Skip to main content
NCBI home page
Atencion Primaria logoLink to Atencion Primaria
. 2008 Nov 18;38(9):490–495. [Article in Spanish] doi: 10.1157/13095052

Utilización de la ecuación de Framingham-REGICOR en un centro de atención primaria. Impacto sobre la prevención primaria de las enfermedades cardiovasculares☆

The use of the framinghamregicor equation in a primary care centre. impact on primary prevention of cardiovascular diseases

Fernando Parrilla Valero a,⁎, Andreu Segura Benedicto b, José Luis Segú Tolsa c
PMCID: PMC7679934  PMID: 17194352

Abstract

Objectives

To evaluate the adequacy of cardiovascular primary prevention by calculating cardiovascular risk (CVR) with 2 different equations and to evaluate the economic impact of the resulting drug expenditure.

Design

By means of a transversal study of all the new cases of lipaemia diagnosed, patients were classified in 2 CVR categories (≥20% and <20%). The Framingham-Wilson (FW) and Framingham-REGICOR (FR) equations were used to analyse the difference between observed treatments (really prescribed) and expected treatments. Costs were compared.

Setting

Barceloneta PCC, Barcelona, Spain.

Patients

Ninety-two cases of lipaemia (2002 and 2003) that met the following inclusion criteria: no coronary history, no taking of lipid-lowering drugs, and age between 35 and 74. There were 10 losses in the 92 individuals through lack of a variable for calculating CVR.

Results

According to the clinical criterion, 22 of the 82 patients were treated with medication (26.82%). The expected proportion of patients treated when the FW equation was used was 24.39% (20/82); and was 0% (0/82) with the FR equation. On applying the FW equation, it was seen that 12 of 22 patients treated and 10 of 60 patients not treated did not receive the correct drug treatment. If the mean cost per patient treated and per year at the PCC is applied to the new cases, there is a 9.09% reduction (€479.2) for the FW equation and 100% (€5271.2) for the FR equation.

Conclusions

The use of one or other algorithm for calculating CVR entails pertinent differences in clinical practice and expenditure. All patients in primary prevention must receive non-pharmacological treatment.

Keywords: Hypercholesterolaemia, Cardiovascular risk, Primary prevention, Framingham

Footnotes

☆

El estudio que aquí se presenta corresponde a un trabajo de tesina del Máster de Salud Pública de la UPF (edición 2002-2004). Este estudio no ha sido presentado ni publicado en ninguna revista científica y únicamente ha sido expuesto al tribunal del Máster.

