Original and REGICOR Framingham Functions in a Nondiabetic Population of a Spanish Health Care Center: A Validation Study

Francisco Buitrago; Juan Ignacio Calvo-Hueros; Lourdes Cañón-Barroso; Gerónimo Pozuelos-Estrada; Luis Molina-Martínez; Manuel Espigares-Arroyo; Juan Antonio Galán-González; Francisco J. Lillo-Bravo

doi:10.1370/afm.1287

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Cardiovascular risk functions
Francisco Buitrago

Published on: 05 October 2011
Cardiovascular Risk-Estimation Systems: are useful for primary care practice?
Vicente Martínez-Vizcaíno

Published on: 27 September 2011

Published on: (5 October 2011)
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Cardiovascular risk functions
Francisco Buitrago, Badajoz, Spain
I share Dr. Martinez Vizcaíno comments on the reasons that could be influencing the clinical management of cardiovascular risk in clinical practice. The main utility of calculating cardiovascular risk is to aid in clinical decision-making by identifying high-risk patients in primary health-care. These patients, together with those who already present arteriosclerosis, are those who would benefit most from drug therapy to...
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I share Dr. Martinez Vizcaíno comments on the reasons that could be influencing the clinical management of cardiovascular risk in clinical practice. The main utility of calculating cardiovascular risk is to aid in clinical decision-making by identifying high-risk patients in primary health-care. These patients, together with those who already present arteriosclerosis, are those who would benefit most from drug therapy to reduce their cardiovascular morbility and mortality. Identification of individuals who are at high risk of developing cardiovascular disease using multivariable risk assessment tools is a recommended approach to primary prevention in many countries, Spain included. Our study1 shows that the original Framingham equation overestimated coronary risk and selected a greater percentage of candidates for antihypertensive and lipid-lowering therapy. Overprediction would inevitably lead to a disproportionate number of people being targeted for treatment, affecting healthcare resources and potentially exposing patients to unnecessary treatment. Similarly, any systematic underprediction of risk could potentially deny patients much needed treatment. There are a lot of cardiovascular risk funtions. Primary care practitioners need a simple risk score using data that are routinely available and that perfomes reasonably well at predicting cardiovascular disease risk in their patients. More then claiming for their uncontrolled use, our findings are further evidence of the need for an adjustement, calibration and validation of the risk functions on large populations representative of each country´s reality.
1.Buitrago F, Calvo-Hueros JI, Cañón-Barroso L, Pozuelos-Estrada G, Molina-Martínez L, Espigares-Arroyo M, Galán-González JA, Lillo-Bravo FJ. Original and REGICOR Framingham Functions in a Nondiabetic Population of a Spanish Health Care Center: A Validation Study Ann Fam Med 2011; 9: 431- 438
Competing interests: None declared
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Competing Interests: None declared.
Published on: (27 September 2011)
Page navigation anchor for Cardiovascular Risk-Estimation Systems: are useful for primary care practice?
Cardiovascular Risk-Estimation Systems: are useful for primary care practice?
Vicente Martínez-Vizcaíno, Cuenca, Spain
During the last decades has been placed great emphasis on the development of clinically useful tools for cardiovascular risk assessment in the clinic practice. However, its use by family doctors is far from being consolidated. What are the reasons for this lack of integration in daily clinical practice? The rationale for their use is commonly accepted: the atherosclerotic process underlying most cardiovascular diseases i...
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During the last decades has been placed great emphasis on the development of clinically useful tools for cardiovascular risk assessment in the clinic practice. However, its use by family doctors is far from being consolidated. What are the reasons for this lack of integration in daily clinical practice? The rationale for their use is commonly accepted: the atherosclerotic process underlying most cardiovascular diseases is frequently the result of the combined effect of several risk factors. Therefore, if GP’s focus their cardiovascular risk approach on single risk factors management the overtreatment or undertreatment may result. Furthermore, the cardiovascular risk functions, as the paper of Buitrago F y cols (1) has evidenced, are useful to discriminate patients according to their risk of suffering a cardiovascular event. Then, the problem is not the lack of confidence in the validity of risk estimation systems. In my opinion two reasons could be influencing the clinical management of cardiovascular risk in clinical practice: 1) the format of the cardiovascular risk estimation systems is not easy of use, and 2) GP’s are not enough conscious about the effectiveness of some interventions such as the polypill or physical activity to modify the whole cardiovascular risk. Incorporating cardiovascular risk functions into the GP’s database so that the estimate could be calculated automatically for each patient may be useful in clinical practice. This approach has been adopted successfully in New Zealand (2). Otherwise a large amount of evidence is available about the effectiveness of physical activity on influence cardiovascular risk (3). To disseminate this evidence may be a effective strategy to persuade GP’s to appropriateness of the use of cardiovascular risk functions
References 1. Buitrago F, Calvo-Hueros JI, Canon-Barroso L, Pozuelos-Estrada G, Molina-Martinez L, Espigares-Arroyo M, Galan-Gonzalez JA, Lillo-Bravo FJ. Original and REGICOR Framingham Functions in a Nondiabetic Population of a Spanish Health Care Center: A Validation Study. Ann Fam Med 2011; 9: 431- 438 2. Wells S, Furness S, Rafter N et al. Integrated electronic decision support increases cardiovascular disease risk assessment four fold in routine primary care practice. Eur J Cardiovasc Prev Rehabil 2008;15 (2):173–178. 3.Shiroma EJ, Lee IM. Exercise in Cardiovascular Disease: Physical Activity and Cardiovascular Health: Lessons Learned From Epidemiological Studies Across Age, Gender, and Race/Ethnicity. Circulation. 2010;122:743- 752
Competing interests: None declared
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Competing Interests: None declared.