Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes

Detalhes bibliográficos
Autor(a) principal: Nascimento, Thiago Augusto Silva
Data de Publicação: 2009
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UFS
Texto Completo: https://ri.ufs.br/handle/riufs/3679
Resumo: Coronary heart disease (CHD) is one of the main causes of death in the world and Framingham Risk Score (FRS) is the most used tool to assess the risk of CHD in asymptomatic patients. However, it underestimates the cardiovascular (CDV) risk in some individuals. To address this problem, Brazilian Society of Cardiology proposes further risk stratification tests, using emerging risk factors - known as aggravating risk factors - that, when present, reclassify the risk category to a higher one than that initially estimated by the FRS. One does not know which of these aggravating risk factors have more influence in this reclassification, nor the frequency of each CDV risk category after their use and its financial cost. In an observational, descriptive study, 66 patients (54,8 ± 13,9 years, 33 men and 33 women) from a private clinic at Aracaju, Sergipe, had been evaluated during their routine medical exams. Forty three (65.2%) patients were at low-risk category and 23 (34.8%) at the intermediate risk. All of them had been submitted to the screening of the following aggravating risk factors: familiar history of premature CHD (FHCHD), metabolic syndrome (MS), left ventricular hypertrophy (LVH), high sensitivity C reactive protein (CPRus), chronic renal failure (CHF) and subclinical carotid atherosclerosis (SCA). Fifty seven individuals (86.4%) had presented some aggravating risk factors, and MS was the most frequent (68.2%), followed by LVH (34.9%), high CPRus (27.3%), SCA (25.8%), FHCHD (16.7%) and CHF (15.2%). After the reclassification, eight patients (12.1%) were of low risk, 36 (54.6%) of intermediate risk and 22 (33.3%) of high CDV risk. The combined diagnosis of MS and FHCHD was the less expensive strategy of reclassification, changing the risk of 48 patients (72.2%) with a cost of US$ 4,60 per each reclassified individual. The most expensive (US$ 327,52 each patient) was the isolated diagnostic of SCA, that changed the risk of only 17 patients (25.8%). Therefore, FRS underestimated CDV risk in the majority of the evaluated patients, because the frequency of risk enhancers was high, especially metabolic syndrome. Combined screening of the aggravating risk factors seems to be the better strategy. However, this screening must be individualized so as not to have unnecessary expenses.
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spelling Nascimento, Thiago Augusto Silvahttp://lattes.cnpq.br/1140562731122924Barreto Filho, José Augusto Soareshttp://lattes.cnpq.br/51230323975816382017-09-26T12:16:37Z2017-09-26T12:16:37Z2009-08-20NASCIMENTO, Thiago Augusto Silva. Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes. 2009. 52 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Sergipe, Aracaju, 2009.https://ri.ufs.br/handle/riufs/3679Coronary heart disease (CHD) is one of the main causes of death in the world and Framingham Risk Score (FRS) is the most used tool to assess the risk of CHD in asymptomatic patients. However, it underestimates the cardiovascular (CDV) risk in some individuals. To address this problem, Brazilian Society of Cardiology proposes further risk stratification tests, using emerging risk factors - known as aggravating risk factors - that, when present, reclassify the risk category to a higher one than that initially estimated by the FRS. One does not know which of these aggravating risk factors have more influence in this reclassification, nor the frequency of each CDV risk category after their use and its financial cost. In an observational, descriptive study, 66 patients (54,8 ± 13,9 years, 33 men and 33 women) from a private clinic at Aracaju, Sergipe, had been evaluated during their routine medical exams. Forty three (65.2%) patients were at low-risk category and 23 (34.8%) at the intermediate risk. All of them had been submitted to the screening of the following aggravating risk factors: familiar history of premature CHD (FHCHD), metabolic syndrome (MS), left ventricular hypertrophy (LVH), high sensitivity C reactive protein (CPRus), chronic renal failure (CHF) and subclinical carotid atherosclerosis (SCA). Fifty seven individuals (86.4%) had presented some aggravating risk factors, and MS was the most frequent (68.2%), followed by LVH (34.9%), high CPRus (27.3%), SCA (25.8%), FHCHD (16.7%) and CHF (15.2%). After the