Framingham risk score for prediction of cardiovascular diseases: a population-based study from southern Europe.

BACKGROUND: The question about what risk function should be used in primary prevention remains unanswered. The Framingham Study proposed a new algorithm based on three key ideas: use of the four risk factors with the most weight (cholesterol, blood pressure, diabetes and smoking), prediction of overall cardiovascular diseases and incorporating the concept of vascular age. The objective of this study was to apply this new function in a cohort of the general non Anglo-Saxon population, with a 10-year follow-up to determine its validity. METHODS: The cohort was studied in 1992-94 and again in 2004-06. The sample comprised 959 randomly-selected persons, aged 30-74 years, who were representative of the population of Albacete, Spain. At the first examination cycle, needed data for the new function were collected and at the second examination, data on all events were recorded during the follow-up period. Discrimination was studied with ROC curves. Comparisons of prediction models and reality in tertiles (Hosmer-Lemeshow) were performed, and the individual survival functions were calculated. RESULTS: The mean risks for women and men, respectively, were 11.3% and 19.7% and the areas under the ROC curve were 0.789 (95%CI, 0.716-0.863) and 0.780 (95%CI, 0.713-0.847) (P<0.001, both). Cardiovascular disease events occurred in the top risk tertiles. Of note were the negative predictive values in both sexes, and a good specificity in women (85.6%) and sensitivity in men (79.1%) when their risk for cardiovascular disease was high. This model overestimates the risk in older women and in middle-aged men. The cumulative probability of individual survival by tertiles was significant in both sexes (P<0.001). CONCLUSIONS: The results support the proposal for "reclassification" of Framingham. This study, with a few exceptions, passed the test of discrimination and calibration in a random sample of the general population from southern Europe.

Using ankle-brachial index to detect peripheral arterial disease: prevalence and associated risk factors in a random population sample.

BACKGROUND AND AIM: The ankle-brachial index (ABI) is being used increasingly to diagnose peripheral arterial disease (PAD) that predicts cardiovascular morbidity and mortality. The aim of this study is to determine the prevalence of PAD and associated risk factors in a Spanish random population sample of age > or =40. METHODS AND RESULTS: PAD is defined as an ABI<0.9 in either leg. 784 participants of age > or =40 were randomly selected in a Spanish province. 55.4% of them were female. The prevalence of PAD in this sample was 10.5% (95% confidence interval (CI) 8.4-12.8); 9.7% in females and 11.4% in males. In logistic regression analyses, adjusted for age and gender, smoking per 10 pack-years (odds ratio (OR) 1.40, 95% CI 1.23-1.58), hypertension (OR 1.85, 95% CI 1.05-3.28), hypercholesterolemia (OR 1.76, 95% CI 1.04-2.98), and diabetes (OR 1.80, 95% CI 1.04-3.11) were positively associated with prevalent PAD. More than 91% of persons with PAD had one or more cardiovascular disease risk factors. CONCLUSIONS: We conclude that in our study hypertension, hypercholesterolemia, diabetes mellitus and smoking are associated with PAD. The majority of individuals with PAD had at least one important cardiovascular risk factor advanced enough to be considered eligible for an aggressive treatment.

[Different uses of home blood pressure measurement in the diagnosis and monitoring of hypertension]. / Diferentes utilidades de la automedición de la presión arterial domiciliaria en el diagnóstico y seguimiento de la hipertensión arterial.

OBJECTIVE: To find differences between measurements of clinical blood pressure and self-monitored home blood pressure measurement (HBPM). DESIGN: Descriptive study developed in a general population census. SETTING: Primary care. SUBJECTS: A total of 1411 subjects > or =18 years old were selected by stratified randomized sampling. METHODS: A skilled nurse made 3 clinical blood pressure (CBP) measurements, and trained patients or their relatives in HBPM, doing 12 in one day. CBP and HBPM employed an electronic device (OMRON 705CP). RESULTS: A total of 12 HBPM from 1184 subjects (52% women) were completed, with a mean age of 47.6 (SD, 17.2); 195 subjects were known to have hypertension. White-coat effect was diagnosed in 14.9% of subjects with normal pressure, 22.3% of hypertense patients treated and 57.6% of subjects with suspicion of isolated clinical hypertension. Possible isolated clinical hypertension was diagnosed in 10% of subjects without hypertension. White Coat normal pressure was found in 2.3% of untreated subjects and 4.7% of subjects with treated hypertension. 20.7% of subjects with hypertension poorly controlled in the clinic were considered pseudo-refractory (11.4% at the end of dosage interval). 77% of subjects conducted HBPM on their own and 89% thought it easy to do so. CONCLUSION: Incorporation of HBPM into daily medical practice could avoid 20%-30% of possible mistakes in diagnosis and monitoring of hypertense patients.

Home-based self-measurement of blood pressure: a proposal using new reference values (the PURAS study).

OBJECTIVES: To establish reference values for blood pressure by means of self-measurement of blood pressure (BP) conducted at home. DESIGN: Descriptive study of the distribution of self-measured BP at home and its correspondence with clinic-based measurements of BP. METHODS: The aim of this study is to define the home BP levels that correspond to clinic BP thresholds 140/90 mmHg (hypertension) and 130/85 mmHg (normality). The sample consisting of 1411 randomly selected adults stratified by age and gender. A pre-calibrated electronic device (Omron 705CP) was used for BP and heart rate (HR) measurements and a trained nurse performed clinic-based sphygmomanometer measurements. The same nurse provided tutorials for the subjects on how to obtain 12 self-measured BP values at home using the Omron device in a single day. RESULTS: Of the 1184 volunteers that attended the appointment, 195 were known as hypertensives and were excluded from the study. The average age of the remaining 989 subjects (50.4% females) was 44.3 years. Clinic BP values were significantly higher than self-measured BP at home regardless of age and gender. Both had good correlations (systolic BP, r=0.84 and diastolic BP, r=0.77). Using linear regression, the self-measured BP at home hypertension threshold would be 131/82 mmHg and the limit of normality 123/78 mmHg. Using corresponding percentiles, these values would be 134/85 and 124/80 mmHg, respectively. CONCLUSIONS: The self-measured BP at home values found in this study, when defining hypertension, are lower than values currently accepted (135/85 mmHg). Long-term studies are necessary to confirm these results.