Validación externa de ecuaciones de riesgo cardiovascular en el Cono Sur de Latinoamérica: ¿cuál predice mejor?

GULAYIN, PABLO; DANAEI, GOODARZ; ADOLFO RUBINSTEIN; VILMA IRAZOLA

Revista Argentina de Cardiología

SAC

Año: 2018

1850-3748

ABSTRACTBackground: Inaccurate estimates of demographic cardiovascular risk may lead to an inadequate management of preventivemedical interventions such as the use of statins.Objectives: The aim of this study was to evaluate the external validity of cardiovascular risk equations in the general populationof the Southern Cone of Latin America.Methods: Equations including variables evaluated in the CESCAS cohort study and that estimate overall cardiovascularmortality (CUORE, Framingham, Globorisk and Pooled Cohort Studies) were assessed. For each equation, an independentanalysis was performed taking into account the cardiovascular events originally considered. Discrimination of each equationwas evaluated through C-statistic and Harrell?s C-index. To assess calibration, a graph was built for each equation with theproportion of observed events vs. the proportion of estimated events by risk quintiles and the β slope of the resulting linearregression was calculated. Sensitivity and specificity were determined for the detection of people at high cardiovascular risk.Results: The median follow-up time of the cohort at the time of the analysis was 2.2 years, with an interquartile range of 1.9to 2.8 years. Sixty cardiovascular events were incorporated into the analysis. All C-statistic and Harrell?s-C index values weregreater than 0.7. The value of the β slope farthest from 1 was that of the Pooled Cohort Studies score.Conclusions: Although the external validation parameters evaluated were similar, CUORE, Globorisk and the Framinghamequations showed the best global performance for cardiovascular risk estimation in our population.