Bibliografía

  • 1.Instituto Nacional de Estadística. Notes de prensa: defunciones según la causa de muerte 2002. 23 de diciembre de 2004. Disponible en: www.ine.es/prensa/prensa.htm
  • 2.Anuari estadístic de Catalunya 2004. Sanitat. Disponible en: http://www.idescat.es/publicacions/anuari/anuari04/AEC2004 _pdf/AEC200416.pdf
  • 3.Tendències de la malaltia coronària a Catalunya, 1985-87: projecte MONICA. Butlletí Epidemiològic de Catalunya. 2000;XXI:1-6.
  • 4.Pérez G., Pena A., Sala J., Roset P.N., Masià R., Marrugat J., and the REGICOR investigators Acute myocardial infartion case fatality, incidence and mortality rates in population registry in Gerona, Spain, 1990-1992. Int J Epidemiol. 1998;27:599–604. doi: 10.1093/ije/27.4.599. [DOI] [PubMed] [Google Scholar]
  • 5.Departament de Sanitat i Seguretat Social. Pla de Salut de Catalunya 2003-2005. Departament de Sanitat i Seguretat Social; Barcelona: 2003. Generalitat de Catalunya. [Google Scholar]
  • 6.Sans S., Puigdefábregas A., Paluzie G., Monterde A., Balaguer-Vintró I. Increasing trends of acute myocardial infarction in Spain: the MONICA-Catalonia Study. Eur Heart J. 2005:505–515. doi: 10.1093/eurheartj/ehi068. [DOI] [PubMed] [Google Scholar]
  • 7.Plaza I., Villar F., Mata P., Pérez F., Maiquez A., Casanovas J.A. Control de la colesterolemia en España, 2000. Un instrumento para la prevención cardiovascular. Rev Esp Cardiol. 2000;53:815–837. doi: 10.1016/s0300-8932(00)75163-3. [DOI] [PubMed] [Google Scholar]
  • 8.Prevention of coronary heart disease in clinical practice Recommendations of the Second Joint Task Force of European and other Societies on coronary prevention. Eur Heart J. 1998;19:1434–1503. doi: 10.1053/euhj.1998.1243. [DOI] [PubMed] [Google Scholar]
  • 9.American Heart Association AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 update. AHA Scientific Statement. Circulation. 2002;106:388–391. doi: 10.1161/01.cir.0000020190.45892.75. [DOI] [PubMed] [Google Scholar]
  • 10.Álvarez-Sala L.A., Núñez-Cortés J.M. Evidencias de la eficacia del tratamiento hipocolesterolemiante en la prevención primaria y secundaria de la cardiopatía isquémica. Med Clin (Barc) 2000;114(Supl 2):1–10. [PubMed] [Google Scholar]
  • 11.Generalitat de Catalunya. Departament de Sanitat i Seguretat Social. Institut Català de la Salut. Direcció clínica en l’atenció primària. Guies de pràctica clínica: hipercolesterolemia. Disponible en: www.gencat.net/ics/professionals/guies/index.htm
  • 12.Dawber T.R. The epidemiology of atheriosclerotic disease. Harvard University Press; Cambrige: 1980. The Framingham Study. [Google Scholar]
  • 13.Kannel W.B., Castelli W.P., Gordon T., McNamara P.M. Serum cholesterol, lipoproteins and the risk of coronary heart disease: the Framingham study. Ann Intern Med. 1971;74:1–12. doi: 10.7326/0003-4819-74-1-1. [DOI] [PubMed] [Google Scholar]
  • 14.Multiple Risk Factor Intervention Trial Research Group Multiple Risk Factor Intervention Trial: risk factor changes and mortality results. JAMA. 1982;248:1465–1477. [PubMed] [Google Scholar]
  • 15.Abadal L.T., Varas Lorenzo C., Pérez I., Puig T., Balaguer Vintro I. Risk factors and 28 year morbidity and mortality of coronary heart disease in a cohort with a low incidence of the disease: the Manresa Study. Rev Esp Salud Publica. 2004;78:229–241. doi: 10.1590/s1135-57272004000200009. [DOI] [PubMed] [Google Scholar]
  • 16.Wilson P.W.F., D’Agostino R.B., Levy D., Belanger A.M., Silbershatz H., Kannel W.B. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–1847. doi: 10.1161/01.cir.97.18.1837. [DOI] [PubMed] [Google Scholar]
  • 17.Anderson K.M., Wilson P.W.F., Odell P.M., Kannel W.B. An update coronary risk profile. A statement for health professionals. Circulation. 1991;83:356–362. doi: 10.1161/01.cir.83.1.356. [DOI] [PubMed] [Google Scholar]
  • 18.Verschuren W.M., Jacobs D.R., Bloemberg B.P. Serum total cholesterol and long-term coronary heart disease morbility in different cultures. Twenty-five-year follow-up of the Seven Countries Study. JAMA. 1995;274:131–136. [PubMed] [Google Scholar]
  • 19.Van den Hoogen P.C., Feskens E.J., Nagelkerke N.J. The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. N Engl J Med. 2000;342:1–8. doi: 10.1056/NEJM200001063420101. [DOI] [PubMed] [Google Scholar]
  • 20.Menotti A., Lanti M., Puddu P.E., Krombout D. Coronary heart disease incidence in northern and southern European populations: a reanalysis of the seven countries study for a European coronary risk chart. Heart. 2000;84:238–244. doi: 10.1136/heart.84.3.238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Marrugat J., Masià R., Elosua R. Cardiovascular protective factors: can they explain for the differences in mortality and morbility between the Mediterranean and the Anglo-Saxon population? Cardiovascular Risk Factors. 1998;8:196–204. [Google Scholar]
  • 22.Hense H.W., Schulte H., Lowel H., Assmann G., Keil U. Framingham risk function overestimates risk of coronary heart disease in men and women from Germany: results from the MONICA Augsburg and the PROCAM cohorts. Eur Heart J. 2003;24:937–945. doi: 10.1016/s0195-668x(03)00081-2. [DOI] [PubMed] [Google Scholar]
  • 23.Brindle P., Emberson J., Lampe F., Walker M., Whincup P., Fahey T. Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study. BMJ. 2003;327:1267. doi: 10.1136/bmj.327.7426.1267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Menotti A., Puddu P.E., Lanti M. Comparison of the Framingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J. 2000;21:365–370. doi: 10.1053/euhj.1999.1864. [DOI] [PubMed] [Google Scholar]
  • 25.Marrugat J., Solanas P., D’Agostino R. Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada. Rev Esp Cardiol. 2003;56:253–261. doi: 10.1016/s0300-8932(03)76861-4. [DOI] [PubMed] [Google Scholar]
  • 26.Marrugat J., D’Agostino R., Sullivan L. An adaptation of the Framingham coronary Herat disease risk function to European Mediterranean areas. J Epidemiol Community Health. 2003;57:634–638. doi: 10.1136/jech.57.8.634. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Segade X.M., Dosil O. Adecuación de la prescripción de hipolipemiantes y riesgo cardiovascular en pacientes con hipercolesterolemia. Gac Sanit. 2002;16:318–323. doi: 10.1016/s0213-9111(02)71931-6. [DOI] [PubMed] [Google Scholar]
  • 28.Sanz T., Escortell E., Fernández M.I., López C., Medina B., Torres C. Calidad del tratamiento farmacológico en pacientes con hiperlipemia de 4 áreas de salud. Aten Primaria. 2000;26:368–373. doi: 10.1016/S0212-6567(00)78685-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Marrugat J., Fiol M., Sala J., Tormo M.J., Segura A., Muñiz J. Variabilidad geográfica en España de las tasas de incidencia y mortalidad poblacionales por infarto agudo de miocardio en el estudio IBERICA (resumen) Rev Esp Cardiol. 2000;53(Supl 2):71. [Google Scholar]
  • 30.Shepherd J. Economics of lipid lowering in primary prevention: lessons from the West of Scotland Coronary Prevention Study. Am J Cardiol. 2001;87:19B–22B. doi: 10.1016/s0002-9149(01)01451-5. [DOI] [PubMed] [Google Scholar]

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES