Valor preditivo do escore de framingham da identificação de alto risco cardiovascular / Predictive value of the framingham risk score in identifying high cardiovascular risk

RESUMO

Fundamentos A estratificação do risco cardiovascular é fundamental para uma adequada abordagem na prevenção primária. No entanto, os atuais escores de risco não apresentam acurácia satisfatória na predição de eventos cardiovasculares.Objetivo: Avaliar se os dois escores de risco recomendados pelas principais sociedades de cardiologia apresentam valor preditivo para identificar pacientes de alto risco cardiovascular já estabelecido. Métodos: Foram analisados 72 pacientes classificados como de alto risco baseado em fatores independentes, conforme recomendação da Sociedade Brasileira de Cardiologia. Na primeira consulta foram calculados o escore de Framingham e o SCORE risk para se proceder à avaliação do seu valor preditivo. Resultados: Dos 72 pacientes, 39 (53,4%) eram do sexo masculino, com média de idade de 59,0±9,5 anos, média de129,0±22 mmHg e 78,0±14 mmHg de pressão arterial sistólica e diastólica, respectivamente. Eram hipertensos 91,8%, diabéticos 46,5%, tabagistas correntes 36,9% e portadores de doença arterial coronariana 72,6%, dos quais 56,1% com infarto prévio. Dentre esses pacientes, 32 (44,4%) foram considerados de baixo risco cardiovascular, 27 (37,5%) de risco intermediário e13 (18,1%) de alto risco pelo escore de Framingham; e 26 (36,1%) pacientes foram considerados de alto risco pelo SCORE risk. Conclusão: Em uma população de alto risco, nem o escore de Framingham nem o SCORE risk foram considerados bons identificadores de pacientes de alto risco cardiovascular.

ABSTRACT

Background: Cardiovascular risk stratification is essential for an adequate approach to primary prevention. However, the current risk score shave no satisfactory accuracy in predicting cardiovascular events. Objective: To evaluate whether the two risk scores recommended by the major cardiology societies have predictive value in identifying patients with an established high cardiovascular risk. Methods: The study included 72 patients classified as high risk based on independent factors as recommended by the Brazilian Society of Cardiology. At the first appointment, the Framingham score and the SCORE risk were calculated in order to evaluate the ability to identify high-risk individuals. Results: Of 72 patients, 39 (53.4%) patients were male with a mean age of 59±9.5 years, mean 129±22mmHg and 78±14mmHg systolic and diastolic blood pressure, respectively. In the sample, 91.8% were hypertensive, 46.5% had diabetes, 36.9% were current smokers and72.6% were patients with coronary artery disease, of which 56.1% had previous myocardial infarction. Among these patients, 32 (44.4%)were considered at low cardiovascular risk, 27 (37.5%) intermediate-risk and 13 (18.1%) high-risk by the Framingham score; and 26 (36.1%) patients were considered at high risk by the SCORE risk. Conclusion: Based on the high-risk population, neither the Framingham score nor the SCORE risk were considered good identifiers of patients at high cardiovascular risk.