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.
METHODSOurs 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.
RESULTSThe 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 classifi ed 14.8% of the population as high risk and the REGICOR Framingham function classifi ed 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
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.
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