Comparison of methods to identify individuals at increased risk of cardiovascular disease in Italian cohorts.
OBJECTIVE
Guidelines for the primary prevention of cardiovascular disease recommend the use of risk-assessment methods to identify high risk patients who can benefit from lifestyle changes and/or drug treatment. Although all these risk-prediction methods are based on the same principle, they produce different risk estimates. The aim of this study was to compare the most recent and widely used cardiovascular risk-prediction methods and the respective guidelines when applied to Italian cohorts.


RESULTS
Seven different risk-assessment methods were applied to two groups of subjects, 536 healthy individuals and 426 diabetic patients. Sensitivity and specificity of Framingham-based risk-assessment methods were calculated using the Framingham full equation as the reference standard. The extent of concordance among the different risk-assessment methods was determined by kappa test. By using NCEP-ATPIII risk calculator, modified Sheffield tables, Joint European Societies charts, Joint British Societies charts, Italian CUORE Project charts, European SCORE charts and New Zealand National Heart Foundation charts in the group of 536 healthy subjects, lipid-lowering treatment would be recommended in 17.5%, 12.7%, 12.1%, 8.6%, 5.0%, 4.7%, and 1.1% subjects, respectively. By using the same risk-assessment methods in the group of 426 diabetic patients, treatment would be recommended for 100%, 82.9%, 66.9%, 77.7%, 43.0%, 74.9%, and 47.4% patients, respectively. The Joint British charts and the modified Sheffield tables showed the closest agreement with the reference standard.


CONCLUSIONS
Our study confirms that the use of different risk-assessment methods in clinical practice can substantially change risk estimation and consequently statin prescription rate. The Framingham-based risk-assessment methods and particularly the NCEP-ATPIII guidelines select for lipid-lowering treatment a higher number of subjects than those identified according to European and Italian recommendations.
Giavarina
Davide
D
Department of Clinical Pathology, San Bortolo Hospital, Via Rodolfi 37, I-36100 Vicenza, Italy. davide.giavarina@ulssvicenza.it
Barzon
Elena
E
Cigolini
Massimo
M
Mezzena
Gabriella
G
Soffiati
Giuliano
G
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D015331:Cohort Studies; D003327:Coronary Disease / Q000209:etiology; D003362:Cost-Benefit Analysis; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment