Cardiovascular risk analysis using three prediction scales in the Colombian adult population

Abstract

Introduction: Cardiovascular diseases are one of the leading causes of morbidity and mortality in Latin America, and risk stratification is a fundamental pillar in the prevention and management of these pathologies. This study analyzes the concordance between three cardiovascular risk prediction systems in a population in northwestern Colombia, comparing the Framingham, PROCAM, and SCORE 2-OP models.

Objectives: To evaluate the concordance between the Framingham, PROCAM, and SCORE 2-OP scores in the stratification of 10-year cardiovascular risk and to analyze the distribution of cardiovascular risk in the study population. In addition, to determine the relationship between cardiometabolic risk factors and the classification obtained with each model.

Method: An observational study was conducted in a cohort of patients over 60 years of age who were part of a cardiovascular prevention program. Patients with active cancer, HIV infection, on hemodialysis, or with a life expectancy of less than one year were excluded. Each participant's cardiovascular risk was calculated using the three models and classified as low, moderate, or high risk. The classifications obtained were compared, and the agreement between the models was evaluated using the weighted kappa correlation coefficient.

Results: Two thousand four hundred eighty-two patients were included, with a gender distribution of 55.2% female and 44.8% male. The agreement between the models was 87% between Framingham and PROCAM (w=0.34; p<0.0001), 91% between Framingham and SCORE 2-OP (w=0.35; p<0.0001), and 88% between PROCAM and SCORE 2-OP (w=0.42; p<0.0001). Framingham classified a higher percentage of patients as moderate risk compared to PROCAM and SCORE 2-OP, a difference that was statistically significant (p<0.0001).

Conclusions: Cardiovascular risk assessment using Framingham, PROCAM, and SCORE 2-OP showed moderate-high agreement, highlighting differences in risk stratification. Framingham tends to classify more patients as moderate risk, suggesting a possible overestimation of risk compared to the other models. These findings highlight the need to adapt the choice of risk score according to the population profile and specific characteristics of the Latin American population.