Cardiovascular risk and validation of cardiovascular risk prediction functions in a cohort of patients with type 2 diabetes followed for 10 years in Badajoz (SPAIN). AN observational study.

AIMS: To analyse whether diabetes behaves as an equivalent of coronary risk and assess the performance of the original and REGICOR Framingham functions in a cohort of patients with type 2 diabetes observed for 10 years in primary care practices in Badajoz, Spain. METHODS: Observational, longitudinal study. A total of 643 patients (mean age 64.0 years, 55.7% women), without evidence of cardiovascular disease were studied. We assessed the incidence of cardiovascular events and the patients' 10-year coronary risk predicted-values at the time of their recruitment. RESULT: The actual incidence rate of coronary events was 14.5% (15.1% in women and 13.7% in men, p = 0.616). Patients who suffered coronary events were older (66.3 vs 63.6 years, p < 0.05), had higher total cholesterol (236.3 vs 219.5 mg/dl, p < 0.01), fasting plasma glucose levels (177.6 vs 159.8 mg/dl, p < 0.01), glycated haemoglobin (7.3 vs 6.7%, p < 0.05) and also higher prevalence of high blood pressure, dyslipidemia and chronic renal disease. The original Framingham equation overpredicted risk by 88%, whereas the REGICOR Framingham function underpredicted risk by 24%. CONCLUSIONS: Diabetes in our cohort does not behave as a coronary heart disease equivalent and both the original and REGICOR Framingham coronary risk functions have little utility in a diabetic population.

[Active Smoking and Coronary Risk in a Population of a Spanish Health-Care Centre: An Observational Cohort Study]. / Tabaquismo y riesgo coronario en la población de un centro de salud. Estudio de cohortes retrospectivo.

OBJECTIVE: Smoking is a major risk factor for multiple chronic diseases, such as cardiovascular diseases and cancer, and an established risk factor for premature death .The objective was to analyze the association between smoking and total coronary risk (incidence of lethal and non-lethal coronary events) in a cohort of 35-74 years old patients followed for 10 years. METHODS: Longitudinal, observational study of a retrospective cohort followed for ten years in primary care practices in Badajoz (Spain). 1011 patients (mean 55.7 year-old; 56.0% women) without evidence of cardiovascular disease was studied. Multivariate analysis was performed using a binary logistic regression model, introducing as the dependent variable the presence of total coronary events during the follow-up period. RESULTS: 29.1% of the patients were smokers. Smokers were younger (52.1 vs 57.2 years, p smaller than 0.001), with less prevalence of arterial hypertension (46.9% vs 61.5%, p smaller than 0.01), obesity (25.5% vs 31.8%, p=0,055) and lower HDL-cholesterol (45.7 vs 54.0 mg/dl, p smaller than 0.001). During the follow-up, they presented a higher mortality (11.2% vs 6.7%, p smaller than 0.05) and higher incidence of total coronary events (14.3% vs 9.2%, p smaller than 0.05). The final model of the logistic regression multivariate analysis revealed that only smoking and age are predictor variables of total coronary events, the greater odds ratio (OR) corresponding to smoking [OR: 2.33; 95% confidence interval (CI):1.31-4.16; p smaller than 0.01]. CONCLUSIONS: In patients aged 35-74 years followed during 10 years, smoking doubles the risk of total coronary events.

OBJETIVO: El tabaquismo es un importante factor de riesgo para múltiples enfermedades crónicas, tales como enfermedades cardiovasculares y cáncer, y también de muerte prematura. El objetivo fue valorar la relación entre tabaquismo y riesgo coronario total en una cohorte de pacientes de 35 a 74 años de edad. METODOS: Estudio observacional de una cohorte retrospectiva de 1.011 personas (edad media 55,7 años, 56,0% mujeres) sin antecedentes de enfermedades cardiovasculares, seguidas durante 10 años en un centro de salud de Badajoz (Extremadura, España). Se realizó un análisis multivariante mediante regresión logística binaria, incluyéndose como variable dependiente la incidencia de eventos coronarios durante el periodo de seguimiento. RESULTADOS: El 29,1% de la población era fumadora, con menor edad (52,1 vs 57,2 años, p menor que 0,001), menores cifras de colesterol-HDL (45,7 vs 54,0 mg/dl, p menor que 0,001), menor prevalencia de hipertensión arterial (46,9% vs 61,5%, p menor que 0,01) y obesidad (25,5% vs 31,8%, p=0,055) que los pacientes no fumadores. Sin embargo, durante el seguimiento presentaron mayores tasas de mortalidad (11,2% vs 6,7%, p menor que 0,05) e incidencia de eventos coronarios totales (14,3% vs 9,2%, p menor que 0,05). En el análisis multivariante solamente la edad y el tabaquismo se comportaron como variables predictoras de eventos coronarios totales, correspondiendo al tabaquismo las mayores odds ratio (OR: 2,33; IC95%:1,31-4,16; p menor que 0,01). CONCLUSIONES: En personas de 35 a 74 años seguidos durante 10 años el consumo de tabaco duplica el riesgo de eventos coronarios.

