Consequences of using different methods to assess cardiovascular risk in primary care.
BACKGROUND
There are two promising methods to assess cardiovascular risk: the Adult Treatment Panel III (ATPIII) and the Systematic Coronary Risk Evaluation (SCORE). The ATPIII calculates the 10-year risk of coronary events based on an adaptation of the original Framingham function. The SCORE chart is based on European studies and measures the absolute risk of cardiovascular mortality in the next 10 years.


OBJECTIVE
To evaluate the clinical consequences of using different methods to calculate cardiovascular risk and different primary prevention guidelines.


METHODS
A cross sectional study of 914 dyslipidemic patients from three primary health centres from Catalonia, Spain, was conducted. Outcome variables were the risk level according to the different equations (classical Framingham table by Anderson, ATPIII adapted Framingham table, and SCORE system), and candidates for lipid lowering treatment according to European and ATPIII guidelines.


RESULTS
The proportion of high-risk patients according to the three equations and excluding diabetic patients was 13.5%, 11.4% and 7.1%, respectively, and 20.2%, 25.7% and 29.2%, respectively when including diabetic patients. The prevalence of candidates for lipid lowering treatment according to European guidelines and ATPIII guidelines were 28.8% and 39.3%, respectively. A 49% disagreement with a Kappa of -0.1, and a 37% disagreement with a Kappa of 0.08 were observed when comparing candidates identified for lipid lowering treatment and patients actually receiving that treatment, according to ATPIII and SCORE guidelines, respectively.


CONCLUSIONS
Our results suggest important clinical and economic consequences when comparing European guidelines or ATPIII guidelines for the treatment of dyslipidemic patients in general practice.
Fornasini
Marco
M
Universidad San Francisco de Quito, Quito, Ecuador.
Brotons
Carlos
C
Sellarès
Jaume
J
Martinez
Mireia
M
Galán
María Luisa
ML
Sáenz
Ignacio
I
da Pena
José Manuel
JM
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D011322:Primary Prevention / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology