Agreement between the SCORE and D’Agostino Scales for the Classification of High Cardiovascular Risk in Sedentary Spanish Patients

BACKGROUND To evaluate agreement between cardiovascular risk in sedentary patients as estimated by the new Framingham-D'Agostino scale and by the SCORE chart, and to describe the patient characteristics associated with the observed disagreement between the scales. DESIGN A cross-sectional study was undertaken involving a systematic sample of 2,295 sedentary individuals between 40-65 years of age seen for any reason in 56 primary care offices. An estimation was made of the Pearson correlation coefficient and kappa statistic for the classification of high risk subjects (> or =20% according to the Framingham-D'Agostino scale, and > or =5% according to SCORE). Polytomous logistic regression models were fitted to identify the variables associated with the discordance between the two scales. RESULTS The mean risk in males (35%) was 19.5% +/- 13% with D'Agostino scale, and 3.2% +/- 3.3% with SCORE. Among females, they were 8.1% +/- 6.8% and 1.2% +/- 2.2%, respectively. The correlation between the two scales was 0.874 in males (95% CI: 0.857-0.889) and 0.818 in females (95% CI: 0.800-0.834), while the kappa index was 0.50 in males (95% CI: 0.44%-0.56%) and 0.61 in females (95% CI: 0.52%-0.71%). The most frequent disagreement, characterized by high risk according to D'Agostino scale but not according to SCORE, was much more prevalent among males and proved more probable with increasing age and increased LDL-cholesterol, triglyceride and systolic blood pressure values, as well as among those who used antihypertensive drugs and smokers. CONCLUSIONS The quantitative correlation between the two scales is very high. Patient categorization as corresponding to high risk generates disagreements, mainly among males, where agreement between the two classifications is only moderate.