Tabaquismo y riesgo coronario en la población de un centro de salud. Estudio de cohortes retrospectivo / Active smoking and coronary risk in a population of a Spanish Health-Care Centre: an observational cohort study

Fundamentos. El tabaquismo es un importante factor de riesgo para múltiples enfermedades crónicas, tales como enfermedades cardiovasculares y cáncer, y también de muerte prematura. El objetivo fue valorar la relación entre tabaquismo y riesgo coronario total en una cohorte de pacientes de 35 a 74 años de edad. Métodos. Estudio observacional de una cohorte retrospectiva de 1.011 pacientes (edad media 55,7 años, 56,0% mujeres) sin antecedentes de enfermedades cardiovasculares, seguidos durante 10 años en un centro de salud de Badajoz (Extremadura, España). Se realizó un análisis multivariante mediante regresión logística binaria, incluyéndose como variable dependiente la incidencia de eventos coronarios durante el periodo de seguimiento. Resultados. El 29,1% de la población era fumadora, con menor edad (52,1 vs 57,2 años, p<0,001), menores cifras de colesterol-HDL (45,7 vs 54,0 mg/dl, p<0,001), menor prevalencia de hipertensión arterial (46,9% vs 61,5%, p<0,01) y obesidad (25,5% vs 31,8%, p=0,055) que los pacientes no fumadores. Sin embargo, durante el seguimiento presentaron mayores tasas de mortalidad (11,2% vs 6,7%, p<0,05) e incidencia de eventos coronarios totales (14,3% vs 9,2%, p<0,05). En el análisis multivariante solamente la edad y el tabaquismo se comportaron como variables predictoras de eventos coronarios totales, correspondiendo al tabaquismo las mayores odds ratio (OR: 2,33; IC95%:1,31-4,16; p<0,01). Conclusiones. En personas de 35 a 74 años seguidos durante 10 años el consumo de tabaco duplica el riesgo de eventos coronarios (AU)

Background. Smoking is a major risk factor for multiple chronic diseases, such as cardiovascular diseases and cancer, and an established risk factor for premature death .The objective was to analyze the association between smoking and total coronary risk (incidence of lethal and non-lethal coronary events) in a cohort of 35-74 year-old patients followed for 10 years. Methods. Longitudinal, observational study of a retrospective cohort followed for ten years in primary care practices in Badajoz (Spain). 1011 patients (mean 55.7 year-old; 56.0% women) without evidence of cardiovascular disease was studied. Multivariate analysis was performed using a binary logistic regression model, introducing as the dependent variable the presence of total coronary events during the follow-up period. Results. 29.1% of the patients were smokers. Smokers were younger (52.1 vs 57.2 years, p<0.001), with less prevalence of arterial hypertension (46.9% vs 61.5%, p<0.01), obesity (25.5% vs 31.8%, p=0,055) and lower HDL-cholesterol (45.7 vs 54.0 mg/dl, p<0.001). During the follow-up, they presented a higher mortality (11.2% vs 6.7%, p<0.05) and higher incidence of total coronary events (14.3% vs 9.2%, p<0.05). The final model of the logistic regression multivariate analysis revealed that only smoking and age are predictor variables of total coronary events, the greater odds ratio (OR) corresponding to smoking [OR: 2.33; 95% confidence interval (CI):1.31-4.16; p<0.01]. Conclusions: In patients aged 35-74 years followed during 10 years, smoking doubles the risk of total coronary events (AU)

Original and REGICOR Framingham functions in a nondiabetic population of a Spanish health care center: a validation study.

PURPOSE: Risk functions can help general practitioners identify patients at high cardiovascular risk, but overprediction inevitably leads to a disproportionate number of patients being targeted for treatment. To assess predicted cardiovascular risk, we analyzed the 10-year performance of the original and REGICOR Framingham coronary risk functions in nondiabetic patients. METHODS: Ours was a longitudinal, observational study of a retrospective cohort of patients observed for 10 years in primary care practices in Badajoz, Spain. Our cohort comprised 447 nondiabetic patients aged 35 to 74 years who had no evidence of cardiovascular disease and were not on lipid-lowering or antihypertensive therapy. We assessed the patients' 10-year coronary risk measurement from the time of their recruitment. We also estimated the percentage of patients who were candidates for antihypertensive and lipid-lowering therapy. RESULTS: The actual incidence rate of coronary events was 6.7%. The original Framingham equation overpredicted risk by 73%, whereas the REGICOR Framingham function underpredicted risk by 64%. The Brier scores were 0.06364 and 0.06093 (P = .365) for the original Framingham and REGICOR Framingham functions, respectively, and the remaining discrimination and calibration parameters were also highly similar for both functions. The original Framingham function classified 14.8% of the population as high risk and the REGICOR Framingham function classified 6.9%. The proportions of patients who, according to the original Framingham and REGICOR functions, would be candidates for lipid-lowering therapy were 14.3% and 6.7%, and for antihypertensive therapy they were 12.5% and 7.8%, respectively. CONCLUSION: The original Framingham equation overestimated coronary risk whereas the REGICOR Framingham function underestimated it. The original Framingham function selected a greater percentage of candidates for antihypertensive and lipid-lowering therapy.

