Validación del índice SCORE y el SCORE para personas mayores en la cohorte de riesgo de enfermedad cardiovascular en Castilla y León / Validation of the SCORE index and SCORE for old people in the Castilla y Léon cardiovascular disease risk cohort

Introducción y objetivos: El Systematic Coronary Risk Evaluation (SCORE) es el índice más extendido en Europa para la valoración del riesgo cardiovascular global. El presente trabajo tiene como objetivo validar el riesgo calculado en 2004 con la mortalidad cardiovascular observada en 10 años de seguimiento de una cohorte de población de 40 a 75 años. Métodos: En 2004 se calculó el SCORE y el SCORE OP para personas mayores en la población de 40 a 64 y de 65 a 74 años, respectivamente. En 2014 se estimó la mortalidad a 10 años con el modelo de supervivencia y el estimador de Kaplan-Meier. Se calcularon la sensibilidad, la especificidad, los valores predictivos, el riesgo relativo con valores SCORE≥5% y el área bajo la curva (estadístico C). Resultados: La mortalidad cardiovascular estimada por el SCORE fue 3 veces superior a la observada. La sensibilidad de un SCORE≥5% fue del 20% en mujeres y del 28,6% por debajo de los 65 años. Los valores predictivos positivos fueron también bajos, sobre todo en las mujeres, con un escaso 0,6%. El estadístico C no fue significativo ni para las mujeres ni para los menores de 65 años. Conclusiones: El índice de riesgo de mortalidad SCORE no refleja adecuadamente al patrón epidemiológico de las enfermedades cardiovasculares en Castilla y León. Se hace necesaria una revisión periódica de los modelos de predicción de enfermedad y de mortalidad para adaptar y corregir los protocolos de prevención y tratamiento. El SCORE OP presenta mejores parámetros de validez que el SCORE tradicional

Introduction and objectives: The Systematic Coronary Risk Evaluation (SCORE) is the most extended index in Europe for overall cardiovascular risk assessment. This study aims to validate the calculated risk with the observed 10-year cardiovascular mortality in a population cohort aged 40 to 75 years. Methods: In 2014 the SCORE and the SCORE OP (for older people) were calculated in a population aged 40 to 64 years-old and 65 to 75 years-old, respectively. In 2014 the 10-year mortality was estimated with the Kaplan-Meier estimator and survival model. Sensitivity, specificity, predictive values, risk ratio of a SCORE value≥5%, and the area under the curve (C statistic) were calculated. Results: Cardiovascular mortality estimated by SCORE was 3 times higher than the observed mortality. The sensitivity of a SCORE≥5% was 20% in women and 28.6% in those less than 65 years old. Predictive positive values were also low, particularly in women with 0.6%. Neither women nor those aged less than 65 years had a significant C statistic. Conclusions: The SCORE index does not suitably reflect the cardiovascular mortality pattern in Castilla y León. The prediction models for morbidity and mortality need to be periodically updated in order to adjust the prevention and treatment protocols. The SCORE OP has better validity parameters than the SCORE calculated below that age

[Validation of the SCORE index and SCORE for old people in the Castilla y Léon cardiovascular disease risk cohort]. / Validación del índice SCORE y el SCORE para personas mayores en la cohorte de riesgo de enfermedad cardiovascular en Castilla y León.

INTRODUCTION AND OBJECTIVES: The Systematic Coronary Risk Evaluation (SCORE) is the most extended index in Europe for overall cardiovascular risk assessment. This study aims to validate the calculated risk with the observed 10-year cardiovascular mortality in a population cohort aged 40 to 75 years. METHODS: In 2014 the SCORE and the SCORE OP (for older people) were calculated in a population aged 40 to 64 years-old and 65 to 75 years-old, respectively. In 2014 the 10-year mortality was estimated with the Kaplan-Meier estimator and survival model. Sensitivity, specificity, predictive values, risk ratio of a SCORE value≥5%, and the area under the curve (C statistic) were calculated. RESULTS: Cardiovascular mortality estimated by SCORE was 3 times higher than the observed mortality. The sensitivity of a SCORE≥5% was 20% in women and 28.6% in those less than 65 years old. Predictive positive values were also low, particularly in women with 0.6%. Neither women nor those aged less than 65 years had a significant C statistic. CONCLUSIONS: The SCORE index does not suitably reflect the cardiovascular mortality pattern in Castilla y León. The prediction models for morbidity and mortality need to be periodically updated in order to adjust the prevention and treatment protocols. The SCORE OP has better validity parameters than the SCORE calculated below that age.

Evolución de los factores de riesgo cardiovascular entre 2004 y 2009 en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL) / Trend in cardiovascular risk factors from 2004 to 2009 in the cohort of the Cardiovascular Disease Risk Study in Castilla y León (RECCYL)

INTRODUCCIÓN: Los factores de riesgo cardiovascular (FRCV) se modifican con la edad y las medidas de prevención y control. El objetivo de este estudio es describir la evolución de la hipertensión, diabetes, hipercolesterolemia, obesidad y hábito tabáquico en una cohorte de población de Castilla y León. MATERIAL Y MÉTODOS: En 2004 se inició el estudio RECCyL en personas ≥15 años residentes en Castilla y León con una anamnesis, exploración física y analítica. En 2009 se realizó un nuevo examen de salud a la muestra superviviente. Se calculó la incidencia acumulada en 5 años para cada FRCV en la población libre de ese factor en 2004. RESULTADOS: De la muestra original de 4.013 personas, se estudió en el año 2009 a 2.954. La incidencia de hipertensión en el quinquenio fue de 17,9%, de diabetes 3,9%, de hipercolesterolemia 15,6%, de obesidad 9,1% y de fumadores (nuevos y recaídas) 6,8%. Los nuevos diagnósticos de hipertensión, diabetes y tabaquismo fueron más frecuentes en edades tempranas. La incidencia fue más elevada en hombres para hipertensión, diabetes, hábito tabáquico e hipercolesterolemia (salvo en la cohorte de ≥75). Para la obesidad, la incidencia total fue mayor en las mujeres excepto en cohortes de edad más tempranas. CONCLUSIONES: Las prevalencias de los FRCV (exceptuando el hábito de fumar) han aumentado desde 2004, con desigual intensidad dependiendo del sexo y la edad. Conocer la incidencia y características de los nuevos diagnósticos, principalmente la distribución de la edad de aparición, es extremadamente útil para establecer actividades de prevención y control de los principales FRCV

INTRODUCTION: Cardiovascular risk factors change with age, as well as with the prevention and control measures. The aim of this study is to describe the trend in hypertension, diabetes, hypercholesterolemia, obesity, and smoking in a population cohort from Castilla y León. MATERIAL AND METHODS: In 2004 the RECCyL study began by recordingmedical history, a physical examination, and blood tests in a sample of the population ≥ 15 years old living in the Community of Castilla y León. In 2009 a new health examination was performed on the survivor sample. The cumulative 5-year incidence was calculated for each cardiovascular risk factor in the population that was free of that factor in 2004. RESULTS: From the original sample of 4013 people, 2954 were studied in 2009. Incidence of hypertension in the period was 17.9%, diabetes 3.9%, hypercholesterolemia 15.6%, obesity 9.1%, and smokers (new and relapse) 6.8%. New diagnoses of hypertension, diabetes and smoking were more common in younger ages. The incidence was higher in men for hypertension, diabetes, smoking, and hypercholesterolemia (except in the cohort of ≥75 years). In the case of obesity, the total incidence is higher for women, except in younger age cohorts. CONCLUSIONS: The prevalences of the cardiovascular risk factors (except smoking) have increased since 2004, with variable intensity depending on sex and age. To know the incidence and characteristics of newly diagnosed people, mainly the distribution of age at onset, is very useful to establish prevention and control activities of the principal cardiovascular risk factors

[Factors associated with control of hypertension in the cohort from the study of Cardiovascular Disease Risk in Castilla y León (RECCyL)]. / Factores asociados al control de la presión arterial en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL).

