[Incidence of cardiovascular disease and validity of equations of coronary risk in diabetic patients with metabolic syndrome]. / Incidencia de enfermedad cardiovascular y validez de las tablas de riesgo coronario en pacientes diabéticos con síndrome metabólico.

BACKGROUND AND OBJECTIVE: We aimed to analyze the contribution of the metabolic syndrome (MetS) and the glycemic control on the incidence of cardiovascular disease in type 2 diabetic patients. Our goal was also to validate to 10 years the coronary risk functions charts that use the original Framingham equation (Framingham-Wilson) and the calibrated one for the Spanish population (Framingham-REGICOR) in diabetic patients with MetS. PATIENTS AND METHOD: We included a total of 206 diabetic patients from a primary care center (63.6% with MetS), with no history of cardiovascular disease, in whom the coronary risk could be calculated prior to 1 January 1995. All were followed up during 10 years. RESULTS: The incidence of stroke, coronary and global events was similar in diabetic patients with and without MetS (15.3% vs 14.7%, 9.2% vs 9.3% and 20.6% vs 21.3%, respectively). The presence of glycosylated hemoglobin > or = 7% increased the risk of global cardiovascular events (relative risk [RR], 2.13; 95% confidence interval [CI], 1.10-4.09) and stroke (RR, 3.4; 95% CI, 1.17-9.84). The considered coronary risk in Framingham-Wilson and REGICOR equations was higher in the patients with MetS (29.6% and 12.4% vs 23.4% and 9.4%, respectively; p < 0,01), but the validity criteria of these equations in the diabetic population are very discreet. CONCLUSIONS: A value of glycosylated hemoglobin > or = 7% increases the risk of cardiovascular events in diabetic patients whereas the incidence of this events was similar in patients with and without MetS. The utility of the Framingham-Wilson and REGICOR equations is reduced in the diabetic population.

[Predictive capacity, comparison and clinic consequences of the Framingham-Wilson and REGICOR tables in persons for whom care has been provided at a health care center, Badajoz, Spain]. / Capacidad predictiva, comparación y consecuencias clínicas de las tablas de Framingham-Wilson y regicor en personas atendidas en un centro de salud de Badajoz.

BACKGROUND: Framingham's original equation modified by Wilson and the REGICOR calibration are widely recommended in coronary risk stratification. This study is aimed at: (1) Analyzing the ten-year predictiveness of the Framingham-Wilson and REGICOR tables among a population for which care has been provided at an urban health care center (2) Evaluating the concordance use of hypolipemiant and antihypertensive drugs resulting from these tables. METHODS: Observational, longitudinal, retrospective study of a cohort of patients for whom care was provided at a primary care center. A total of 1011 patients ages 35-74 (mean age 55.7, 56.0% females) without any evidence of cardiovascular disease. Those patients having a > or =20% risk in Wilson and > or =10% in REGICOR were considered high-risk. RESULTS: The actual coronary risk of the population was 10.7%, whilst the mean coronary risk estimated with the functions was 17.0% in Wilson and 6.6% in REGICOR. A total 29.6% was classified high-risk in Wilson as compared to the 18.2% in RECIGOR (p < 0.05). The percentage of high-risk males was significantly higher in Wilson than in REGICOR (49.0% vs. 29.4%, p < 0.01). The Kappa index was 0.70 (95 CI: 0.67, 0.73). A total of 39.5% of the patients (as per Wilson) and 31.4% (as per REGICOR) were candidates for taking hypolipemiant drugs (p < 0.001). The validity criteria of both of these functions are quite discreet: sensitivity, specificity and odds ratio diagnosed at 50.9%, 73.1% and 2.11 in Wilson and 28.7%, 83.1% and 1.98 in REGICOR, respectively. CONCLUSIONS: The Wilson and REGICOR tables show an acceptable degree of concordance, but their validity parameters are discreet. The Framingham-Wilson function screens a higher percentage of patients as being candidates for hypolipemiant drugs.

[Comparison of the SCORE function chart and the Framingham-REGICOR equation to estimate the cardiovascular risk in an urban population after 10 years of follow-up]. / Comparación entre la tabla del SCORE y la función Framingham-REGICOR en la estimación del riesgo cardiovascular en una población urbana seguida durante 10 años.