Cardiovascular events in patients with obesity: an observational study.

BACKGROUND: Overweight and obesity are positively correlated with increased risk of morbidity and mortality. AIM: To evaluate whether obesity may be considered an independent cardiovascular risk factor in patients of ages from 35 to 74 years followed-up for 10 years. DESIGN OF STUDY: Observational, longitudinal retrospective study. SETTING: Primary care practices in Badajoz (Spain). METHOD: A cohort of 899 patients (mean 55.7 years; 58.2% female) without evidence of cardiovascular disease was studied. RESULTS: A total of 33.5% of the population were obese (body mass index > or =30 kg/m2). Patients meeting the obesity criteria were more commonly female (36.6%) and were older, had higher mean values of blood pressure and triglycerides, higher percentages of diabetes, and higher coronary risk using either the original Framingham or the Framingham function calibrated for the Spanish population (Framingham-REGICOR). During the follow-up period, the rates of cardiovascular events and death in patients with obesity tended to be higher: 16.3% versus 11.7%, P = 0.056 and 4.7% versus 2.2%, P<0.05, respectively. In the final model of the logistic regression multivariate analysis, the significant predictors of cardiovascular events in patients with obesity were age, sex (male), diastolic blood pressure, diabetes, and smoking. The highest odds ratio corresponded to smoking (odds ratio 2.03; 95% confidence interval = 1.22 to 3.38). CONCLUSION: Obesity may not be considered an independent cardiovascular risk factor in patients aged from 35 to 74 years followed-up for 10 years.

Hidden chronic renal insufficiency and cardiovascular events in patients with hypertension in a primary care center.

OBJECTIVES: The aims of this study were to evaluate whether hidden chronic renal insufficiency (CRI) may be considered an independent cardiovascular risk factor in patients with hypertension and to calculate cardiovascular risk in this population. METHODS: A total of 756 hypertensive patients of ages from 35 to 74 years (mean 57.0 years; 58.2% women) and without evidence of cardiovascular disease were studied and followed during 10 years. Their glomerular filtration rate (GFR) was estimated using the simplified MDRD (result of the Modification of Diet in Renal Disease study) and Cockcroft-Gault formulas. Hidden CRI was identified by a GFR <60 mL/min/1.73 m(2) with normal serum creatinine concentration (<1.4 mg/dL men; <1.3 mg/dL women). RESULTS: Of the patients with hidden CRI using the MDRD equation, 22% presented cardiovascular events (RR, 1.60; 95% confidence interval (CI), 1.06-2.43; p < 0.05). While the estimated coronary risk using the original Framingham function was similar in patients with and without hidden CRI (18.2%), using the REGICOR function it was higher in those with CRI (7.7 vs. 7.2%, p < 0.05). Logistic regression analysis showed that smoking, male sex, age, and diastolic blood pressure were predictors of cardiovascular events. The presence of hidden CRI was not a statistically significant predictor using either the MDRD (OR, 1.37; 95% CI, 0.72-2.61; p = 0.340) or the Cockcroft-Gault (OR, 1.05; 95% CI, 0.50-2.23; p = 0.893) formulas. CONCLUSIONS: The hypertensive population of 35-74 years in age with hidden CRI showed a higher incidence of cardiovascular events, but hidden CRI may not be considered an independent cardiovascular risk factor.

[Cardiovascular events in patients with hidden renal failure detected by equations of glomerular filtration]. / Episodios cardiovasculares en pacientes con insuficiencia renal oculta detectada mediante fórmulas de filtrado glomerular.

OBJECTIVE: The objective of this work was to value the relationship between cardiovascular disease and presence of hidden renal failure in patients between 35 and 74 years followed up for 10 years. DESIGN: Observational, longitudinal, retrospective study of a cohort of patients. SETTING: Primary care health centre. PARTICIPANTS: We studied 875 patients (average age, 55.6 years, with 57.4% women) without evidence of cardiovascular disease, cared for in an urban primary health centre. MEASUREMENTS AND MAIN RESULTS: Glomerular filtration was estimated using Cockcroft-Gault and simplified MDRD equations. Hidden renal failure was considered if the glomerular filtration was <60 mL/min with a normal serum creatinine concentration. Using the Cockcroft-Gault equation 11.2% of study population had hidden renal failure and 12% when using MDRD, and 16.3% of patients with hidden renal failure using Cockcroft-Gault equation had coronary events. The relative risk in this group was 1.8 (95% confidence interval [CI], 1.1-2.9; P< .05). The percentage of coronary events was 16.2% when glomerular filtration was estimated by MDRD (relative risk, 1.9; 95% CI, 1.2-3.1; P< .05). Binary logistic regression analysis showed that age, male sex, smoking, diabetes, and diastolic pressure were the predicting variables of cardiovascular events, the highest odds ratio corresponding to the smoking population. The presence of hidden renal failure was not statistically significant using either Cockcroft (odds ratio, 1.21; 95% CI, 0.64-2.28; P=.566) or MDRD (odds ratio, 1.64; 95% CI, 0.77-3.48; P=.200) CONCLUSIONS: The prevalence of occult renal dysfunction in the 35-74 years population is high, but it does not behave as an independent cardiovascular risk factor.

