title: Cardiovascular risk stratification in overweight or obese patients in primary prevention. Implications for use of statins.
abstract: OBJECTIVE
  Cardiovascular risk estimation in patients with overweight/obesity is not standardized. Our objectives were to stratify cardiovascular risk using different scores, to analyze use of statins, to report the prevalence of carotid atherosclerotic plaque (CAP), and to determine the optimal cut-off point (OCP) of scores that discriminate between subjects with or without CAP.
  
  
  METHODS
  Non-diabetic patients with overweight or obesity in primary prevention were enrolled. The Framingham score (FS), the European score (ES), and the score proposed by the new American guidelines (NS) were calculated, and statin indication was evaluated. Prevalence of CAP was determined by ultrasound examination. A ROC analysis was performed.
  
  
  RESULTS
  A total of 474 patients (67% with overweight and 33% obese) were enrolled into the study. The FS classified the largest number of subjects as low risk. PAC prevalence was higher in obese as compared to overweight subjects (44.8% vs. 36.1%, P=.04). According to the FS, ES, and NS respectively, 26.7%, 39.1%, and 39.1% of overweight subjects and 28.6%, 39.0%, and 39.0% of obese subjects had an absolute indication for statins. All three scores were shown to acceptably discriminate between subjects with and without CAP (area under the curve>0.7). The OCPs evaluated did not agree with the risk category values.
  
  
  CONCLUSIONS
  Risk stratification and use of statins varied in the overweight/obese population depending on the function used. Understanding of the relationship between scores and presence of CAP may optimize risk estimate.
authors.affiliation: Consejo de Epidemiología y Prevención Cardiovascular, Sociedad Argentina de Cardiología, Buenos Aires, Argentina. Electronic address: walter.masson@hospitalitaliano.org.ar.
authors.forename: Walter
authors.initials: W
authors.lastname: Masson
authors.affiliation: Consejo de Epidemiología y Prevención Cardiovascular, Sociedad Argentina de Cardiología, Buenos Aires, Argentina.
authors.forename: Martín
authors.initials: M
authors.lastname: Lobo
authors.affiliation: Consejo de Epidemiología y Prevención Cardiovascular, Sociedad Argentina de Cardiología, Buenos Aires, Argentina.
authors.forename: Melina
authors.initials: M
authors.lastname: Huerín
authors.affiliation: Consejo de Epidemiología y Prevención Cardiovascular, Sociedad Argentina de Cardiología, Buenos Aires, Argentina.
authors.forename: Graciela
authors.initials: G
authors.lastname: Molinero
authors.affiliation: Consejo de Epidemiología y Prevención Cardiovascular, Sociedad Argentina de Cardiología, Buenos Aires, Argentina.
authors.forename: Diego
authors.initials: D
authors.lastname: Manente
authors.affiliation: Consejo de Epidemiología y Prevención Cardiovascular, Sociedad Argentina de Cardiología, Buenos Aires, Argentina.
authors.forename: Mario
authors.initials: M
authors.lastname: Pángaro
authors.affiliation: Consejo de Epidemiología y Prevención Cardiovascular, Sociedad Argentina de Cardiología, Buenos Aires, Argentina.
authors.forename: Laura
authors.initials: L
authors.lastname: Vitagliano
authors.affiliation: Consejo de Epidemiología y Prevención Cardiovascular, Sociedad Argentina de Cardiología, Buenos Aires, Argentina.
authors.forename: Horacio
authors.initials: H
authors.lastname: Zylbersztejn
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D003327:Coronary Disease / Q000235:genetics; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications*; D015995:Prevalence; D011322:Primary Prevention; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular risk estimation; Carotid atherosclerotic plaque; Estimación del riesgo cardiovascular; Obesidad; Obesity; Overweight; Placa aterosclerótica carotídea; Puntajes de riesgo; Risk scores; Sobrepeso