reclassification, eight patients (12.1%) were of low risk, 36 (54.6%) of intermediate risk and 22 (33.3%) of high CDV risk. The combined diagnosis of MS and FHCHD was the less expensive strategy of reclassification, changing the risk of 48 patients (72.2%) with a cost of US$ 4,60 per each reclassified individual. The most expensive (US$ 327,52 each patient) was the isolated diagnostic of SCA, that changed the risk of only 17 patients (25.8%). Therefore, FRS underestimated CDV risk in the majority of the evaluated patients, because the frequency of risk enhancers was high, especially metabolic syndrome. Combined screening of the aggravating risk factors seems to be the better strategy. However, this screening must be individualized so as not to have unnecessary expenses.A doença arterial coronariana (DAC) é uma das principais causas de morte no mundo e o Escore de Risco de Framingham (ERF) é uma das ferramentas mais utilizada para identificar indivíduos assintomáticos predispostos a essa patologia. Entretanto, ele subestima o risco cardiovascular (CDV) em determinados pacientes. Para contornar esse problema, a Sociedade Brasileira de Cardiologia preconiza a pesquisa de algumas variáveis clínicas e laboratoriais - conhecidas como critérios agravantes de risco que, quando presentes, reclassificam os pacientes numa categoria de risco superior aquela inicialmente estimada pelo ERF. Não se sabe quais dos critérios agravantes propostos têm maior influência nessa reclassificação, a freqüência de cada faixa de risco CDV nem o custo financeiro após a utilização desses agravantes. Trata-se de um estudo observacional, descritivo, foram avaliados 66 indivíduos com idade média de 54,8 ± 13,9 anos, atendidos em um serviço privado de Aracaju, Sergipe, para check-up cardiológico rotineiro. Eram 43 (65,2%) pacientes de baixo e 23 (34,8%) de médio risco pelo ERF, sendo 33 homens e 33 mulheres. Todos foram submetidos à pesquisa dos seguintes critérios agravantes: história familiar de DAC precoce (HFDAC), síndrome metabólica (SM), hipertrofia ventricular esquerda (HVE), proteína C reativa de alta sensibilidade elevada (PCRas), insuficiência renal crônica (IRC) e aterosclerose subclínica de carótidas (ATCL). Cinqüenta e sete indivíduos (86,4%) apresentaram algum agravante de risco, sendo a SM o mais frequente (68,2%), seguida pela HVE (34,9%), PCRas elevada (27,3%), ATCL (25,8%), HFDAC (16,7%) e IRC (15,2%). Após a reclassificação, oito pacientes (12,1%) eram de baixo risco, 36 (54,6%) de médio risco e 22 (33,3%) de alto risco CDV. A pesquisa combinada de SM e HFDAC foi a estratégia mais barata de reestratificação, mudando o risco de 48 pacientes (72,2%) a um custo de US$ 4,60 por indivíduo reclassificado. A mais cara (US$ 327,52 por paciente) foi a investigação isolada de ATCL, que mudou a categoria do risco em apenas 17 pessoas (25,8%). Em suma, o ERF subestimou o risco CDV na maioria dos pacientes estudados devido à elevada freqüência de critérios agravantes. Todavia, a solicitação de exames deve ser criteriosa para que não haja gastos desnecessários. A pesquisa combinada de SM e HFDAC foi a estratégia com melhor relação custo benefício.application/pdfporUniversidade Federal de SergipePós-Graduação em Ciências da SaúdeUFSBRDoença arterial coronarianaEscore de risco de FraminghamSíndrome metabólicaCoronary heart diseaseFramingham risk scoreMetabolic syndromeCNPQ::CIENCIAS DA SAUDE::MEDICINAReclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantesESTIMATED RISK OF CARDIOVASCULAR REGRADING BY THE FRAMINGHAM SCORE USING THE CONCEPT OF CRITERIA AGGRAVATINGinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFSinstname:Universidade Federal de Sergipe (UFS)instacron:UFSTEXTTHIAGO_AUGUSTO_SILVA_NASCIMENTO.pdf.txtTHIAGO_AUGUSTO_SILVA_NASCIMENTO.pdf.txtExtracted texttext/plain93118https://ri.ufs.br/jspui/bitstream/riufs/3679/2/THIAGO_AUGUSTO_SILVA_NASCIMENTO.pdf.txtc6e96b7f4d90a7061b5d34dd74e860b7MD52THUMBNAILTHIAGO_AUGUSTO_SILVA_NASCIMENTO.pdf.jpgTHIAGO_AUGUSTO_SILVA_NASCIMENTO.pdf.jpgGenerated Thumbnailimage/jpeg1307https://ri.ufs.br/jspui/bitstream/riufs/3679/3/THIAGO_AUGUSTO_SILVA_NASCIMENTO.pdf.jpg27584a60cd55766a1480a8ed28b00028MD53ORIGINALTHIAGO_AUGUSTO_SILVA_NASCIMENTO.pdfapplication/pdf443344https://ri.ufs.br/jspui/bitstream/riufs/3679/1/THIAGO_AUGUSTO_SILVA_NASCIMENTO.pdf45df4211eb77491742b5c6641286277bMD51riufs/36792017-11-28 17:00:52.845oai:ufs.br:riufs/3679Repositório InstitucionalPUBhttps://ri.ufs.br/oai/requestrepositorio@academico.ufs.bropendoar:2017-11-28T20:00:52Repositório Institucional da UFS - Universidade Federal de Sergipe (UFS)false