Episodios cardiovasculares en pacientes con insuficiencia renal oculta detectada mediante fórmulas de filtrado glomerular / Cardiovascular events in patients with hidden renal failure detected by equations of glomerular filtration

Objetivo. Valorar la relación entremorbimortalidad cardiovascular y presenciade insuficiencia renal oculta en pacientesde 35-74 años de edad seguidos durante10 años.Diseño. Estudio observacional, longitudinal,de una cohorte retrospectiva.Emplazamiento. Atención primaria, centrode salud.Participantes. Un total de 875 pacientes(media, 55,6 años; 57,4%,mujeres) sinevidencia de enfermedad cardiovascular.Resultados y mediciones principales. El filtradoglomerular se estimó mediante las fórmulasde Cockcroft-Gault y MDRD abreviada,derivada del estudio Modification of Dietin Renal Disease. Se consideró insuficienciarenal oculta la presencia de un filtradoglomerular inferior a 60 ml/min con cifrasnormales de creatinina. Un 11,2% de lapoblación tenía insuficiencia renal ocultausando la fórmula de Cockcroft-Gaulty un 12,0% según MDRD. Un 16,3% delos pacientes con insuficiencia renal ocultaen la fórmula de Cockcroft-Gault presentaronacontecimientos coronarios (RR = 1,8; IC del95%, 1,1-2,9; p < 0,05). El porcentaje fuedel 16,2% (RR = 1,9; IC del 95%, 1,2-3,1;p < 0,05) cuando el filtrado glomerular se estimócon MDRD. En el análisis de regresiónlogística se observó que la edad, el sexo varón,el tabaquismo, la diabetes y la presión arterialdiastólica fueron las variables predictorasde episodios cardiovasculares en los modelosfinales, correspondiendo al tabaquismolas mayores odds ratio (OR). La presenciade insuficiencia renal oculta no alcanzósignificación estadística cuando la definiciónse realizó con la fórmula de Cockcroft-Gault(OR = 1,21; IC del 95%, 0,64-2,28;p = 0,566) o con la de MDRD (OR = 1,64;IC del 95%, 0,77-3,48; p = 0,200).Conclusiones. En pacientes de 35-74 añosexiste una alta prevalencia de insuficienciarenal oculta, pero esta entidad no secomporta como un predictor independientede episodios cardiovasculares

Objective. The objective of this work wasto value the relationship betweencardiovascular disease and presence ofhidden renal failure in patients between35 and 74 years followed up for 10 years.Design. Observational, longitudinal,retrospective study of a cohort of patients.Setting. Primary care health centre.Participants. We studied 875 patients(average age, 55.6 years, with 57.4% women)without evidence of cardiovascular disease,cared for in an urban primary health centre.Measurements and main results. Glomerularfiltration was estimated using Cockcroft-Gault and simplified MDRD equations.Hidden renal failure was considered if theglomerular filtration was <60 mL/min witha normal serum creatinine concentration.Using the Cockcroft-Gault equation 11.2%of study population had hidden renal failureand 12% when using MDRD, and 16.3%of patients with hidden renal failure usingCockcroft-Gault equation had coronaryevents. The relative risk in this groupwas 1.8 (95% confidence interval [CI],1.1-2.9; P<.05). The percentage ofcoronary events was 16.2% when glomerularfiltration was estimated by MDRD (relativerisk, 1.9; 95% CI, 1.2-3.1; P<.05). Binarylogistic regression analysis showed that age,male sex, smoking, diabetes, and diastolicpressure were the predicting variables ofcardiovascular events, the highest odds ratiocorresponding to the smoking population.The presence of hidden renal failure wasnot statistically significant using eitherCockcroft (odds ratio, 1.21; 95% CI, 0.64-2.28; P=.566) or MDRD (odds ratio, 1.64;95% CI, 0.77-3.48; P=.200)Conclusions. The prevalence of occult renaldysfunction in the 35-74 years populationis high, but it does not behave as anindependent cardiovascular risk factor

[Cardiovascular risk in patients with renal failure]. / Riesgo cardiovascular en pacientes con insuficiencia renal.

