Abstract
Assessment of cardiovascular risk is widely proposed as a basis for taking management
decisions about patients presenting with hypertension or hypercholesterolemia. Our
aim was to critically assess the use of risk equations derived from epidemiological
studies for the purpose of identifying high-risk patients.
Risk equations were retrieved from the MEDLINE database and then applied to a data
set of 118 patients. This data set was an evaluation study of the clinical value of
the World Health Organization 1993 hypertension guidelines for the decision to treat
mild hypertensive patients. We calculated agreement: 1) between equations and 2) between
equations and the decision to treat taken by the physician.
Most models were not applicable to our population, mainly because the original population
had a narrow age range or comprised only males. Between-model agreement was better
for the lower and upper risk quintiles than for the three other risk quintiles (0.58,
0.33, 0.34, 0.45, 0.70, from the lower to the upper risk quintile). When using an
arbitrary threshold for defining high-risk patients (i.e. >2% per year), we observed
a huge variation of the proportion of patients classified at high risk (from 0 to
17%). There was a poor agreement between risk models and the decision to treat taken
by the physician. These results suggest that risk-based guidelines should be validated
before their diffusion.
Keywords
Prediction - Risk Models - Cardiovascular Disease