dc.title.por.fl_str_mv Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes
dc.title.alternative.eng.fl_str_mv ESTIMATED RISK OF CARDIOVASCULAR REGRADING BY THE FRAMINGHAM SCORE USING THE CONCEPT OF CRITERIA AGGRAVATING
title Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes
spellingShingle Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes
Nascimento, Thiago Augusto Silva
Doença arterial coronariana
Escore de risco de Framingham
Síndrome metabólica
Coronary heart disease
Framingham risk score
Metabolic syndrome
CNPQ::CIENCIAS DA SAUDE::MEDICINA
title_short Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes
title_full Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes
title_fullStr Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes
title_full_unstemmed Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes
title_sort Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes
author Nascimento, Thiago Augusto Silva
author_facet Nascimento, Thiago Augusto Silva
author_role author
dc.contributor.author.fl_str_mv Nascimento, Thiago Augusto Silva
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/1140562731122924
dc.contributor.advisor1.fl_str_mv Barreto Filho, José Augusto Soares
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/5123032397581638
contributor_str_mv Barreto Filho, José Augusto Soares
dc.subject.por.fl_str_mv Doença arterial coronariana
Escore de risco de Framingham
Síndrome metabólica
topic Doença arterial coronariana
Escore de risco de Framingham
Síndrome metabólica
Coronary heart disease
Framingham risk score
Metabolic syndrome
CNPQ::CIENCIAS DA SAUDE::MEDICINA
dc.subject.eng.fl_str_mv Coronary heart disease
Framingham risk score
Metabolic syndrome
dc.subject.cnpq.fl_str_mv CNPQ::CIENCIAS DA SAUDE::MEDICINA
description Coronary heart disease (CHD) is one of the main causes of death in the world and Framingham Risk Score (FRS) is the most used tool to assess the risk of CHD in asymptomatic patients. However, it underestimates the cardiovascular (CDV) risk in some individuals. To address this problem, Brazilian Society of Cardiology proposes further risk stratification tests, using emerging risk factors - known as aggravating risk factors - that, when present, reclassify the risk category to a higher one than that initially estimated by the FRS. One does not know which of these aggravating risk factors have more influence in this reclassification, nor the frequency of each CDV risk category after their use and its financial cost. In an observational, descriptive study, 66 patients (54,8 ± 13,9 years, 33 men and 33 women) from a private clinic at Aracaju, Sergipe, had been evaluated during their routine medical exams. Forty three (65.2%) patients were at low-risk category and 23 (34.8%) at the intermediate risk. All of them had been submitted to the screening of the following aggravating risk factors: familiar history of premature CHD (FHCHD), metabolic syndrome (MS), left ventricular hypertrophy (LVH), high sensitivity C reactive protein (CPRus), chronic renal failure (CHF) and subclinical carotid atherosclerosis (SCA). Fifty seven individuals (86.4%) had presented some aggravating risk factors, and MS was the most frequent (68.2%), followed by LVH (34.9%), high CPRus (27.3%), SCA (25.8%), FHCHD (16.7%) and CHF (15.2%). After the reclassification, eight patients (12.1%) were of low risk, 36 (54.6%) of intermediate risk and 22 (33.3%) of high CDV risk. The combined diagnosis of MS and FHCHD was the less expensive strategy of reclassification, changing the risk of 48 patients (72.2%) with a cost of US$ 4,60 per each reclassified individual. The most expensive (US$ 327,52 each patient) was the isolated diagnostic of SCA, that changed the risk of only 17 patients (25.8%). Therefore, FRS underestimated CDV risk in the majority of the evaluated patients, because the frequency of risk enhancers was high, especially metabolic syndrome. Combined screening of the aggravating risk factors seems to be the better strategy. However, this screening must be individualized so as not to have unnecessary expenses.
publishDate 2009
dc.date.issued.fl_str_mv 2009-08-20
dc.date.accessioned.fl_str_mv 2017-09-26T12:16:37Z
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identifier_str_mv NASCIMENTO, Thiago Augusto Silva. Reclassificação do risco cardiovascular estimado pelo Escore de Framingham utilizando o conceito dos critérios agravantes. 2009. 52 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Sergipe, Aracaju, 2009.
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