BACKGROUND AND OBJECTIVE: Patients with renal failure (RF) have an increased risk of cardiovascular events. The aims of the present study were: a) to evaluate if RF is an independent cardiovascular risk factor, and b) to analyze the predictive capacity of the original Framingham and REGICOR functions charts in patients with RF. PATIENTS AND METHOD: A total of 912 patients between 35-74 years old (average: 55.7 years; 56.4% female) with no evidence of cardiovascular disease, were included in the present study. The RF was defined in patients with a glomerular filtration < 60 ml/min (estimated with the equation of Cockroft-Gaukt). RESULTS: 13.5% of the patients presented RF criteria. The final rate of cardiovascular events was higher in the population with RF (21.1% vs 12.0%; p < 0.01; relative risk = 1.76; 95% confidence interval [CI], 1.19-2.59). Statistically significant differences were not found between men and women. The multiple logistic regression analysis showed that cigarette smoking (odds ratio [OR] = 2.17; 95% CI, 1.38-3.35), diabetes (OR = 2.08; 95% CI, 1.37-3.15), RF (OR = 1.83; 95% CI, 1.10-3.06), antihypertensive treatment (OR = 2.03; IC del 95%, 1.32-3.11), and hypertension (OR = 2.06; 95% CI, 1.06-4.05) were important factors for the prediction of coronary and cardiovascular events. The original Framingham function predicted suitably the coronary risk in the population with RF (18.3% versus 17.9%; p = 0.869) whereas REGICOR underestimated it (7.5% versus 17.9%; p < 0.05). The area under the receiver operator characteristic (ROC) curve obtained with the original Framingham function was similar to that of REGICOR function: 0.61 (95% CI, 0.47-0.75) and 0.62 (95% CI, 0.48-0.76), respectively. CONCLUSIONS: The RF behaves like an important cardiovascular risk factor. The area under ROC curve obtained with the original Framingham function was similar to that of REGICOR function.

Riesgo cardiovascular en pacientes con insuficiencia renal / Cardiovascular risk in patients with renal failure

FUNDAMENTO Y OBJETIVO: El riesgo de presentar episodios cardiovasculares es elevado en pacientes con insuficiencia renal (IR). El presente estudio se diseñó con estos objetivos: a) evaluar si la IR se comporta como un factor independiente de riesgo cardiovascular, y b) analizar la capacidad predictiva de la función original de riesgo coronario de Framingham y la calibrada del REGICOR en pacientes con IR.PACIENTES Y MÉTODO: Se estudió a un total de 912 pacientes de 35-74 años (media, 55,7 años;un 56,4% de mujeres) sin evidencia de enfermedad cardiovascular, con un seguimiento de 10años. La IR se definió por la presencia de un filtrado glomerular estimado en la fórmula de Cockroft-Gault menor de 60 ml/min.RESULTADOS: El 13,5% de los pacientes reunía criterios de IR. La tasa final de episodios cardiovascularesfue superior en la población con IR (un 21,1 frente a un 12,0%; p < 0,01; riesgo relativo= 1,76; intervalo de confianza [IC] del 95%, 1,19-2,59), sin diferencias estadísticamente significativas entre varones y mujeres. En el análisis multivariante mediante regresión logística se mantuvieron como variables predictoras de eventos cardiovasculares el tabaquismo (odds ratio [OR] =2,17; IC del 95%, 1,38-3,35), la diabetes (OR = 2,08; IC del 95%, 1,37-3,15), la IR (OR =1,83; IC del 95%, 1,10-3,06), el tratamiento antihipertensivo (OR = 2,03; IC del 95%, 1,32-3,11) y la hipertensión arterial (OR = 2,06; IC del 95%, 1,06-4,05). La función original de Framingham predijo adecuadamente el riesgo coronario de la población con IR (un 18,3 frente a un 17,9%; p = 0,869), mientras que REGICOR lo infravaloró (un 7,5 frente a un 17,9%; p < 0,05). Las curvas de eficacia diagnóstica para la función original de Framingham y la REGICOR fueron similares: 0,61 (IC del 95%, 0,47-0,75) y 0,62 (IC del 95%, 0,48-0,76), respectivamente.CONCLUSIONES: La IR se comporta como un importante factor de riesgo cardiovascular. Las curvasde eficacia diagnóstica son similares en ambas funciones de riesgo coronario, Framingham y REGICOR