BACKGROUND AND OBJECTIVE: Framingham-REGICOR and SCORE (Systematic Coronary Risk Evaluation) are 2 functions charts recommended to estimate the cardiovascular risk stratification in Spain. The aim of the present study was to validate to 10 years the SCORE and REGICOR functions charts in 40 to 65 years old population. PATIENTS AND METHOD: 608 patients (56.7% female) with non evidence of cardiovascular disease were included in the present study. Patients were classified as high risk by REGICOR (> or = 10%) and by SCORE (> or = 5%) functions. RESULTS: The 90.6% of the population (551 subjects) did not experienced any cardiovascular events during the 10 years follow-up. The REGICOR function chart underestimated the coronary risk (4.9% vs 7.9%; p < 0.001), whereas the SCORE overestimated the cardiovascular risk of death (2.1% vs 1.5%; p < 0.001). In the SCORE function, the average risk of patients with events was 6.1%, whereas the average risk of patients without events was 2.0% (p < 0.001) and 7.1% vs 4.8% (p < 0.001) in the REGICOR equation. The SCORE function obtained better validity criteria than REGICOR with a sensibility of 66.7% (95% confidence interval [CI], 66.2-67.2), especificity of 91.7%, (95% CI, 91.2-92.2) positive likelihood ratio of 8 (95% CI, 7.5-8.5), and eficacy of 91.1% (95% CI, 90.6-91.6). These results were observed in both sexes: women -sensibility: 33.3% (95% CI, 32.4-34.2); especificity: 97.4% (95% CI, 96.5-98.3)- and men -sensibility: 83.3% (95% CI, 82.7-83.9); especificity: 84.0% (95% CI, 83.4-84.6). CONCLUSIONS: The SCORE equation obtains better validity criteria than the REGICOR equation both in the total population and in males and females separately. These results make the SCORE function a powerful tool to estimate the cardiovascular risk.

[Prevalence of hidden renal failure calculated through formulas on the degree of renal function in hypertense patients over 60 referred to out-patients for blood pressure monitoring]. / Prevalencia de insuficiencia renal oculta estimada mediante fórmulas de cálculo del grado de función renal en hipertensos mayores de 60 años, remitidos para medición ambulatoria de la presión arterial.

OBJECTIVES: To validate the Cockroft-Gault and the abbreviated Modification of Diet in Renal Disease (MDRD) formulas in a hypertense population aged over 60 and with blood pressure monitored in out-patients. To evaluate the prevalence of various stages of hidden chronic kidney disease in this population. DESIGN: Descriptive study of validation of diagnostic tests. SETTING: Urban primary care centre. PARTICIPANTS: A total of 113 patients over 60 (53.8% female) with hypertension and no history of chronic kidney disease, on whom blood pressure could be monitored in a 24-hour session. MAIN MEASUREMENTS: Calculation of the glomerular filtration rate. Validity parameters of diagnostic tests. RESULTS: Renal clearance estimated in the Cockroft-Gault and MDRD equations was similar (77.9 mL/min and 76.9 mL/min, respectively). There was 37.3% prevalence of chronic kidney disease, using the Cockroft-Gault equation; and 27.0%, using the MDRD. The degree of agreement between the two equations was excellent in classifying patients with stage-2 chronic kidney disease (kappa index =0.9) and it was acceptable for stage-3 (kappa index =0.5). In both equations, validity indexes were acceptable for the presence of microalbuminuria as a manifestation of renal damage. CONCLUSIONS: There is a high prevalence of hidden chronic kidney disease in the hypertense population over 60 years old. Glomerular filtration should be determined systematically in these patients, even when their plasma creatinine figures are normal.

[Comparison of the REGICOR and SCORE function charts for classifying cardiovascular risk and for selecting patients for hypolipidemic or antihypertensive treatment]. / Comparación de las tablas REGICOR y SCORE para la clasificación del riesgo cardiovascular y la identificación de pacientes candidatos a tratamiento hipolipemiante o antihipertensivo.

