Alcocer LA, Lozada O, Fanghänel G, Sánchez-Reyes L, Campos-Franco E

Language: Spanish
References: 19
Page: 168-174
PDF size: 290.90 Kb.

ABSTRACT

Background: In the Mexican population we are unaware if the Framingham model is a better system than the SCORE system for stratifying cardiovascular risk. The present study was conducted to compare risk stratification with the Framingham tables using the same procedure but using the SCORE, with the aim of recommending the use of the most appropriate method.
Methods: We analyzed a database of apparently healthy workers from the Mexico City General Hospital included in the study group “PRIT” (Prevalencia de Factores de Riesgo de Infarto del Miocardio en Trabajadores del Hospital General de México) and we calculated the risk in each simultaneously with the Framingham method and the SCORE method.
Results: It was possible to perform risk calculation with both methods in 1990 subjects from a total of 5803 PRITHGM study participants. When using the SCORE method, we stratified 1853 patients into low risk, 133 into medium risk and 4 into high risk. The Framingham method qualified 1586 subjects as low risk, 268 as medium risk and 130 as high risk. Concordance between scales to classify both patients according to the same risk was 98% in those classified as low risk, 19.4% among those classified as intermediate risk and only 3% in those classified as high risk.
Conclusions: According to our results, it seems more appropriate in our country to recommend the Framingham model for calculating cardiovascular risk due to the fact that the SCORE model underestimated risk.

REFERENCES

1. Cupples LA, D’Agostino RB. Section 34: Some risk factors related to the annual incidence of cardiovascular disease and death in pooled biennial measurements. In: Kannel WB, Wolf PA, Garrison RJ, eds. Framingham Heart Study: 30 Year Follow-Up. Bethesda, MD: US Department of Health and Human Services; 1987. NIH publicationNo. 87. pp. 2703-2707.

2. Jackson R, Lawes CM, Bennett DA, Milne RJ, Rodgers A. Treatment with drugs to lower blood pressure and blood cholesterol based on an individual’s absolute cardiovascular risk. Lancet 2005;365:434-441.

3. Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al.; For the SCORE Project Group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE. Eur Heart J 2003;24:987-1003.

4. Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in woman: the Reynolds risk score. JAMA 2007;297:611-619.

5. Woodward M, Brindle P, Tunstall Pedoe H; For the SIGN Group on Risk Estimation. Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC). Heart 2007;93:172-176.

6. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.

7. Dawber TR. The Framingham Study. The Epidemiology of Atherosclerosis Disease. Cambridge, MA: Harvard University Press; 1980. pp. 1-68.

8. Beswick A, Brindle P. Risk scoring in the assessment of cardiovascular risk. Curr Opin Lipidol 2006;17:375-386.

9. Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Baker G, et al. Estimation of ten year risk of fatal cardiovascular disease in Europe: The SCORE Project. Eur Heart J 2003;24:987-1003.

10. Marrugat J, Solanas P, D’Agostino R, Cordón F. Estimación del riesgo coronario en España mediante la función de Framingham calibrada. Rev Esp Cardiol 2003;56:253-261.

11. Menotti A, Pudd PE, Lanti M. Comparison of the Framingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J 2000;21:365-370.

12. Maiques-Galán A. Valoración del riesgo cardiovascular. ¿Qué tabla utilizar? Atencion Primaria 2003;32:586-589.

13. Álvarez A. Díaz-Gonzalez L, López-Fernández V, Prieto-Díaz MA, Suárez S. Comparación de los modelos SCORE y Framingham en el cálculo de alto riesgo cardiovascular para una muestra de varones de 45 y 65 años de Asturias. Rev Esp Salud Publica 2005;79:465-473.

14. Maiques A, Antón F, Franch M, Albert X, Aleixandre E, Collado A. Riesgo cardiovascular del SCORE comparado con el Framingham. Consecuencias del cambio propuesto por las sociedades europeas. Med Clin 2004;123:681-685.

15. Fanghanel-Salmón G, Sánchez-Reyes L, Arrellano-Montano S. Prevalencia de factores de riesgo coronario en trabajadores del Hospital General de México. Salud Publica Mex 1997;39:427-432.

16. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult treatment Panel III). JAMA 2001;285:2486-2490.

17. Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds risk score. JAMA 2007;297:611-619.

18. Ridker PM, Danielson E, Fonseca FAH. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008;359:2195-2207.