Use of Different Scores for Cardiovascular Risk Stratification in Primary Prevention and Their Implications in Statin Indication

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


Background: Our setting lacks a cardiovascular risk score arising from a local epidemiological study, and so scores developedfrom great epidemiological studies in other regions are used. However, although these scores are very useful in clinical practice,they have limitations associated to calibration and discrimination capacity.Objectives: The purpose of this study was to 1) to stratify cardiovascular risk in a primary prevention population using differentscores; 2) to estimate the concordance between these scores; 3) to analyze statin use recommendations; and 4) to estimatethe prevalence of carotid atherosclerotic plaque (CAP) and the optimal cut-off point (OCP) of the new American score (NS)to discriminate between subjects with or without CAP.Methods: Primary prevention patients without diabetes or lipid-lowering therapy were included in the study. The Framinghamscore (FS), the European score (ES), the score recommended by the World Health Organization (WHOS) and the NS proposedby the new American guidelines were calculated, analyzing the concordance among them. The indication of statins was basedon each score. Ultrasound was used to assess CAP occurrence. A ROC analysis was performed to analyze results.Results: The study included 772 patients. Mean age was 52 ± 11 years and 66% were women. According to FS, ES and WHOS,78.8%, 50.9% and 91.7% of the population were respectively classified at “low risk”. A poor level of agreement between scoresConsejo

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020