INTRODUCTION AND OBJECTIVES: In Spain, use of the Framingham-REGICOR (Registre Gironí del Cor) and SCORE (Systematic Coronary Risk Evaluation) risk charts is recommended for stratifying cardiovascular disease risk. The aims of the present study were to evaluate the degree of agreement between these charts when used to evaluate cardiovascular disease risk in nondiabetic individuals aged 40-65 years and to estimate the percentage of patients recommended for hypolipidemic or antihypertensive treatment. METHODS: The study included 608 nondiabetic patients aged between 40-65 years (mean 52.8 years, 56.7% female) with no evidence of cardiovascular disease who were attending a primary healthcare center between 1990-1994. REGICOR and SCORE equations were used to calculate 10-year cardiovascular disease risks. Patients were classified as high-risk if their risk was > or =10% with REGICOR or > or =5% with SCORE. RESULTS: Some 7.9% of the population was classified as high-risk with REGICOR and 9.2%, with SCORE (P=.41). Only 2.6% and 2.9% (P=.81) of women were classified as high-risk, compared with 14.8% and 17.5% of men, with REGICOR and SCORE, respectively (P=.40). The kappa coefficient was 0.45. According to European professional society guidelines, 23.8% of patients classified by SCORE and 23.0% classified by REGICOR (P=.73) would be recommended hypolipidemic treatment, while 31.2% and 31.7% (P=.85), respectively, would be recommended antihypertensive treatment. CONCLUSIONS: There was moderately good agreement between REGICOR and SCORE charts when used to evaluate nondiabetic individuals aged 40-65 years. They identified similar percentages of patients who would be recommended for hypolipidemic or antihypertensive treatment.

Capacidad predictiva, comparación y consecuencias clínicas de las tablas de Framingham-Wilson y Regicor en personas atendidas en un Centro de Salud de Badajoz / Predictive capacity, comparison and clinic consecuences of the Framingham- Wilson and REGICOR tables in persons for whom care has been provided at a health care center, Badajoz, Spain

Fundamento: La ecuación original de Framingham modificada por Wilson y la calibrada del REGICOR son ampliamente recomendadas en la estratificación del riesgo coronario. Este estudio tiene por objetivos: 1) Analizar la capacidad predictiva a diez años de las tablas de Framingham-Wilson y REGICOR en población atendida en un centro de salud urbano; y 2) Evaluar la concordancia y el consumo de fármacos hipolipemiantes y antihipertensivos derivado de su uso. Métodos: Estudio observacional, longitudinal, retrospectivo de una cohorte de pacientes atendidos en un centro de atención primaria. Un total de 1.011 pacientes de 35-74 años (media 55,7 años, 56,0% mujeres) sin evidencia de enfermedad cardiovascular. Se consideró pacientes de riesgo alto aquellos con un riesgo >20% en Wilson y >10% en REGICOR. Resultados: El riesgo coronario real de la población fue del 10,7% mientras que el riesgo coronario medio estimado con las funciones fue 17,0% en Wilson y 6,6% en REGICOR. El 29,6% fue catalogado de riesgo alto en Wilson frente al 18,2% en REGICOR (p<0,05), siendo también significativamente mayor el porcentaje de varones de riesgo alto en Wilson que en REGICOR (49,0% vs 29,4%, p<0,01). El índice Kappa fue 0,70 (IC 95%: 0,67; 0,73). El 39,5% de los pacientes (según Wilson) y el 31,4% (según REGICOR) serían candidatos al tratamiento con hipolipemiantes (p<0,001). Los criterios de validez de ambas funciones son muy discretos: sensibilidad, especificidad y odds ratio diagnósticas del 50,9%, 73,1% y 2,11 en Wilson y 28,7%, 83,1% y 1,98, en REGICOR, respectivamente. Conclusiones. Las tablas de Wilson y REGICOR presentan concordancia aceptable pero sus parámetros de validez son discretos. La función Framingham-Wilson selecciona un mayor porcentaje de pacientes candidatos a recibir tratamiento con hipolipemiantes