BACKGROUND AND OBJECTIVE: Patients with renal failure (RF) have an increased risk of cardiovascularevents. The aims of the present study were: a) to evaluate if RF is an independent cardiovascularrisk factor, and b) to analyze the predictive capacity of the original Framingham and REGICOR functions charts in patients with RF.PATIENTS AND METHOD: A total of 912 patients between 35-74 years old (average: 55.7 years; 56.4% female) with no evidence of cardiovascular disease, were included in the present study. The RF was defined in patients with a glomerular filtration < 60 ml/min (estimated with theequation of Cockroft-Gaukt).RESULTS: 13.5% of the patients presented RF criteria. The final rate of cardiovascular events washigher in the population with RF (21.1% vs 12.0%; p < 0.01; relative risk = 1.76; 95% confidenceinterval [CI], 1.19-2.59). Statistically significant differences were not found between men and women. The multiple logistic regression analysis showed that cigarette smoking (odds ratio [OR] = 2.17; 95% CI, 1.38-3.35), diabetes (OR = 2.08; 95% CI, 1.37-3.15), RF (OR = 1.83; 95% CI, 1.10-3.06), antihypertensive treatment (OR = 2.03; IC del 95%, 1.32-3.11), and hypertension(OR = 2.06; 95% CI, 1.06-4.05) were important factors for the prediction of coronary and cardiovascular events. The original Framingham function predicted suitably the coronary risk in the population with RF (18.3% versus 17.9%; p = 0.869) whereas REGICOR underestimated it (7.5% versus 17.9%; p < 0.05). The area under the receiver operator characteristic (ROC) curve obtained with the original Framingham function was similar to that of REGICOR function: 0.61(95% CI, 0.47-0.75) and 0.62 (95% CI, 0.48-0.76), respectively.CONCLUSIONS: The RF behaves like an important cardiovascular risk factor. The area under ROCcurve obtained with the original Framingham function was similar to that of REGICOR function

Análisis de la capacidad predictiva de las funciones de Framingham-REGICOR y SCORE en la población de un centro de salud / Analysis of predictive value of Framingham-REGICOR and SCORE functions in primary health care

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[Predictive capacity, comparison and clinic consequences of the Framingham-Wilson and REGICOR tables in persons for whom care has been provided at a health care center, Badajoz, Spain]. / Capacidad predictiva, comparación y consecuencias clínicas de las tablas de Framingham-Wilson y regicor en personas atendidas en un centro de salud de Badajoz.

BACKGROUND: Framingham's original equation modified by Wilson and the REGICOR calibration are widely recommended in coronary risk stratification. This study is aimed at: (1) Analyzing the ten-year predictiveness of the Framingham-Wilson and REGICOR tables among a population for which care has been provided at an urban health care center (2) Evaluating the concordance use of hypolipemiant and antihypertensive drugs resulting from these tables. METHODS: Observational, longitudinal, retrospective study of a cohort of patients for whom care was provided at a primary care center. A total of 1011 patients ages 35-74 (mean age 55.7, 56.0% females) without any evidence of cardiovascular disease. Those patients having a > or =20% risk in Wilson and > or =10% in REGICOR were considered high-risk. RESULTS: The actual coronary risk of the population was 10.7%, whilst the mean coronary risk estimated with the functions was 17.0% in Wilson and 6.6% in REGICOR. A total 29.6% was classified high-risk in Wilson as compared to the 18.2% in RECIGOR (p < 0.05). The percentage of high-risk males was significantly higher in Wilson than in REGICOR (49.0% vs. 29.4%, p < 0.01). The Kappa index was 0.70 (95 CI: 0.67, 0.73). A total of 39.5% of the patients (as per Wilson) and 31.4% (as per REGICOR) were candidates for taking hypolipemiant drugs (p < 0.001). The validity criteria of both of these functions are quite discreet: sensitivity, specificity and odds ratio diagnosed at 50.9%, 73.1% and 2.11 in Wilson and 28.7%, 83.1% and 1.98 in REGICOR, respectively. CONCLUSIONS: The Wilson and REGICOR tables show an acceptable degree of concordance, but their validity parameters are discreet. The Framingham-Wilson function screens a higher percentage of patients as being candidates for hypolipemiant drugs.

A propósito de la «comparación de las tablas REGICOR y SCORE ». Respuesta / Comment on «Comparison of the REGICOR and SCORE Function Charts ». Response

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Capacidad predictiva, comparación y consecuencias clínicas de las tablas de Framingham-Wilson y Regicor en personas atendidas en un Centro de Salud de Badajoz / Predictive capacity, comparison and clinic consecuences of the Framingham- Wilson and REGICOR tables in persons for whom care has been provided at a health care center, Badajoz, Spain

