 12 points, and the men's table reads 13 percent over 10 years. If he quits smoking, the total falls to 9 points and the table reads 8 percent. One habit, 5 points of risk.

Example 2: a 78-year-old woman with atrial fibrillation, untreated pressure 158. Age 77 to 78 gives 8 points. Untreated pressure in the 156 to 167 band gives 6. Atrial fibrillation adds 6. The total is 20 points, which reads 37 percent. Her age band average is 15.5 percent, so the irregular heartbeat is doing most of the work here.

Example 3, from the NINDS worksheet itself: a 65-year-old woman on treated pressure in the 107 to 113 band, who smokes and has atrial fibrillation. Age 65 to 67 gives 4, treated pressure gives 2, smoking gives 3, atrial fibrillation gives 6, for 15 points and 16 percent. Quitting smoking takes her to 12 points, or 9 percent.

Each of those three cases is checkable against the tables above. Add the points yourself and see whether the probability matches.

Atrial fibrillation and prior heart disease carry the big weights

Atrial fibrillation adds 6 points for women and 4 for men. It earns that place because blood can pool in the upper chambers of the heart and form a clot that travels to the brain. The NINDS prevention page ties atrial fibrillation to about one in four strokes after age 80.

Prior cardiovascular disease adds 4 points for men and 2 for women. Left ventricular hypertrophy on an ECG adds 5 for men and 4 for women, because a thickened left ventricle usually reflects years of pressure the heart had to push against.

For a 70-year-old, the arithmetic is blunt. Age alone can account for 5 or 6 points. Adding atrial fibrillation pushes a mid-range score into the high teens, and the probability table follows. That is why a stroke conversation at that age tends to start with heart rhythm and blood pressure rather than with cholesterol.

Which points you can lower this year

Four of the eight inputs respond to treatment or habit changes. Cigarettes move fastest: quitting removes 3 points for either sex, which took the man in Example 1 from 13 percent to 8 percent. The CDC counts about 795,000 strokes a year in the United States, and roughly 610,000 of those are first strokes, the exact event this profile predicts.

Blood pressure is the next lever, and it works in steps. On the men's untreated scale, dropping systolic pressure from 152 into the 126 to 135 band removes 2 points. Moving from the 136 to 145 band down to 116 to 125 removes 2 more. No single change rewrites a score, but three modest moves can take a man from 12 points to 8.

Diabetes adds 2 points for men and 3 for women. The point value does not change with better control, yet the condition's effect on small vessels does, so the table understates the value of managing it. Atrial fibrillation is the same story: the table assigns a fixed 6 or 4, and anticoagulation changes real stroke risk without changing the number.

Limits of the score, and how to use it well

The tables were built on Framingham participants aged 55 to 84 who had not had a stroke, so a score for a 45-year-old is an extrapolation, not a validated estimate. The output is a group average. Some people with 20 points never have a stroke, and some with 6 points do.

The cohort also reflects the care of its era. It does not credit modern anticoagulation for atrial fibrillation or current blood pressure targets, so it can overstate risk for a well-treated patient and understate it for someone untreated. Stroke burden is not spread evenly: the CDC reports that first-stroke risk is nearly twice as high for non-Hispanic Black adults as for White adults, a difference the Framingham tables do not capture.

One practical snag: left ventricular hypertrophy needs an ECG reading. Without a test result that says you have it, answer no. Guessing yes inflates the total by 4 or 5 points.

This page is an educational estimate. It is not medical advice and it does not diagnose anything. Take the point total to an appointment and let a clinician read it against your history, your medicines and your own goals.