INTRODUCTION: Cardiovascular diseases and related risk factors suppose a challenge to public health due to the mortality and health costs involved. This study has aimed to assess the blood pressure control in a population cohort and to identify the factors associated with poor control. MATERIAL AND METHODS: A cardiovascular health examination was carried out in a random sample of 4013 individuals aged 15 years and above who were living in Castilla y Leon in 2004. The study included the medical history, physical exam and blood tests. A new health study was performed in 2009, including 2954 people from the initial sample, 1306 of whom were patients with hypertension. Strict blood pressure control was defined as <140/90 mm Hg. Bivariate analysis was performed and odds ratio was calculated by a regression logistic model. RESULTS: Blood pressure levels were above the established levels in 55.9%, without differences between men and women. The regression model showed that diabetes, obesity, smoking habit and previous systolic blood pressure values, with odds ratio of 3.87, 1.58, 1.49 and 1.13 per 5 mm Hg, respectively, are independently associated with uncontrolled blood pressure. Age did not show statistical significance. CONCLUSION: More than half of the patients with hypertension are not well controlled. This study provides information about the characteristics of the patients with poor control of hypertension in Castilla y León, which will allow policy makers to develop new primary and secondary prevention activities.

Factores asociados al control de la presión arterial en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL) / Factors associated with control of hypertension in the cohort from the study of Cardiovascular Disease Risk in Castilla y León (RECCyL)

Introducción: Las enfermedades cardiovasculares y sus factores de riesgo suponen un reto para la salud pública por la mortalidad y el coste sanitario que conllevan. El objetivo de este estudio es conocer el grado de control de la presión arterial en una cohorte poblacional y determinar los factores asociados al mal control. Material y métodos: En 2004 se llevó a cabo un examen de salud cardiovascular con anamnesis, exploración y analítica básica, en una muestra aleatoria de 4.013 personas ≥15 años residentes en Castilla y León. En 2009 se realizó un nuevo examen de salud a 2.954 personas de la muestra inicial de las que 1.306 tenían hipertensión arterial. Se consideró control estricto si la presión arterial era <140/90. Se realizó análisis bivariante y se calcularon odds ratio en un modelo de regresión logística. Resultados: El 55,9% presentaron valores de presión arterial por encima de los límites establecidos, sin diferencias entre hombres y mujeres. El modelo de regresión mostró que la diabetes, la obesidad, el hábito de fumar y los valores previos de presión arterial sistólica, con odds ratio de 3,87; 1,58; 1,49 y 1,13 por cada 5 mmHg respectivamente, se asociaban de manera independiente con un mal control. La edad no presentaba significación estadística. Conclusión: Más de la mitad de los pacientes con hipertensión arterial no están bien controlados. Este estudio aporta información sobre las características de los pacientes hipertensos de Castilla y León que presentan un mal control, lo que permitirá desarrollar actividades de prevención primaria y secundaria

Introduction: Cardiovascular diseases and related risk factors suppose a challenge to public health due to the mortality and health costs involved. This study has aimed to assess the blood pressure control in a population cohort and to identify the factors associated with poor control. Material and methods: A cardiovascular health examination was carried out in a random sample of 4013 individuals aged 15 years and above who were living in Castilla y Leon in 2004. The study included the medical history, physical exam and blood tests. A new health study was performed in 2009, including 2954 people from the initial sample, 1306 of whom were patients with hypertension. Strict blood pressure control was defined as <140/90 mmHg. Bivariate analysis was performed and odds ratio was calculated by a regression logistic model. Results: Blood pressure levels were above the established levels in 55.9%, without differences between men and women. The regression model showed that diabetes, obesity, smoking habit and previous systolic blood pressure values, with odds ratio of 3.87, 1.58, 1.49 and 1.13 per 5 mmHg, respectively, are independently associated with uncontrolled blood pressure. Age did not show statistical significance. Conclusion: More than half of the patients with hypertension are not well controlled. This study provides information about the characteristics of the patients with poor control of hypertension in Castilla y León, which will allow policy makers to develop new primary and secondary prevention activities