Fundamento: La ecuación original de Framingham modificada por Wilson y la calibrada del REGICOR son ampliamente recomendadas en la estratificación del riesgo coronario. Este estudio tiene por objetivos: 1) Analizar la capacidad predictiva a diez años de las tablas de Framingham-Wilson y REGICOR en población atendida en un centro de salud urbano; y 2) Evaluar la concordancia y el consumo de fármacos hipolipemiantes y antihipertensivos derivado de su uso. Métodos: Estudio observacional, longitudinal, retrospectivo de una cohorte de pacientes atendidos en un centro de atención primaria. Un total de 1.011 pacientes de 35-74 años (media 55,7 años, 56,0% mujeres) sin evidencia de enfermedad cardiovascular. Se consideró pacientes de riesgo alto aquellos con un riesgo >20% en Wilson y >10% en REGICOR. Resultados: El riesgo coronario real de la población fue del 10,7% mientras que el riesgo coronario medio estimado con las funciones fue 17,0% en Wilson y 6,6% en REGICOR. El 29,6% fue catalogado de riesgo alto en Wilson frente al 18,2% en REGICOR (p<0,05), siendo también significativamente mayor el porcentaje de varones de riesgo alto en Wilson que en REGICOR (49,0% vs 29,4%, p<0,01). El índice Kappa fue 0,70 (IC 95%: 0,67; 0,73). El 39,5% de los pacientes (según Wilson) y el 31,4% (según REGICOR) serían candidatos al tratamiento con hipolipemiantes (p<0,001). Los criterios de validez de ambas funciones son muy discretos: sensibilidad, especificidad y odds ratio diagnósticas del 50,9%, 73,1% y 2,11 en Wilson y 28,7%, 83,1% y 1,98, en REGICOR, respectivamente. Conclusiones. Las tablas de Wilson y REGICOR presentan concordancia aceptable pero sus parámetros de validez son discretos. La función Framingham-Wilson selecciona un mayor porcentaje de pacientes candidatos a recibir tratamiento con hipolipemiantes

Background: Framingham’s original equation modified by Wilson and the REGICOR calibration are widely recommended in coronary risk stratification. This study is aimed at: 1) Analyzing the ten-year predictiveness of the Framingham- Wilson and REGICOR tables among a population for which care has been provided at an urban health care center 2) Evaluating the concordance use of hypolipemiant and antihypertensive drugs resulting from these tables. Methods: Observational, longitudinal, retrospective study of a cohort of patients for whom care was provided at a primary care center. A total of 1011 patients ages 35-74 (mean age 55.7, 56.0% females) without any evidence of cardiovascular disease. Those patients having a >20% risk in Wilson and >10% in REGICOR were considered high-risk. Results: The actual coronary risk of the population was 10.7%, whilst the mean coronary risk estimated with the functions was 17.0% in Wilson and 6.6% in REGICOR. A total 29.6% was classified high-risk in Wilson as compared to the 18.2% in RECIGOR (p<0.05). The percentage of high-risk males was significantly higher in Wilson than in REGICOR (49.0% vs. 29.4%, p<0.01). The Kappa index was 0.70 (95 CI: 0.67, 0.73). A total of 39.5% of the patients (as per Wilson) and 31.4% (as per REGICOR) were candidates for taking hypolipemiant drugs (p<0.001). The validity criteria of both of these functions are quite discreet: sensitivity, specificity and odds ratio diagnosed at 50.9%, 73.1% and 2.11 in Wilson and 28.7%, 83.1% and 1.98 in REGICOR, respectively. Conclusions. The Wilson and REGICOR tables show an acceptable degree of concordance, but their validity parameters are discreet. The Framingham-Wilson function screens a higher percentage of patients as being candidates for hypolipemiant drugs

[Prevalence of hidden renal failure calculated through formulas on the degree of renal function in hypertense patients over 60 referred to out-patients for blood pressure monitoring]. / Prevalencia de insuficiencia renal oculta estimada mediante fórmulas de cálculo del grado de función renal en hipertensos mayores de 60 años, remitidos para medición ambulatoria de la presión arterial.

OBJECTIVES: To validate the Cockroft-Gault and the abbreviated Modification of Diet in Renal Disease (MDRD) formulas in a hypertense population aged over 60 and with blood pressure monitored in out-patients. To evaluate the prevalence of various stages of hidden chronic kidney disease in this population. DESIGN: Descriptive study of validation of diagnostic tests. SETTING: Urban primary care centre. PARTICIPANTS: A total of 113 patients over 60 (53.8% female) with hypertension and no history of chronic kidney disease, on whom blood pressure could be monitored in a 24-hour session. MAIN MEASUREMENTS: Calculation of the glomerular filtration rate. Validity parameters of diagnostic tests. RESULTS: Renal clearance estimated in the Cockroft-Gault and MDRD equations was similar (77.9 mL/min and 76.9 mL/min, respectively). There was 37.3% prevalence of chronic kidney disease, using the Cockroft-Gault equation; and 27.0%, using the MDRD. The degree of agreement between the two equations was excellent in classifying patients with stage-2 chronic kidney disease (kappa index =0.9) and it was acceptable for stage-3 (kappa index =0.5). In both equations, validity indexes were acceptable for the presence of microalbuminuria as a manifestation of renal damage. CONCLUSIONS: There is a high prevalence of hidden chronic kidney disease in the hypertense population over 60 years old. Glomerular filtration should be determined systematically in these patients, even when their plasma creatinine figures are normal.

