RESUMEN
OBJECTIVE: To determine the concordance and predictive capacity of various methods for calculating coronary risk in diabetic patients. DESIGN: Prospective study of cohorts, with a 10-year follow-up. SETTING: Urban health centre in a socially depressed area, with high prevalence of DM2. PARTICIPANTS: Population diagnosed with type-2 diabetes mellitus in 1991-93 (112 individuals, with an average age of 66.7+/-11.6 years, 59% of whom were male). MAIN MEASUREMENTS: At the moment of diagnosis, the parameters normally used to calculate coronary risk were determined. The tables of the Framingham scale '91 and '98, of the United Kingdom Prospective Study (UKPDS) (based on an exclusively diabetic population) and of the REgistre GIroni del COr (REGICOR-Girona Heart Register) (based on a Mediterranean population) were each used to calculate individually coronary risk at 10 years. The coronary events suffered in the 10 years following DM2 diagnosis were recorded. The Kappa indices for concordance of the tables and their predictive capacity were calculated. RESULTS: 18.2% of men and 15.2% of women suffered some coronary event. The coronary risk calculations were, for men and women, 30%-20% (Framingham '91), 36%-21% (Framingham '98), 38%-23% (UKPDS), and 15%-10% (REGICOR). CONCLUSIONS: The various methods for calculating coronary risk in diabetics suffer large variability. We should highlight their low diagnostic value in individual cases, with sensitivities of 25%-75% and low specificity (mainly in men) regarding real risk of coronary disease.
Asunto(s)
Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/etiología , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/etiología , Diabetes Mellitus Tipo 2/complicaciones , Anciano , Femenino , Humanos , Masculino , Estudios Prospectivos , Medición de RiesgoRESUMEN
Objetivo. Determinar la concordancia y capacidad predictiva de distintos métodos de cálculo de riesgo coronario en pacientes diabéticos. Diseño. Estudio de cohortes prospectivo con un seguimiento de 10 años. Emplazamiento. Centro de salud urbano de un área sociodeprimida con una elevada prevalencia de diabetes mellitus tipo 2 (DM2) . Participantes. Población diagnosticada de DM2 entre los años 1991 y 1993 (112 individuos; edad media, 66,7 ± 11,6 años; 59%, varones). Mediciones principales. En el momento del diagnóstico se determinan los parámetros de uso habitual para el cálculo del riesgo coronario. Se utilizan las tablas de Framingham 91 y 98, del United Kingdom Prospective Study (UKPDS) (basadas en la población exclusivamente diabética) y del REgistre GIroní del COR (REGICOR), (basadas en la población mediterránea) y se calcula individualmente el riesgo coronario en 10 años según cada una de ellas. Se registran los eventos coronarios aparecidos en los primeros 10 años tras el diagnóstico de DM2. Se calculan los índices kappa de concordancia entre ellas y su capacidad predictiva. Resultados. Un 18,2% de los varones y un 15,2% de las mujeres presentaron algún evento coronario. Las estimaciones de riesgo coronario fueron para varones-mujeres del 30-20% (Framingham91), 36-21% (Framingham98), 38-23% (UKPDS) y 15-10% (REGICOR). Conclusiones. Hay una gran variabilidad entre las distintas estimaciones de riesgo coronario en diabéticos. Cabe destacar el discreto valor diagnóstico individual de todas ellas, con sensibilidades del 25-75% y una baja especificidad (principalmente en varones) con respecto al riesgo real de coronariopatía
Objective. To determine the concordance and predictive capacity of various methods for calculating coronary risk in diabetic patients. Design. Prospective study of cohorts, with a 10-year follow-up. Setting. Urban health centre in a socially depressed area, with high prevalence of DM2. Participants. Population diagnosed with type- 2 diabetes mellitus in 1991-93 (112 individuals, with an average age of 66.7±11.6 years, 59% of whom were male). Main measurements. At the moment of diagnosis, the parameters normally used to calculate coronary risk were determined. The tables of the Framingham scale 91 and 98, of the United Kingdom Prospective Study (UKPDS) (based on an exclusively diabetic population) and of the REgistre GIroni del COr (REGICORGirona Heart Register) (based on a Mediterranean population) were each used to calculate individually coronary risk at 10 years. The coronary events suffered in the 10 years following DM2 diagnosis were recorded. The Kappa indices for concordance of the tables and their predictive capacity were calculated. Results. 18.2% of men and 15.2% of women suffered some coronary event. The coronary risk calculations were, for men and women, 30%-20% (Framingham 91), 36%-21% (Framingham 98), 38%-23% (UKPDS), and 15%-10% (REGICOR). Conclusions. The various methods for calculating coronary risk in diabetics suffer large variability.We should highlight their low diagnostic value in individual cases, with sensitivities of 25%-75% and low specificity (mainly in men) regarding real risk of coronary disease