Background: Framingham’s original equation modified by Wilson and the REGICOR calibration are widely recommended in coronary risk stratification. This study is aimed at: 1) Analyzing the ten-year predictiveness of the Framingham- Wilson and REGICOR tables among a population for which care has been provided at an urban health care center 2) Evaluating the concordance use of hypolipemiant and antihypertensive drugs resulting from these tables. Methods: Observational, longitudinal, retrospective study of a cohort of patients for whom care was provided at a primary care center. A total of 1011 patients ages 35-74 (mean age 55.7, 56.0% females) without any evidence of cardiovascular disease. Those patients having a >20% risk in Wilson and >10% in REGICOR were considered high-risk. Results: The actual coronary risk of the population was 10.7%, whilst the mean coronary risk estimated with the functions was 17.0% in Wilson and 6.6% in REGICOR. A total 29.6% was classified high-risk in Wilson as compared to the 18.2% in RECIGOR (p<0.05). The percentage of high-risk males was significantly higher in Wilson than in REGICOR (49.0% vs. 29.4%, p<0.01). The Kappa index was 0.70 (95 CI: 0.67, 0.73). A total of 39.5% of the patients (as per Wilson) and 31.4% (as per REGICOR) were candidates for taking hypolipemiant drugs (p<0.001). The validity criteria of both of these functions are quite discreet: sensitivity, specificity and odds ratio diagnosed at 50.9%, 73.1% and 2.11 in Wilson and 28.7%, 83.1% and 1.98 in REGICOR, respectively. Conclusions. The Wilson and REGICOR tables show an acceptable degree of concordance, but their validity parameters are discreet. The Framingham-Wilson function screens a higher percentage of patients as being candidates for hypolipemiant drugs

Respuesta de los autores: Comparación entre la tabla del SCORE y la función Framingham-REGICOR en la estimación del riesgo cardiovascular / Autor’s reply: Comparison of the SCORE function chart and the Framingham-REGICOR equation to estimate the cardiovascular risk

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Respuesta de los autores: Validaciones de las tablas de riesgo cardiovascular: ¿nos aclaran o nos confunden todavía más? / Reply to the authors: Validation of cardiovascular risk tables: are we more or less confused?

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A propósito de la «comparación de las tablas REGICOR y SCORE ». Respuesta / Comment on «Comparison of the REGICOR and SCORE Function Charts ». Response

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Análisis de la capacidad predictiva de las funciones de Framingham-REGICOR y SCORE en la población de un centro de salud / Analysis of predictive value of Framingham-REGICOR and SCORE functions in primary health care

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Prevalencia de insuficiencia renal oculta estimada mediante fórmulas de cálculo del grado de función renal en hipertensos mayores de 60 años, remitidos para medición ambulatoria de la presión arterial / Prevalence of hidden renal failure calculated through formulas on the degree of renal function in hypertense patients over 60 referred to out-patients for blood pressure monitoring

Objetivos. Validar las fórmulas de Cockcroft-Gault y la abreviada del estudio Modification of Diet in Renal Disease (MDRD) en la población hipertensa mayor de 60 años en la que se realiza medición ambulatoria de la presión arterial, y conocer la prevalencia de diferentes estadios de enfermedad renal crónica oculta en ese grupo de población. Diseño. Estudio descriptivo, de validación de pruebas diagnósticas. Emplazamiento. Atención primaria. Centro de salud urbano. Participantes. Un total de 113 pacientes mayores de 60 años (el 53,8% mujeres), hipertensos, sin historia de enfermedad renal crónica conocida y a quienes se les realizó una sesión de medición ambulatoria de presión arterial durante 24 h. Mediciones principales. Estimación del grado de filtración glomerular. Parámetros de validez de pruebas diagnósticas. Resultados. El aclaramiento renal estimado por las fórmulas de Cockroft-Gault y MDRD fue similar (77,9 y 76,9 ml/min, respectivamente). Se encontró una prevalencia de enfermedad renal crónica del 37,3% en la ecuación de Cockroft-Gault y del 27,0% en la de MDRD. El índice de concordancia de ambas ecuaciones fue excelente en la catalogación de los pacientes con enfermedad renal crónica en estadio 2 (kappa = 0,9) y aceptable (kappa = 0,5) para el estadio 3. Los índices de validez de las 2 ecuaciones son discretos frente a la presencia de microalbuminuria como manifestación de daño renal. Conclusiones. Hay una alta prevalencia de enfermedad renal crónica oculta en la población hipertensa mayor de 60 años. La estimación del filtrado glomerular debería realizarse sistemáticamente en esta población, aunque sus cifras de creatinina plasmática sean normales

