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[Cardiovascular risk by Framingham and SCORE in patients 40-65 years old]
Carmen González1, Enrique Rodilla, José A Costa
1Servicio de Medicina Preventiva, Hospital de Sagunto, Puerto de Sagunto, Valencia, España.
Insights
The Systematic Coronary Risk Evaluation (SCORE) identifies nearly twice as many high-risk individuals as the Framingham function in Spanish adults aged 40-65. This impacts cardiovascular risk stratification and treatment recommendations.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Context:
- Cardiovascular disease remains a leading cause of mortality globally.
- Accurate risk stratification is crucial for effective preventive strategies.
- Current guidelines utilize various risk assessment tools with differing implications.
Purpose:
- To compare the clinical utility of the Systematic Coronary Risk Evaluation (SCORE) and the Framingham function (NCEP-ATP-III) for cardiovascular risk stratification.
- To evaluate the implications of these systems on hypolipidemic treatment recommendations in a Spanish population aged 40-65.
- To assess the concordance between the two risk assessment tools.
Summary:
- The study included 929 non-diabetic patients aged 40-65. SCORE identified 4.1% of patients as high risk, while Framingham identified 2.5%.
- Concordance between the systems was low, with SCORE identifying more high-risk individuals, particularly males.
- Treatment recommendations for hypolipidemic therapy varied significantly between the European guidelines (SCORE-based) and NCEP-ATP-III guidelines.
Impact:
- SCORE charts appear to identify a larger proportion of high-risk individuals compared to Framingham in this population.
- The choice of risk stratification system influences the number of patients recommended for hypolipidemic treatment.
- These findings highlight the need to consider the implications of different risk assessment tools in clinical practice, especially for males.
Background And Objective:
The aim of this study was to compare the clinical and treatment implications of 2 cardiovascular risk stratification systems in a population of patients 40-65 years old.
Patients And Method:
929 non diabetic patients (40-65 years old) (51% female) with no evidence of previous cardiovascular disease were included in the study. The risk of cardiovascular death was assessed with the charts of the Systematic Coronary Risk Evaluation (SCORE), and coronary risk by the Framingham function (National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults -NCEP-ATP-III-). Patients were considered of high risk if risk of cardiovascular death was >or= 5% and coronary risk was > 20%, respectively.
Results:
4.1% of patients were considered as high risk by SCORE and 2.5% by Framingham. Only 0.2% of females were classified as high risk with either system. 8.2% and 4.8% of male population were considered as high risk by SCORE and Framingham, respectively. There was a low level of concordance between both systems. Patients classified as high risk by SCORE but not by Framingham were older, smoke less and had a better lipid profile. According to European Guidelines 28% of male and 23% of female were candidates to hypolipemic treatment, that proportion was higher, 43% of males and 28% of females, by NCEP-ATP-III guidelines.
Conclusions:
In Spanish patients 40-65 years old, SCORE charts almost duplicate the number of high risk individuals compared to Framingham. although the number of patients candidates to hypolipemic treatment is lower with the European than ATP-III guidelines. Differences were more evident in male.
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