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Vol. 60. Issue 11.
Pages 1214-1215 (November 2007)
Vol. 60. Issue 11.
Pages 1214-1215 (November 2007)
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Francisco Buitragoa, Lourdes Cañón- Barrosoa, Natalio Díaz-Herreraa, Eloísa Cruces-Muroa
a Unidad Docente de Medicina Familiar y Comunitaria, Centro de Salud Universitario La Paz, Badajoz, Spain
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To the Editor:

We would like to express our appreciation for the interesting comments made by Morales-Salinas et al in relation to the paper published in the Revista Española de Cardiología1 and share most of their opinions. It is true that the REGICOR and SCORE function charts are hard to compare. Each one predicts a type of risk and considers different age brackets. However, many studies have compared the various function charts of Framingham and SCORE,2,3 and some have analyzed the actual predictive capacity of these function charts in the health care center population followed up for 10 years.4 The relevance of such comparisons is fully justifiable. Cardiovascular risk estimation is recommended by numerous scientific bodies and societies, as this strategy is considered to be the most cost-effective for primary cardiovascular prevention in asymptomatic individuals, identified as those with a higher probability of experiencing a cardiovascular event in upcoming years. However, cardiovascular risk is not a disease. No one is a "cardiovascular-risk patient" and, therefore, the charts are a screening, rather than diagnostic, tool for cardiovascular disease prevention. In their daily health care practice, many physicians, particularly primary-care physicians, encounter patients who present various cardiovascular risk factors, and they must decide whether or not continuous prescription of 1 or more drugs is indicated. In this situation, a cardiovascular risk chart will help identify patients at high cardiovascular risk who would benefit from ongoing use of cholesterol-lowering and/or antihypertensive drugs, as well as lifestyle modifications. The importance and practical implications of solving this dilemma are enormous.

Determination of the value of a chart as an aid for accurate decision-making requires validation studies. The REGICOR function chart has been validated in the Spanish population5 and can be applied to a larger age bracket than SCORE. However, a comparison of the predictive capacity of REGICOR and SCORE in the population group shared by both function charts (40-65 years) favors SCORE and, therefore, research on these aspects should continue in Spain.

Despite the limitations of cardiovascular risk charts, they are currently the best tools available for screening and selecting high-cardiovascular-risk patients. Therefore, an agreement should be reached on the cut-off point for the risk at 10 years that would optimize the therapeutic effort, capacity for expenditure of the country, and optimal sensitivity and specificity, taking into account that both cannot be elevated at the same time. High sensitivity implies a low percentage of false negatives, ie, patients who developed a cardiovascular event, but had been previously categorized as not high risk. However, it tends to be accompanied by low specificity and a high percentage of false positives, ie, patients who would have been mistakenly categorized as high cardiovascular risk and who might unnecessarily be prescribed one or more drugs for a number of years. In this context, it is evident that to implement cardiovascular prevention strategies further investigation is required and broad consensus among scientific societies and the health administration is needed on the ideal risk function chart for our population.

Buitrago F, Cañón-Barroso L, Díaz-Herrera N, Cruces-Muro E, Escobar-Fernández M, Serrano-Arias JM..
Comparación de las tablas REGICOR y SCORE para la clasificación del riesgo cardiovascular y la identificación de pacientes candidatos a tratamiento hipolipemiante o antihipertensivo..
Rev Esp Cardiol, 60 (2007), pp. 139-47
Maiques A, Antón A, Franch M, Albert X, Aleixandre E, Collado A..
Riesgo cardiovascular del SCORE comparado con el de Framingham. Consecuencias del cambio propuesto por las sociedades europeas..
Med Clin (Barc), 123 (2004), pp. 681-5
Baena Díez JM, del Val García JL, Salas Gaetgens LH, Sánchez Pérez R, Altes Vaques E, Deixens Martínez B, et al..
Comparación de los modelos SCORE y REGICOR para el cálculo del riesgo cardiovascular en sujetos sin enfermedad cardiovascular atendidos en un centro de salud de Barcelona..
Rev Esp Salud Pública, 79 (2005), pp. 453-64
Buitrago F, Cañón L, Diaz N, Cruces E, Bravo B, Pérez I..
Comparación entre la tabla del SCORE y la función de Framingham-REGICOR en la estimación del riesgo cardiovascular en una población urbana seguida durante 10 años..
Med Clin (Barc), 127 (2006), pp. 368-73
Marrugat J, Subirana I, Comín E, Cabezas C, Vils J, Elosúa R, et al, for the VERIFICA Investigators..
Validity of an adaptation of the Framingham cardiovascular risk function: the VERIFICA Study..
J Epidemiol Community Health, 61 (2007), pp. 40-7
Revista Española de Cardiología (English Edition)

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