Objectives. To validate the Cockroft-Gault and the abbreviated Modification of Diet in Renal Disease (MDRD) formulas in a hypertense population aged over 60 and with blood pressure monitored in out-patients. To evaluate the prevalence of various stages of hidden chronic kidney disease in this population. Design. Descriptive study of validation of diagnostic tests. Setting. Urban primary care centre. Participants. A total of 113 patients over 60 (53.8% female) with hypertension and no history of chronic kidney disease, on whom blood pressure could be monitored in a 24-hour session. Main measurements. Calculation of the glomerular filtration rate. Validity parameters of diagnostic tests. Results. Renal clearance estimated in the Cockroft-Gault and MDRD equations was similar (77.9 mL/min and 76.9 mL/min, respectively). There was 37.3% prevalence of chronic kidney disease, using the Cockroft-Gault equation; and 27.0%, using the MDRD. The degree of agreement between the two equations was excellent in classifying patients with stage-2 chronic kidney disease (kappa index =0.9) and it was acceptable for stage-3 (kappa index =0.5). In both equations, validity indexes were acceptable for the presence of microalbuminuria as a manifestation of renal damage. Conclusions. There is a high prevalence of hidden chronic kidney disease in the hypertense population over 60 years old. Glomerular filtration should be determined systematically in these patients, even when their plasma creatinine figures are normal

Comparación de las tablas REGICOR y SCORE para la clasificación del riesgo cardiovascular y la identificación de pacientes candidatos a tratamiento hipolipemiante o antihipertensivo / Comparison of the REGICOR and SCORE function charts for classifying cardiovascular risk and for selecting patients for hypolipidemic or antihypertensive treatment

Introducción y objetivos. Las funciones de Framingham-REGICOR y SCORE son funciones recomendadas en la estratificación del riesgo cardiovascular en nuestro país. El objetivo del presente estudio fue evaluar la concordancia de estas tablas en la estratificación del riesgo en la población no diabética de 40-65 años y estimar el porcentaje de pacientes candidatos a recibir tratamiento hipolipemiante e hipotensor. Métodos. Se incluyó a un total de 608 pacientes no diabéticos de 40-65 años de edad (media, 52,8 años; 56,7%, mujeres) sin evidencia de enfermedad cardiovascular, atendidos en el centro de salud durante los años 1990-1994. El riesgo cardiovascular a los 10 años se calculó mediante la ecuación de REGICOR y SCORE. Se consideró pacientes de riesgo alto a los que tenían un riesgo ≥ 10% en REGICOR y ≥ 5% en SCORE. Resultados. Un 7,9% de la población fue catalogada de riesgo alto en REGICOR y un 9,2% en SCORE (p = 0,41). Solamente el 2,6 y el 2,9% de las mujeres (p = 0,81) se incluyeron en la categoría de riesgo alto, frente al 14,8 y 17,5% de los varones (p = 0,40) en REGICOR y SCORE, respectivamente. El coeficiente kappa fue 0,45. El seguimiento de las recomendaciones de las Sociedades Europeas implicaría que el 23,8% de los pacientes, según SCORE, y el 23,0%, según REGICOR (p = 0,73), serían candidatos a recibir tratamiento hipolipidemiante, y el 31,2 y el 31,7% (p = 0,85), a recibir fármacos antihipertensivos. Conclusiones. Las tablas REGICOR y SCORE presentan una concordancia moderada en la población no diabética de 40-65 años de edad. Su aplicación identifica a un porcentaje similar de pacientes candidatos a recibir tratamiento hipolipemiante o antihipertensivo

Introduction and objectives. In Spain, use of the Framingham-REGICOR (Registre Gironí del Cor) and SCORE (Systematic Coronary Risk Evaluation) risk charts is recommended for stratifying cardiovascular disease risk. The aims of the present study were to evaluate the degree of agreement between these charts when used to evaluate cardiovascular disease risk in nondiabetic individuals aged 40-65 years and to estimate the percentage of patients recommended for hypolipidemic or antihypertensive treatment. Methods. The study included 608 nondiabetic patients aged between 40-65 years (mean 52.8 years, 56.7% female) with no evidence of cardiovascular disease who were attending a primary healthcare center between 1990-1994. REGICOR and SCORE equations were used to calculate 10-year cardiovascular disease risks. Patients were classified as high-risk if their risk was ≥10% with REGICOR or ≥5% with SCORE. Results. Some 7.9% of the population was classified as high-risk with REGICOR and 9.2%, with SCORE (P=.41). Only 2.6% and 2.9% (P=.81) of women were classified as high-risk, compared with 14.8% and 17.5% of men, with REGICOR and SCORE, respectively (P=.40). The kappa coefficient was 0.45. According to European professional society guidelines, 23.8% of patients classified by SCORE and 23.0% classified by REGICOR (P=.73) would be recommended hypolipidemic treatment, while 31.2% and 31.7% (P=.85), respectively, would be recommended antihypertensive treatment. Conclusions. There was moderately good agreement between REGICOR and SCORE charts when used to evaluate nondiabetic individuals aged 40-65 years. They identified similar percentages of patients who would be recommended for hypolipidemic or antihypertensive treatment

