Consequences of using different methods to assess cardiovascular risk in primary care

Fornasini, Marco; Brotons, Carlos; Sellarés, Jaume; Martínez, M.; Galán, María Luisa Cid; Sáenz, Ignacio; Pena, José Manuel da

doi:10.1093/fampra/cmi092

Cited by 33 publications

(21 citation statements)

References 13 publications

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“…In our study, risk estimates with the three equations were different, similar to the findings from previous studies using different risk algorithms [6,[27][28][29]. The high risk group was largest (25.4%) when risk estimation was done with NCEP-ATP III criteria, and smallest (8.2%) when the risk was estimated using WHO/ISH criteria.…”

Section: Papersupporting

confidence: 84%

“…We studied the CHD risk (NCEP-ATP III), the total CVD risk (WHO/ISH), and the risk of CVD mortality (SCORE). Finally, some previous studies have been confined to those with selected risk factors [28,29], whereas others had excluded participants with certain risk factors. We did not select participants according to the presence or absence of risk factors, and therefore our data may be more applicable to the community at large.…”

Section: Malementioning

confidence: 99%

“…[13][14][15][16][17][18][19][20][21][22][23]. The risk prediction tools to calculate the absolute CVD risk have been developed, and used, mainly in the developed world [13, [24][25][26][27][28][29][30][31].…”

Section: Introductionmentioning

confidence: 99%

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Risk estimates of cardiovascular diseases in a Sri Lankan community

et al. 2016

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Objectives Quantifying the risk of cardiovascular disease (CVD) in a community is important in planning preventive strategies, but such data are limited from developing countries, especially South Asia. We aimed to estimate the risks of coronary heart disease (CHD), total CVD, and CVD mortality in a Sri Lankan community.Methods A community survey was conducted in an urban health administrative area among individuals aged 35-64 years, selected by stratified random sampling. Their 10-year CHD, total CVD, and CVD mortality risks were estimated using three risk prediction tools: National Cholesterol Education Program -Adult Treatment Panel III (NCEP-ATP III), Systematic Coronary Risk Evaluation (SCORE), and World Health Organisation/ International Society of Hypertension (WHO/ISH) charts.Results Among study participants (n=2985), 54.5% were females, and mean age (SD) was 52.4 (7.8) years. According to NCEP-ATP III ('hard' CHD risk), WHO/ISH (total CVD risk), and SCORE (CVD mortality risk) criteria, 25.4% (95% CI 23.6-27.2), 8.2% (95% CI 7.3-9.2), and 11.8 (95% CI 10.5-13.1) respectively were classified as at 'high risk'. The proportion of high risk participants increased with age. 'High risk' was commoner among males (30.3% vs 20.6%, p<0.001) according to NCEP-ATP III criteria, but among females (9.7% vs. 6.7%, p<0.001) according to WHO/ISH criteria. No significant gender difference was noted in SCORE risk categories.Conclusions A large proportion of individuals in this community are at risk of developing cardiovascular diseases, especially in older age groups. Risk estimates varied with the different prediction tools, and were comparatively higher with NCEP-ATP III charts.

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Section: Papersupporting

confidence: 84%

Section: Malementioning

confidence: 99%

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Risk estimates of cardiovascular diseases in a Sri Lankan community

et al. 2016

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“…In Spain, some authors reported a prevalence of high risk in asymptomatic and non-diabetic individuals ranging from 4.1-9.2% (Gonzalez et al 2006;Buitrago et al 2007;Fornasini et al 2006). In one of the studies, the prevalence of high-risk individuals raises to 29.2% when diabetic patients were included (Fornasini et al 2006).…”

Section: Discussionmentioning

confidence: 99%

Assessment of global cardiovascular risk and risk factors in Portugal according to the SCORE® model

