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[Evaluation of cardiovascular risk in the longitudinal phase of the Mediterranean study]
V F Gil-Guillén1, J Merino-Sánchez, T Sánchez-Ruiz
1REDIAPP-CV. Unidad de Investigación. Docencia y Práctica Clínica departamento 18 CV. Universidad Miguel Hernández. Elche. Alicante. España. atención.primaria@umh.es
Insights
This study adjusted the Framingham-Anderson scale for Spanish patients with hypertension and hypercholesterolemia, identifying key risk factors for cardiovascular events. The adjusted scale improves cardiovascular risk prediction in this population.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Context:
- Limited longitudinal cardiovascular data exists for Spanish populations.
- Hypertension (AHT) and hypercholesterolemia (HC) are prevalent conditions with suboptimal initial control in many patients.
- Understanding cardiovascular event incidence and risk factors is crucial for effective primary prevention strategies.
Purpose:
- To quantify incidence rates, cumulative incidence, relative risks, and survival curves for cardiovascular events in Spanish patients with AHT and/or HC.
- To adjust and validate the Framingham-Anderson scale (FAS) for accurate cardiovascular risk assessment in this specific patient cohort.
- To identify significant prognostic factors and assess therapeutic compliance impacting cardiovascular outcomes.
Summary:
- A longitudinal study of 6,893 primary prevention patients with AHT and/or HC over 1.22 years revealed a cumulative incidence of 1.59% for cardiovascular events.
- Key significant risk factors identified include age, elevated blood pressure, coronary history, left ventricular hypertrophy, microalbuminuria, high total cholesterol, hyperglycemia, elevated creatinine, and poor therapeutic compliance in HC patients.
- The Framingham-Anderson scale was successfully adjusted for the Spanish population, with a validated formula showing high correlation (r=0.9962) and intraclass correlation (ICI=0.9969).
Impact:
- Provides an validated tool (adjusted FAS) for precise cardiovascular risk stratification in Spanish hypertensive and hypercholesterolemic patients.
- Highlights the prognostic significance of various clinical and biochemical markers, aiding in targeted interventions.
- Quantifies the benefit of total cholesterol reduction on cardiovascular risk in hypercholesterolemic patients, reinforcing the importance of lipid management.
Introduction And Objectives:
There is little information on cardiovascular longitudinal studies. In Spanish patients with hypertension (AHT)) and/or hypercholesterolemia (HC), with poor initial control of blood pressure (BP) and/or total cholesterol (TC), incidence rate (IR), cumulative incidence (CI), relative risks (RR), survival curves (SC), therapeutic compliance (TC) were quantified and the Framingham-Anderson scale (FAS) was adjusted to our patients.
Patients And Methods:
A total of 6,893 primary prevention patients with AHT and/or with HC were included in primary prevention, with an average of 1.22 years of follow-up. A total of 480 physicians participated. Incidence rate (IR), cumulative incidence (CIN), relative risks (RR), survival curves (SC) by Kaplan-Meier method, and therapeutic compliance (TCOM) by Haynes-Sackett self-reported questionnaire were calculated. The Framingham-Anderson scale (FAS) was validated with Pearson's correlation coefficient (r) and intraclass correlation index (ICI).
Results:
CIN was 1.59% (1.31-1.90); the IR 1,321.6 cardiovascular events/ 100,000 patients/year (1,026.6-1,598.8). RRs with statistical significance were: age (p = 0.03). Blood pressure at the end of the study (p = 0.02), coronary background (p = 0.00), left ventricular hypertrophy (LVH) (p = 0.00), microalbuminuria (p = 0.02), CT >/= 250 mg/dl (p = 0.01), fasting glycemia (Gb) >/= 126 mg/dl (p = 0.00), creatinine >/= 1.2 mg/dl at the beginning (p = 0.00) and at the end of the study (p = 0.00), and poor compliance in HC patients (p = 0.00). SC have statistical significance (p < 0.05) for AHT background, fasting glucose >/= 126 mg/dl, target organ damage, and high cardiovascular risk with FAS scale. The adjusted FAS formula for global cardiovascular risk was (0.415 x FAS Risk%) + 0.517%, r = 0.9962 (p = 0.00) and ICI = 0.9969 (p < 0.0001).
Conclusions:
The equation for the FAS scale was adjusted for Spanish AHT/HC patients. Prognostic factors and SC were calculated. Benefit between TC and decrease of CVR in HC patients was quantified.
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