Incidencia de enfermedad cardiovascular y validez de las tablas de riesgo coronario en pacientes diabéticos con síndrome metabólico / Incidence of cardiovascular disease and validity of equations of coronary risk in diabetic patients with metabolic syndrome

Fundamento y objetivo: Los objetivos del estudio han sido, por un lado, analizar la contribución del síndrome metabólico (SM) y el control glucémico sobre la incidencia de enfermedad cardiovascular en pacientes con diabetes tipo 2, y por otro, evaluar a 10 años las tablas de riesgo coronario que utilizan la función de Framingham original (Framingham-Wilson) y la calibrada para población española (Framingham-REGICOR) en pacientes con diabetes y SM. Pacientes y método: Se incluyó en el estudio a un total de 206 pacientes con diabetes de un centro de salud urbano (un 63,6% con SM), sin antecedentes de enfermedades cardiovasculares, a quienes se les pudo calcular el riesgo coronario antes del 1 de enero de 1995. El período de seguimiento fue de 10 años. Resultados: La incidencia de episodios cardiovasculares fue similar en los pacientes con y sin SM: un 15,3 frente al 14,7% de eventos coronarios; un 9,2 frente a un 9,3% de episodios cerebrovasculares, y un 20,6 frente a un 21,3% de eventos cardiovasculares globales. Los valores de hemoglobina glucosilada iguales o mayores del 7% incrementaron el riesgo de episodios cardiovasculares globales, con un riesgo relativo de 2,13 (intervalo de confianza [IC] del 95%, 1,10-4,09) y de acontecimientos cerebrovasculares, con un riesgo relativo de 3,4 (IC del 95%, 1,17-9,84). El riesgo coronario estimado en las 2 ecuaciones fue mayor en los pacientes con SM ­un 29,6 frente a un 23,4% (p < 0,01) en la de Framingham-Wilson y un 12,4 frente a un 9,4% (p < 0,01) en la de Framingham-REGICOR­, pero los criterios de validez de estas ecuaciones en población diabética son muy discretos. Conclusiones: Un valor de hemoglobina glucosilada del 7% o superior incrementa el riesgo de episodios cardiovasculares en pacientes diabéticos, mientras que la incidencia de estos eventos fue similar en pacientes con y sin SM. La utilidad de las ecuaciones de Framingham-Wilson y REGICOR es reducida en población diabética

Background and objective: We aimed to analyze the contribution of the metabolic syndrome (MetS) and the glycemic control on the incidence of cardiovascular disease in type 2 diabetic patients. Our goal was also to validate to 10 years the coronary risk functions charts that use the original Framingham equation (Framingham-Wilson) and the calibrated one for the Spanish population (Framingham-REGICOR) in diabetic patients with MetS. Patients and method: We included a total of 206 diabetic patients from a primary care center (63.6% with MetS), with no history of cardiovascular disease, in whom the coronary risk could be calculated prior to 1 January 1995. All were followed up during 10 years. Results: The incidence of stroke, coronary and global events was similar in diabetic patients with and without MetS (15.3% vs 14.7%, 9.2% vs 9.3% and 20.6% vs 21.3%, respectively). The presence of glycosylated hemoglobin >= 7% increased the risk of global cardiovascular events (relative risk [RR], 2.13; 95% confidence interval [CI], 1.10-4.09) and stroke (RR, 3.4; 95% CI, 1.17-9.84). The considered coronary risk in Framingham-Wilson and REGICOR equations was higher in the patients with MetS (29.6% and 12.4% vs 23.4% and 9.4%, respectively; p = 7% increases the risk of cardiovascular events in diabetic patients whereas the incidence of this events was similar in patients with and without MetS. The utility of the Framingham-Wilson and REGICOR equations is reduced in the diabetic population