et al. 2008

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Background/objective Cardiovascular diseases (CVD) are the leading cause of mortality in European countries. This study aimed at estimating the 10-year risk of fatal CVD in Portuguese adults and to assess the prevalence of major cardiovascular risk factors, according to the SCORE® risk prediction system. Subjects and methods A cross-sectional survey was carried out in 60 community pharmacies (CP) from October 2005 to January 2006 in a sample of CP users (≥40 and ≤65 years). Data were collected by patient interviews using a structured questionnaire applied by a trained pharmacist. Results A total of 1,043 individuals were enrolled in the study (participation rate: 91%). The mean age was 53.7 years (SD: 7.1) with a ratio men/women of 0.68. The average risk in the sample was 1.94 (minimum 0, maximum 28, SD=2.69). About 20% of the studied adults were at high risk, of which 39.4% were asymptomatic. CV risk was significantly higher in the oldest age group and in men (p< 0.05). The prevalence of main CV risk factors was: hypertension-54.8%; hypercholesterolemia-63.1%, diabetes-13.4%; smoking-10.4% and obesity-29.0%. About 1/3 of those asked had family history of premature CVD. Mean values of biochemical and clinical parameters were: systolic blood pressure (mmHg): 134.8± 19.7; diastolic blood pressure (mmHg): 81.0±11.4; total cholesterol (mg/dl): 193.8±34.6; body mass index (kg/m 2 ): 28.0±4.5. Conclusions According to SCORE®, about one-fifth of the individuals was classified as high risk, and 7.7% was asymptomatic. CV risk was significantly higher in the oldest age group (55-65 years old) and in men (p<0.05). These results show a high prevalence of some risk factors, particularly hypertension and hypercholesterolemia.

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“…Uncritical adoption of such protocols may result in negative clinical and economic consequences. 43 To address the absence of a CVD risk profiling tool for developing countries, WHO in 2000 developed a package for the assessment and management of cardiovascular risk in low-resource settings. 44 The package, developed through consultations with experts from all WHO regions, was designed as an adaptable, cost-effective tool for systematic case management at all health-care levels, and consequently for scaling up countries' health systems.…”

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confidence: 99%

Can non-physician health-care workers assess and manage cardiovascular risk in primary care?

Abegunde

Shengelia

Luyten

et al. 2007

Bull World Health Organ

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Objective To ascertain the reliability of applying the WHO Cardiovascular Risk Management Package by non-physician health-care workers (NPHWs) in typical primary health-care settings. Methods Based on an a priori 80% agreement level between the NPHWs and the "expert" physicians (gold standard), 649 paired (matched) applications of the protocol were obtained for analysis using Kappa statistic and multivariate logit regression. Findings Results indicate over 80% agreement between raters, from moderate to perfect levels of agreement in almost all of the sections in the package. The odds of obtaining a difference between raters and a benchmark are not statistically significant. Conclusion Applying the WHO Cardiovascular Risk Management Package, NPHWs can be retrained to reliably and effectively assess and manage cardiovascular risks in primary health-care settings where there are no attending physicians. The package could be a useful tool for scaling up the management of cardiovascular diseases in primary health care. IntroductionChronic noncommunicable diseases, especially cardiovascular diseases, are a major and increasing cause of death and disability worldwide, and may have retarding effects on the economies of affected individuals, households and countries. 1,2 The epidemiological and economic effects of cardiovascular diseases (specifically stroke and heart diseases) and diabetes, are especially pervasive in low-and middle-income countries 1-3 where health systems are less likely to adequately respond to the challenges of the increasing burden. Socioeconomic barriers and inequalities in access to treatment, suboptimal staffing of health-care facilities and limited capacity for ancillary investigations that complement cardiovascular risk profiling are some of the common problems limiting these countries' control of chronic diseases, especially at the primary healthcare level. 4 This situation is worsened by the brain-drain syndrome 5-9 resulting in shortages of skilled workers.Can non-physician health-care workers assess and manage cardiovascular risk in primary care? 29 However, such risk profiling protocols lack universal applicability 11,13,14,[29][30][31][32][33][34][35][36][37][38][39][40][41][42] and may be of limited applicability in developing countries, whose populations were not sampled for the Framingham 31,32 and other studies. Uncritical adoption of such protocols may result in negative clinical and economic consequences. 43 To address the absence of a CVD risk profiling tool for developing countries, WHO in 2000 developed a package for the assessment and management of cardiovascular risk in low-resource settings. 44 The package, developed through consultations with experts from all WHO regions, was designed as an adaptable, cost-effective tool for systematic case management at all health-care levels, and consequently for scaling up countries' health systems. The expert panel based the design of the package on the graded evidence available.The package includes three scenarios that reflect commonl...

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Consequences of using different methods to assess cardiovascular risk in primary care

Abstract: Our results suggest important clinical and economic consequences when comparing European guidelines or ATPIII guidelines for the treatment of dyslipidemic patients in general practice.

Cited by 33 publications

References 13 publications

Risk estimates of cardiovascular diseases in a Sri Lankan community

Risk estimates of cardiovascular diseases in a Sri Lankan community

Assessment of global cardiovascular risk and risk factors in Portugal according to the SCORE® model

Can non-physician health-care workers assess and manage cardiovascular risk in primary care?

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