Estratificación del riesgo cardiovascular utilizando diferentes puntajes de riesgo en prevención primaria. Implicancias en la indicación de estatinas

Masson, Walter; Lobo, Martín; Huerín, Melina; Molinero, Graciela; Manente, Diego; Pángaro, Mario; Vitagliano, Laura; Zylbersztejn, Horacio

doi:10.7775/rac.es.v82.i6.4527

Cited by 6 publications

(6 citation statements)

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“…Similar results were reported in previous studies, in which 20-30% of patients categorized as "low risk" by different scores exhibited CAP. (23,24) Likewise, in large population-based studies, 11% to 15% "low-risk" patients were recategorized when CAC score was considered. (25) Although the percentages are lower than those reported in our paper, our sample of patients is made up of individuals who consulted for cardiovascular risk assessment and had a higher prevalence of risk factors compared to the general population.…”

Section: Discussionmentioning

confidence: 99%

Limitations of Cardiovascular Risk Scores in Primary Prevention. An Opportunity for Risk Modulators?

Siniawski,

Masson,

Barbagelata

2023

Rev Argent Cardiol

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Background: Cardiovascular risk scores have limitations related to calibration, discrimination, and low sensitivity. Different "risk modulators" have been identified to improve cardiovascular risk stratification: carotid atherosclerotic plaque (CAP), coronary artery calcium (CAC) score and lipoprotein(a) [Lp(a)]. Objectives: The aims of this study were: 1) to determine the prevalence of risk modulators mentioned in a primary prevention population; 2) determine the concordance between the 2 methods of detecting subclinical atherosclerosis; and 3) establish which proportion of patients should receive statins according to the initial risk stratification and after being recategorized by screening for risk modulators. Methods: Individuals aged 18 to 79 years who consulted for cardiovascular risk assessment and who were not receiving lipid-lowering treatment were included. The risk score was calculated in each patient using ASCVD Risk Estimator. The presence of CAP, CAC score and Lp(a) level were evaluated. Results: The cohort was made up of 348 patients; mean age was 55.6 ± 12.2 years and 45.4% were men. In the total population, 29.8%, 36.8%, and 53.2% of patients showed Lp(a) value ≥ 50 mg/dL, CAP, or a CAC score > 0, respectively. The prevalence of CAP and CAC score was progressively higher according to the cardiovascular risk category; however, the proportion of low-risk subjects who had risk modulators was considerable (Lp(a) ≥ 50 mg/dl: 25.7%; CAP: 22%; CAC score > 0: 33%). In the 60 subjects <45 years , the prevalence of CAC score > 0 and CAP was 18.3% and 10%, respectively. The agreement between the two methods for quantifying subclinical atheromatosis was fair (kappa= 0.33). The indication for statin treatment increased by 31.6% after evaluating the presence of modulators. Conclusion: The presence of risk modulators was common in this population in primary prevention, even in low-risk subjects or <45 years. Detection of risk modulators could improve initial stratification and lead to reconsideration of statin treatment.

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Section: Discussionmentioning

confidence: 99%

Limitations of Cardiovascular Risk Scores in Primary Prevention. An Opportunity for Risk Modulators?

Siniawski,

Masson,

Barbagelata

2023

Rev Argent Cardiol

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“…Our group previously investigated the clinical applicability of different scores in a primary prevention population without specifically assessing the overweight or obese population. 12 On the other hand, there is evidence that the addition of information regarding the presence or absence of a carotid atherosclerotic plaque (CAP) to a model consisting of the traditional risk factors facilitates the prediction of cardiovascular events. 13 The optimal cut-off point (OCP) that best discriminates between subjects with or without CAP in several risk scores has previously been assessed, 12,14,15 but a similar analysis has not been reported in the population with an increased BMI.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular risk stratification in overweight or obese patients in primary prevention. Implications for use of statins

Masson¹,

Lobo²,

Huerín³

et al. 2015

Endocrinología y Nutrición (English Edition)

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“…Las mismas recomiendan un nuevo puntaje de riesgo (NP), aunque tampoco incluye para su cálculo al sobrepeso o la obesidad. Nuestro grupo ha investigado previamente la aplicabilidad clínica de diferentes puntajes en una población en prevención primaria, sin evaluar específicamente a la población con sobrepeso u obesidad 12 .…”

Section: Introductionunclassified

“…El punto de corte óptimo (PCO) que mejor discrimina entre sujetos con o sin PAC de varios puntajes de riesgo han sido previamente evaluados 12,14,15 , aunque no se ha reportado un análisis similar en la población con un IMC aumentado.…”

Section: Introductionunclassified

Estratificación del riesgo cardiovascular en pacientes con sobrepeso u obesidad en prevención primaria. Implicaciones en la utilización de estatinas

Masson¹,

Lobo²,

Huerín³

et al. 2015

Endocrinología y Nutrición

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Estratificación del riesgo cardiovascular utilizando diferentes puntajes de riesgo en prevención primaria. Implicancias en la indicación de estatinas

Cited by 6 publications

References 0 publications

Limitations of Cardiovascular Risk Scores in Primary Prevention. An Opportunity for Risk Modulators?

Limitations of Cardiovascular Risk Scores in Primary Prevention. An Opportunity for Risk Modulators?

Cardiovascular risk stratification in overweight or obese patients in primary prevention. Implications for use of statins

Estratificación del riesgo cardiovascular en pacientes con sobrepeso u obesidad en prevención primaria. Implicaciones en la utilización de estatinas

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