Comparación entre la tabla del SCORE y la función Framingham-REGICOR en la estimación del riesgo cardiovascular en una población urbana seguida durante 10 años / Comparison of the SCORE function chart and the Framingham-REGICOR equation to estimate the cardiovascular risk in an urban population after 10 years of follow-up

Fundamento y objetivo: Las funciones de Framingham-REGICOR y SCORE (Systematic Coronary Risk Evaluation) se recomiendan para la estratificación del riesgo cardiovascular en nuestro país. El objetivo del presente estudio ha sido validar a 10 años las tablas del SCORE y REGICOR en población de 40-65 años de edad. Pacientes y método: La muestra estaba formada por un total de 608 pacientes (un 56,7% mujeres) sin evidencia de enfermedad cardiovascular. Se consideraron pacientes de riesgo alto aquellos con un riesgo >= 10% en REGICOR y >= 5% en SCORE. Resultados: El 90,6% de la población (551 pacientes) se mantuvo libre de episodios cardiovasculares durante los 10 años de seguimiento. La función de REGICOR subestimó el riesgo coronario (el 4,9 frente al 7,9%; p < 0,001), mientras que el SCORE sobrestimó el riesgo de muerte cardiovascular (un 2,1 frente a un 1,5%; p < 0,001). El riesgo medio de los pacientes que presentaron episodios comparado con el de los que no los sufrieron fue del 6,1 frente al 2,0% (p < 0,001) en las tablas SCORE y del 7,1 frente al 4,8% (p < 0,001) en la función de REGICOR. La función SCORE logró mejores criterios de validez que REGICOR, con una sensibilidad del 66,7% (intervalo de confianza [IC] del 95%, 66,2-67,2), especificidad del 91,7% (IC del 95%, 91,2-92,2), cociente de probabilidad positivo de 8 (IC del 95%, 7,5-8,5) y eficacia del 91,1% (IC del 95%, 90,6-91,6). Estos mejores resultados se observaron tanto en mujeres ­sensibilidad del 33,3% (IC del 95%, 32,4-34,2); especificidad del 97,4% (IC del 95%, 96,5-98,3)­ como en varones ­sensibilidad del 83,3% (IC del 95%, 82,7-83,9); especificidad del 84,0% (IC del 95%, 83,4-84,6). Conclusiones: La ecuación del SCORE obtiene mejores criterios de validez que la tabla del REGICOR tanto en la población total como en varones y en mujeres, lo que justificaría su elección como función de cálculo de riesgo cardiovascular

Background and objetive: Framingham-REGICOR and SCORE (Systematic Coronary Risk Evaluation) are 2 functions charts recommended to estimate the cardiovascular risk stratification in Spain. The aim of the present study was to validate to 10 years the SCORE and REGICOR functions charts in 40 to 65 years old population. Patients and method: 608 patients (56.7% female) with non evidence of cardiovascular disease were included in the present study. Patients were classified as high risk by REGICOR (>= 10%) and by SCORE (>= 5%) functions. Results: The 90.6% of the population (551 subjets) did not experienced any cardiovascular events during the 10 years follow-up. The REGICOR function chart underestimated the coronary risk (4.9% vs 7.9%; p < 0.001), whereas the SCORE overestimated the cardiovascular risk of death (2.1% vs 1.5%; p < 0.001). In the SCORE function, the average risk of patients with events was 6.1%, whereas the average risk of patients without events was 2.0% (p < 0.001) and 7.1% vs 4.8% (p < 0.001) in the REGICOR equation. The SCORE function obtained better validity criteria than REGICOR with a sensibility of 66.7% (95% confidence interval [CI], 66.2-67.2), especificity of 91.7%, (95% CI, 91.2-92.2) positive likelihood ratio of 8 (95% CI, 7.5-8.5), and eficacy of 91.1% (95% CI, 90.6-91.6). These results were observed in both sexes: women ­sensibility: 33.3% (95% CI, 32.4-34.2); especificity: 97.4% (95% CI, 96.5-98.3)­ and men ­sensibility: 83.3% (95% CI, 82.7-83.9); especificity: 84.0% (95% CI, 83.4-84.6). Conclusions: The SCORE equation obtains better validity criteria than the REGICOR equation both in the total population and in males and females separately. These results make the SCORE function a powerful tool to estimate the cardiovascular risk