Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 Laboratórios 151 e 152, Santa Efigênia, Belo Horizonte, Minas Gerais 30130090, Brasil.
Int J Clin Pract. 2010 May;64(6):739-45. doi: 10.1111/j.1742-1241.2009.02248.x.
The aim of this was to compare the performance of the Framingham, Systematic Coronary Risk Evaluation (SCORE) and Prospective Cardiovascular Munster (PROCAM) scoring systems in the risk assessment of HIV-infected patients with no overt vascular disease.
A cross-sectional study of 220 HIV-infected patients was conducted at the outpatient clinic of a referral and training centre in infectious and parasitic diseases in Belo Horizonte, Brazil. The Framingham, SCORE and PROCAM equations were calculated. Patients were classified as having low, moderate or high risk, which according to the Framingham and PROCAM equations corresponded to < 10%, 10-20% and > 20% respectively, and according to SCORE corresponded to < 3%, 3-4% and > or = 5% respectively. Cohen's kappa coefficient was used to assess agreement between the methods.
Of a total of 220 HIV-infected patients, 56 were antiretroviral (ARV)-naïve while 164 had already been treated with ARV. The prevalence of patients with a high 10-year cardiovascular risk was 3.7%, 2.5% and 1.9% according to the Framingham, PROCAM and SCORE equations respectively. The degree of agreement was moderate between the Framingham and PROCAM risk estimates (kappa = 0.433; p < 0.001), poor-to-fair between the Framingham and SCORE estimates (kappa = 0.220; p < 0.001) and moderate between the PROCAM and SCORE systems (kappa = 0.478; p < 0.001).
There are differences in risk assessment and in the identification of high risk individuals between the three risk functions under evaluation and only a prospective study will be capable of assessing which offers the best current sensitivity, specificity and predictive values for the population under investigation.
本研究旨在比较Framingham、系统性冠状动脉风险评估（SCORE）和前瞻性心血管明斯特（PROCAM）评分系统在无明显血管疾病的 HIV 感染患者风险评估中的表现。
在巴西贝洛奥里藏特传染病和寄生虫病转诊和培训中心的门诊进行了一项 220 例 HIV 感染患者的横断面研究。计算了Framingham、SCORE 和 PROCAM 方程。患者被分为低危、中危或高危，根据 Framingham 和 PROCAM 方程，分别对应<10%、10-20%和>20%，根据 SCORE 方程，分别对应<3%、3-4%和≥5%。采用 Cohen's kappa 系数评估各方法间的一致性。
在总共 220 例 HIV 感染患者中，56 例为抗逆转录病毒（ARV）初治患者，164 例已接受 ARV 治疗。根据Framingham、PROCAM 和 SCORE 方程，10 年心血管风险高的患者比例分别为 3.7%、2.5%和 1.9%。Framingham 和 PROCAM 风险估计之间的一致性为中度（kappa=0.433；p<0.001），Framingham 和 SCORE 估计之间的一致性为差到适度（kappa=0.220；p<0.001），PROCAM 和 SCORE 系统之间的一致性为中度（kappa=0.478；p<0.001）。
在评估的三种风险函数之间，风险评估和高危个体的识别存在差异，只有前瞻性研究才能评估哪种方法对研究人群具有最佳的当前敏感性、特异性和预测值。
