Estimating Cardiovascular Risk in Spain by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice

Amor, Antonio J.; Masana, L.; Soriguer, Federico; Goday, Albert; Calle-Pascual, Alfonso; Gaztambide, Sonia; Rojo-Martínez, Gemma; Valdés, Sergio; Gomis, Ramón; Ortega, Emilio

doi:10.1016/j.rec.2014.05.023

Cited by 9 publications

(13 citation statements)

References 42 publications

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“…Concurring with prior studies,14, 34 the prevalence of high or very high risk among women was half that found in men (18% versus 36%), even though women were older by study design. Consequently, the higher incidence of CVD events (MACE and expanded MACE) in men compared with women was not unexpected.…”

Section: Discussionsupporting

confidence: 64%

“…However, even in the setting of this primary CVD prevention trial, the high proportion of non–high‐risk persons is somewhat surprising, given the participants' characteristics, namely, 50% with diabetes mellitus and/or ≥3 cardiovascular risk factors. Indeed, the baseline cardiovascular risk distribution was similar to that observed in a nonselected nationwide population‐based sample 14. This may be due to the fact that 40% of PREDIMED participants were treated with statins and 74% received antihypertensive agents, thus blunting the potency of cholesterol concentrations and blood pressure—critical factors used to evaluate cardiovascular risk.…”

Section: Discussionsupporting

confidence: 60%

“…In the PREDIMED cohort, cardiovascular risk estimated with the F‐R equation was mostly moderate (44.5%), with only 8% of participants identified as very high risk (Figure ). Prevalent CVD is the main determinant of future events and explains most of the very high‐risk category in population‐based studies . However, even in the setting of this primary CVD prevention trial, the high proportion of non–high‐risk persons is somewhat surprising, given the participants' characteristics, namely, 50% with diabetes mellitus and/or ≥3 cardiovascular risk factors.…”

Section: Discussionmentioning

confidence: 96%

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Prediction of Cardiovascular Disease by the Framingham‐REGICOR Equation in the High‐Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata

Amor

Serra‐Mir

Martínez‐González

et al. 2017

JAHA

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BackgroundThe usefulness of cardiovascular disease (CVD) predictive equations in different populations is debatable. We assessed the efficacy of the Framingham‐REGICOR scale, validated for the Spanish population, to identify future CVD in participants, who were predefined as being at high‐risk in the PREvención con DIeta MEDiterránea (PREDIMED) study—a nutrition‐intervention primary prevention trial—and the impact of adherence to the Mediterranean diet on CVD across risk categories.Methods and ResultsIn a post hoc analysis, we assessed the CVD predictive value of baseline estimated risk in 5966 PREDIMED participants (aged 55–74 years, 57% women; 48% with type 2 diabetes mellitus). Major CVD events, the primary PREDIMED end point, were an aggregate of myocardial infarction, stroke, and cardiovascular death. Multivariate‐adjusted Cox regression was used to calculate hazard ratios for major CVD events and effect modification from the Mediterranean diet intervention across risk strata (low, moderate, high, very high). The Framingham‐REGICOR classification of PREDIMED participants was 25.1% low risk, 44.5% moderate risk, and 30.4% high or very high risk. During 6‐year follow‐up, 188 major CVD events occurred. Hazard ratios for major CVD events increased in parallel with estimated risk (2.68, 4.24, and 6.60 for moderate, high, and very high risk), particularly in men (7.60, 13.16, and 15.85, respectively, versus 2.16, 2.28, and 3.51, respectively, in women). Yet among those with low or moderate risk, 32.2% and 74.3% of major CVD events occurred in men and women, respectively. Mediterranean diet adherence was associated with CVD risk reduction regardless of risk strata (P>0.4 for interaction).ConclusionsIncident CVD increased in parallel with estimated risk in the PREDIMED cohort, but most events occurred in non–high‐risk categories, particularly in women. Until predictive tools are improved, promotion of the Mediterranean diet might be useful to reduce CVD independent of baseline risk.Clinical Trial Registration URL: http://www.Controlled-trials.com. Unique identifier: ISRCTN35739639.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 96%

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Prediction of Cardiovascular Disease by the Framingham‐REGICOR Equation in the High‐Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata

Amor

Serra‐Mir

Martínez‐González

et al. 2017

JAHA

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“…Results from a previous study performed only in the Mainland Portuguese Population, in 2005/2006 16 show a proportion of the population aged between 40 and 65 years old at high CV risk similar to the one obtained in the present study (19.5% versus 17.1%). Despite some methodological differences between the studies, we found a lower estimate in comparison with the Spanish (22.8% in 2009 -2010) 24 and Italian populations (26.0% in 2015) 25 , which are also considered low-CV risk countries just like Portugal.Men and older adults were at higher CV risk and these results are corroborated by other national and international authors. 16,26 Regarding the CV risk of the older age group (60 -65 years), it is important to point out that SCORE probably overestimates the risk because, based on SCORE, the weight of the age factor leads to higher absolute risk estimates given.…”

Section: Discussioncontrasting

confidence: 63%

Estimation of the 10-Year Risk of Fatal Cardiovascular Disease in the Portuguese Population: Results from the First Portuguese Health Examination Survey (INSEF 2015)

Gaio¹,

Rodrigues²,

Kislaya³

et al. 2020

Acta Med Port

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Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in Portugal and globally. Cardiovascular risk algorithms, namely the SCORE (Systematic Coronary Risk Evaluation), are recommended in the context of cardiovascular disease prevention. Our aim is to estimate and characterize the cardiovascular risk of the Portuguese population aged between 40 and 65 years old, in 2015, using the SCORE algorithm.Material and Methods: This study was performed on a subsample of the first Portuguese National Health Examination Survey - INSEF, including all participants between 40 and 65 years old with available data on sex, age, smoking status, total cholesterol and systolic blood pressure (n = 2945). The prevalence of the cardiovascular risk categories were stratified by sex, age group, marital status, educational level, occupational activity, urbanization of living area, region and income.Results: In 2015, about 5.1% and 11.9% of the Portuguese resident population aged between 40 and 65 years old were, respectively, at high and very high risk of having a fatal CV event in the following 10 years. The highest prevalence of very high cardiovascular risk was found in males, individuals aged 60-65 years old, married or living with someone, without any formal education or just with the 1st cycle of basic education and belonging to the less skilled category of the occupational activity (C category) in comparison with the othercorresponding groups.Discussion: A previous national study found a similar proportion of the population at high/very high cardiovascular risk (19.5% versus 17.1%). Our study is representative of the adult Portuguese population and adopted the European Health Examination Survey procedures, which are essential for future comparisons with other European countries. Some of the limitations of this study include the possible participation bias and the non-calibration of the SCORE algorithm for the Portuguese population.Conclusion: In 2015, a considerable proportion of the Portuguese population aged between 40 and 65 years old had a high or very high risk of developing a fatal cardiovascular event in the next 10 years. Due to the possible overestimation of the cardiovascular risk already reported in other European countries, it will be important to carry out a follow-up study to validate the adequacy of using the SCORE algorithm in the Portuguese population.

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“…Cardiovascular diseases (CVD) cause 47% of all deaths in Europe and are the main cause of death in women in all countries in Europe and the main cause of death in men in all but six countries (Nichols et al., ). Furthermore, in Spain, CVD are responsible for 30.5% of deaths (Amor et al., ). One of the most important reasons explaining the impact on the burden of CVD and mortality is demographic evolution.…”

Section: Introductionmentioning

confidence: 99%

Physical activity prescription by primary care nurses using health assets: Study design of a randomized controlled trial in patients with cardiovascular risk factors

Riera-Sampol

Tauler

Bennasar‐Veny

et al. 2017

Journal of Advanced Nursing

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Estimating Cardiovascular Risk in Spain by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice

Cited by 9 publications

References 42 publications

Prediction of Cardiovascular Disease by the Framingham‐REGICOR Equation in the High‐Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata

Prediction of Cardiovascular Disease by the Framingham‐REGICOR Equation in the High‐Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata

Estimation of the 10-Year Risk of Fatal Cardiovascular Disease in the Portuguese Population: Results from the First Portuguese Health Examination Survey (INSEF 2015)

Physical activity prescription by primary care nurses using health assets: Study design of a randomized controlled trial in patients with cardiovascular risk factors

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