[Validation of 3 equations of coronary risk in diabetic population of a primary care center]. / Validación de tres ecuaciones de riesgo coronario en población diabética de un centro de salud.

BACKGROUND AND OBJECTIVE: We intended to validate to 10 years 3 equations of coronary risk that use the function of original Framingham (Framingham-Anderson and Framingham-Wilson) and calibrated for Spanish population (Framingham-REGICOR) in diabetic patients type 2. PATIENTS AND METHOD: We included a total of 190 diabetic patients from a primary care center, without coronary heart disease, in whom the coronary risk could be calculated before 1 January 1995. All were followed during 10 years. RESULTS: The highest score of cardiovascular risk was obtained in the Framingham-Wilson function chart (25.4%) and the lowest in the Framingham-REGICOR (10.8%). The real incidence of coronary events was 14.7% (p < 0.001). Statistically significant differences between patients with or without coronary events were only observed in the Framingham-REGICOR equation (13.3% vs 10.3%; p = 0.046). Framingham-Anderson and Framingham-Wilson functions charts more than doubled the risk of coronary disease in men (p < 0.001). The agreement degree between the 3 functions was acceptable except for the calculation of coronary risk in men between Framingham-REGICOR and Framingham-Wilson equations (kappa index = 0.3). Framingham-Anderson and Framingham-Wilson functions charts showed similar profiles for the patients with high coronary risk. Sensitivity was superior in Framingham-Anderson and Framingham-Wilson functions (67.8%) and specificity was optimal in Framingham-REGICOR equation (51.2%). The positives predictive values were low and the negatives predictive values were high. CONCLUSIONS: The equations of Framingham-Wilson and Framingham-Anderson overestimate the coronary risk in diabetics, whereas the Framingham-REGICOR functions underestimates it. The utility of these 3 methods is reduced in the diabetic population.

Validación de tres ecuaciones de riesgo coronario en población diabética de un centro de salud / Validation of 3 equations of coronary risk in diabetic population of a primary care center

Fundamento y objetivo: Validar a 10 años 3 ecuaciones de riesgo coronario que utilizan la función de Framingham original (Framingham-Anderson y Framingham-Wilson) y la calibrada para población española (Framingham-REGICOR) en pacientes con diabetes mellitus tipo 2. Pacientes y método: Se incluyó en el estudio a un total de 190 pacientes diabéticos de un centro de salud urbano, sin antecedentes de cardiopatía isquémica, en quienes pudo calcularse el riesgo coronario antes del 1 de enero de 1995 y a los que se realizó un seguimiento de 10 años. Resultados: La mayor puntuación de riesgo se obtuvo en la tabla de Framingham-Wilson (25,4%) y la menor en la de REGICOR (10,8%); la incidencia real de episodios coronarios fue del 14,7% (p < 0,001). Solamente en la ecuación de Framingham-REGICOR se observaron diferencias significativas en el riesgo de los pacientes con y sin episodios coronarios (el 13,3 frente al 10,3%; p = 0,046). Las ecuaciones Framingham-Anderson y Wilson duplicaron y casi triplicaron, respectivamente, la estimación del riesgo coronario en varones (p < 0,001). El grado de concordancia entre las ecuaciones fue aceptable, salvo entre las tablas de Framingham-REGICOR y Wilson en el cálculo de riesgo coronario en varones (índice kappa = 0,3). Las tablas de Framingham-Anderson y Wilson coincidieron plenamente en el perfil de pacientes catalogados de riesgo coronario alto. La sensibilidad fue superior en las funciones de Framingham-Anderson y Wilson (67,8%) y la especificidad en la de Framingham-REGICOR (51,2%), con unos valores predictivos positivos bajos y negativos altos. Conclusiones: Las ecuaciones de Framingham-Wilson y Framingham-Anderson sobrestiman el riesgo coronario en diabéticos, mientras que la de Framingham-REGICOR lo infravalora. La utilidad de estas 3 ecuaciones es reducida en población diabética

Background and objective: We intended to validate to 10 years 3 equations of coronary risk that use the function of original Framingham (Framingham-Anderson and Framingham-Wilson) and calibrated for Spanish population (Framingham-REGICOR) in diabetic patients type 2. Patients and method: We included a total of 190 diabetic patients from a primary care center, without coronary heart disease, in whom the coronary risk could be calculated before 1 January 1995. All were followed during 10 years. Results: The highest score of cardiovascular risk was obtained in the Framingham-Wilson function chart (25.4%) and the lowest in the Framingham-REGICOR (10.8%). The real incidence of coronary events was 14.7% (p < 0.001). Statistically significant diferences between patients with or without coronary events were only observed in the Framingham-REGICOR equation (13.3% vs 10.3%; p = 0.046). Framingham- Anderson and Framingham-Wilson functions charts more than doubled the risk of coronary disease in men (p < 0.001). The agreement degree between the 3 functions was acceptable except for the calculation of coronary risk in men between Framingham-REGICOR and Framingham-Wilson equations (kappa index = 0.3). Framingham-Anderson and Framingham-Wilson functions charts showed similars profiles for the patients with high coronary risk. Sensitivity was superior in Framingham-Anderson and Framingham-Wilson functions (67.8%) and specificity was optimal in Framingham-REGICOR equation (51.2%). The positives predictives values were low and the negatives predictives values were high. Conclusions: The equations of Framingham-Wilson and Framingham-Anderson overestimate the coronary risk in diabetics, whereas the Framingham-REGICOR functions underestimates it. The utility of these 3 methods is reduced in the diabetic population

Tablas de riesgo para diabéticos: ¿son realmente necesarias? / Risk score for diabetic patients. Is really necessary?

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