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[Calculation of coronary risk in primary care: which table is more suitable for our patients?]
Diana Rodríguez Villar1, Lorena Muñoz Devesa, Ulpiano P García López
1Medicina Familiar y Comunitaria, Centro de Salud Fuente de San Luis, Valencia, España. drodriguez118j@cv.gva.es
Insights
The Framingham-Wilson (F) coronary risk table overestimates cardiovascular risk compared to the REGICOR (R) table, leading to more lipid-lowering treatment indications. This difference is notable across most patient groups, except for diabetics.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Accurate cardiovascular risk assessment is crucial for initiating lipid-lowering treatment.
- Different coronary risk tables exist, potentially leading to varied clinical decisions.
Purpose of the Study:
- To compare the indications for starting lipid-lowering treatment using the Framingham-Wilson (F) and REGICOR (R) coronary risk tables.
- To evaluate discrepancies in risk stratification and treatment recommendations between the two risk assessment tools.
Main Methods:
- A cross-sectional observational study was conducted with 355 adults aged 40-70 without prior cardiovascular events or lipid-lowering treatment.
- Coronary risk was calculated using both Framingham-Wilson (F) and REGICOR (R) tables.
- Indications for lipid-lowering treatment were assessed based on ATP-III guidelines.
Main Results:
- The REGICOR (R) table classified 34.9% of patients into a specific risk category, differing significantly from the Framingham-Wilson (F) table (kappa=0.125).
- Treatment indication agreement between the tables was substantial (kappa=0.669), with similar results for both sexes and smokers.
- For diabetic patients, risk stratification differed maximally (kappa=0.006), but treatment indication remained consistent (kappa=1) as all were high-risk.
Conclusions:
- The Framingham-Wilson (F) table tends to overestimate coronary risk in the studied population compared to the REGICOR (R) table.
- This overestimation results in a 6.1% higher indication for lipid-lowering treatment with the F table across most groups, excluding diabetics.
Objective:
To evaluate whether there are differences in the indications for starting lipid lowering treatment when using the different coronary risk tables.
Design:
Cross-sectional observational study.
Setting:
A Health Centre in Department 10, Valencia, Spain.
Participants:
Three-hundred and fifty-five individuals of both sexes, between 40 and 70 years with no cardiovascular events or lipid lowering treatment who participated in the Adult Health Program between January 1, 2003 and December 31, 2004, of which 192 were lost.
Main Measurements:
The variables that are counted in the Framingham-Wilson (F) and REGICOR (R) tables were collected. The total coronary risk was calculated using each table and whether there were differences. It was then evaluated to see if there were differences in the indication for starting lipid lowering treatment according to the ATP-III guides.
Results:
The risk groups obtained and the indication to treat were compared using contingency tables and the kappa (kappa) level of agreement. With table R, 34.9% of the patients fell into the risk category compared to table F (kappa=0.125). As regards treatment indication the kappa was 0.669. This result is similar when analysed for both sexes and smokers. For diabetics the difference between the risk tables is maximum (kappa=0.006), however the therapeutic action does not vary (kappa=1) since all are considered high risk.
Conclusions:
Table F overestimates coronary risk in our environment, which means starting lipid lowering treatment in 6.1% of patients more than with R in all groups except diabetics.
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