Prevalencia de insuficiencia renal oculta estimada mediante fórmulas de cálculo del grado de función renal en hipertensos mayores de 60 años, remitidos para medición ambulatoria de la presión arterial / Prevalence of hidden renal failure calculated through formulas on the degree of renal function in hypertense patients over 60 referred to out-patients for blood pressure monitoring

Objetivos. Validar las fórmulas de Cockcroft-Gault y la abreviada del estudio Modification of Diet in Renal Disease (MDRD) en la población hipertensa mayor de 60 años en la que se realiza medición ambulatoria de la presión arterial, y conocer la prevalencia de diferentes estadios de enfermedad renal crónica oculta en ese grupo de población. Diseño. Estudio descriptivo, de validación de pruebas diagnósticas. Emplazamiento. Atención primaria. Centro de salud urbano. Participantes. Un total de 113 pacientes mayores de 60 años (el 53,8% mujeres), hipertensos, sin historia de enfermedad renal crónica conocida y a quienes se les realizó una sesión de medición ambulatoria de presión arterial durante 24 h. Mediciones principales. Estimación del grado de filtración glomerular. Parámetros de validez de pruebas diagnósticas. Resultados. El aclaramiento renal estimado por las fórmulas de Cockroft-Gault y MDRD fue similar (77,9 y 76,9 ml/min, respectivamente). Se encontró una prevalencia de enfermedad renal crónica del 37,3% en la ecuación de Cockroft-Gault y del 27,0% en la de MDRD. El índice de concordancia de ambas ecuaciones fue excelente en la catalogación de los pacientes con enfermedad renal crónica en estadio 2 (kappa = 0,9) y aceptable (kappa = 0,5) para el estadio 3. Los índices de validez de las 2 ecuaciones son discretos frente a la presencia de microalbuminuria como manifestación de daño renal. Conclusiones. Hay una alta prevalencia de enfermedad renal crónica oculta en la población hipertensa mayor de 60 años. La estimación del filtrado glomerular debería realizarse sistemáticamente en esta población, aunque sus cifras de creatinina plasmática sean normales

Objectives. To validate the Cockroft-Gault and the abbreviated Modification of Diet in Renal Disease (MDRD) formulas in a hypertense population aged over 60 and with blood pressure monitored in out-patients. To evaluate the prevalence of various stages of hidden chronic kidney disease in this population. Design. Descriptive study of validation of diagnostic tests. Setting. Urban primary care centre. Participants. A total of 113 patients over 60 (53.8% female) with hypertension and no history of chronic kidney disease, on whom blood pressure could be monitored in a 24-hour session. Main measurements. Calculation of the glomerular filtration rate. Validity parameters of diagnostic tests. Results. Renal clearance estimated in the Cockroft-Gault and MDRD equations was similar (77.9 mL/min and 76.9 mL/min, respectively). There was 37.3% prevalence of chronic kidney disease, using the Cockroft-Gault equation; and 27.0%, using the MDRD. The degree of agreement between the two equations was excellent in classifying patients with stage-2 chronic kidney disease (kappa index =0.9) and it was acceptable for stage-3 (kappa index =0.5). In both equations, validity indexes were acceptable for the presence of microalbuminuria as a manifestation of renal damage. Conclusions. There is a high prevalence of hidden chronic kidney disease in the hypertense population over 60 years old. Glomerular filtration should be determined systematically in these patients, even when their plasma creatinine figures are normal

[Incidence of cardiovascular disease and validity of equations of coronary risk in diabetic patients with metabolic syndrome]. / Incidencia de enfermedad cardiovascular y validez de las tablas de riesgo coronario en pacientes diabéticos con síndrome metabólico.

BACKGROUND AND OBJECTIVE: We aimed to analyze the contribution of the metabolic syndrome (MetS) and the glycemic control on the incidence of cardiovascular disease in type 2 diabetic patients. Our goal was also to validate to 10 years the coronary risk functions charts that use the original Framingham equation (Framingham-Wilson) and the calibrated one for the Spanish population (Framingham-REGICOR) in diabetic patients with MetS. PATIENTS AND METHOD: We included a total of 206 diabetic patients from a primary care center (63.6% with MetS), with no history of cardiovascular disease, in whom the coronary risk could be calculated prior to 1 January 1995. All were followed up during 10 years. RESULTS: The incidence of stroke, coronary and global events was similar in diabetic patients with and without MetS (15.3% vs 14.7%, 9.2% vs 9.3% and 20.6% vs 21.3%, respectively). The presence of glycosylated hemoglobin > or = 7% increased the risk of global cardiovascular events (relative risk [RR], 2.13; 95% confidence interval [CI], 1.10-4.09) and stroke (RR, 3.4; 95% CI, 1.17-9.84). The considered coronary risk in Framingham-Wilson and REGICOR equations was higher in the patients with MetS (29.6% and 12.4% vs 23.4% and 9.4%, respectively; p < 0,01), but the validity criteria of these equations in the diabetic population are very discreet. CONCLUSIONS: A value of glycosylated hemoglobin > or = 7% increases the risk of cardiovascular events in diabetic patients whereas the incidence of this events was similar in patients with and without MetS. The utility of the Framingham-Wilson and REGICOR equations is reduced in the diabetic population.