title: Assessment of cardiovascular risk in primary care patients in France.
abstract: BACKGROUND
  Current guidelines for the prevention of cardiovascular disease emphasize the importance of assessing global cardiovascular risk, but there is evidence that risk is often assessed inaccurately.
  
  
  OBJECTIVE
  To compare general practitioner-reported global cardiovascular risk in French primary care patients with estimates based on established risk-scoring systems, and to identify factors accounting for any mismatch between the analyses.
  
  
  METHODS
  Data on patients, aged 50 years or older, seen during two 3-day periods were provided by 619 general practitioners. Physicians rated each patient's cardiovascular risk as low, moderate or high, according to their perception; in addition, risk was assessed using the Framingham and Systematic coronary risk evaluation (SCORE) risk-scoring systems.
  
  
  RESULTS
  A total of 13,446 patients aged greater or equal to 50 years were included. Of 11,241 patients with no previous history of cardiovascular disease, 47% were considered by their physicians to be at low risk of cardiovascular disease and 14% to be at high risk. In that population, 72% of patients rated as high risk according to the Framingham system and 77% rated as high risk according to SCORE system were incorrectly assessed by their physicians; similar results were observed in patient cohorts based on whether or not patients had received treatment for dyslipidaemia. Weighted kappa analysis showed poor agreement between physician risk assessment and both the Framingham and SCORE risk-scoring systems.
  
  
  CONCLUSIONS
  This study underlines the mismatch between GP-estimated cardiovascular risk and the risk assessed using scoring systems, especially for high-risk patients.
authors.affiliation: Service d'endocrinologie métabolisme, hôpital Pitié-Salpêtrière, pavillon Delessert, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 1, France. eric.bruckert@psl.aphp.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Bruckert
authors.forename: Geneviève
authors.initials: G
authors.lastname: Bonnelye
authors.forename: Florence
authors.initials: F
authors.lastname: Thomas-Delecourt
authors.forename: Lucas
authors.initials: L
authors.lastname: André
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Delaage
mesh_terms: D000368:Aged; D000465:Algorithms; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents