A Avaliação do perfil de risco cardiovascular pelo escore de Framinghamem uma amostra da população adulta de Mateus Leme (MG)

Abstract

Objective: To describe the main clinical features of the subjects of this study, to determine the prevalence of the modifiable risk factors (high blood pressure, diabetes mellitus, dyslipidemia, obesity, psychology stress, physical inactivity and smoking) and to estimate the cardiovascular risk, individual and collective, in an adult population sample of Mateus Leme (MG) - Brazil. Methods and Results: In this transversal study were assessed 231 participants aged 45 to 72years, 141 (61%) women and 90 (39%) men, from April, 28 to October, 17 of 2007. The protocol consisted of interview, anthropometric registers, physical examination, laboratorial exams, thorax x-rays and ECG. The cardiovascular risk was estimated by the Framingham Score(FS). The means of age ± SD were 58.40 ± 7.74 for women and 58.67 ± 7.67 for men. The median found was 4.0 risk factors / participant and 25 (10.8%) of them had known atherosclerotic CVD (stroke and/or CHD). Six risk factors were more prevalent among women: hypertension(p=0.025), diabetes (p=0.047), dyslipidemia (p=0.015), overweight and obesity (p=0.004), stress (p=0.004) and physical inactivity (p=0.002). Smoking was more prevalent among men (p<0.001). The BMI = 25 kg/m2 was identified in 122 (86.5%) women and in 63 (70%) men (p = 0.002). Likewise, a ratio of increased and/or very increased waist circumferencewas found in 136 (96.5%) women and in 63 (70%) men (p < 0.001). On the other hand, it was found similar proportions (0.686) for increased waist-hip ratio between female (86.5%) and male (88.9%) groups. In the primary estimate (in 10 years), involving 130 (63%) women and 76 (37%) men, the absolute total risk was 15.7 ± 9.52% (CI95% 14.6 - 16.7%) for the group, 13.59 ± 7.42% (12.31 - 14.88) for women and 18.87 ± 11.69% (16.00 - 21.34) for men (p=0.002). The absolute hard risk was 11.09 ± 8.36% (9.94 12.24) for the group, 8.89 ± 6.32% (7.80 - 9.99) for women and 14.84 ± 9.98% (12.56 - 17.12) for men (p<0.001). The relative risk was of 2.70 ± 1.46 in the group and similar (p=0.559) among women (2.69±1.55) and men (2.71±1.32). It was identified 66 (32%) high risk participants for primary prevention, being 33 (25.4%) women and 33 (43.4%) men (p=0.009). In the secondary estimate (in two years), involving 11 (44%) women and 14 (56%) men, the total risk was 9.44 ± 4.65% (7.52 11.36) in the group, 7.36 ± 4.93% (4.06 - 10.67) for women and 11.07 ± 3.83% (8,86 13,28) for men (p=0.085). However, robust evidences have shown that the Framingham risk function underestimate the predicted risk in high-risk population or with CV mortality rate rising. Efforts have been focused to adapt predictive equations fit to local population characteristics. Conclusion: It was found high prevalence of modifiable risk factors, mainly among women, resulting in a median of 4.0 risk factors / participant. In this study, the waist circumference was matching with BMI in the obesity diagnosis. The 10-year cardiovascular risk estimated was 15.47% for total CHD risk, 11.09% for hard risk and 2.7 for relative risk. It was identified 66 (32%) high-risk participants to primary prevention. However, adding 25 (10.8%) persons who had known atherosclerotic CVD, it was included 91 (39.4%) participants in the high- risk category for an intensive intervention. Although is possible that the actual risk may have been underestimated, the multiple CV risk assessment was regarded as a fundamental step in the risk stratification of the subjects of this study, becoming possible to identify the high risk condition. This valuable information guides the rational planning to intervention management. However, the results might have been more reliable with the risk equation adapted to Brazilian population characteristics.