DISAGREEMENT AMONG THE MAIN ALGORITHMS FOR CARDIOVASCULAR RISK ESTIMATION IN PATIENTS STRATIFICATION AND IN THEIR CORRELATION WITH ARTERIAL STIFFNESS

Introduction: Cardiovascular risk (CVR) estimation algorithms assist physician in clinical management of risk factor, in the choice of treatment, and in the prescription of drugs that are reimbursed by national health institute (SSN). The main guidelines for cardiovascular prevention suggest the use of different algorithms with potential dif- ferences in risk stratification of the same patients. Aim: To assess the consistency of these algorithms and to evaluate the correlation of estimated CVR with arterial stiffness. Methods: 300 primary prevention patients were clinically evaluated and arterial stiffness (Augmentation index and Pulse Wave Velocity) was assessed by using the Vicorder system. For each patient, CVR was estimated by using the Euro- SCORE, Framingham Risk Score (FRS), ‘‘Progetto Cuore’’ and ESH/ESC 2007 hypertension guidelines algorithms. Then, each patient was assigned to one of the four risk class by using the CVR cut-off recommended for each algorithm. Results: Among the different algorithms, the ‘‘Progetto Cu- ore’’ stratified a significantly higher percentage of patients (62.4 %) into the lowest risk category in comparison with ESH/ ESC Guidelines (38.1 %), EuroSCORE (39.8 %), and FRS (27.3 %; p \ 0.001). Conversely, patients included in the highest risk category were sensibly lower by using ‘‘Progetto Cuore’’ algorithm (1,1 %) when compared with the others (ESH/ESC: 7.4 %; FRS: 10.8 %; EuroSCORE: 5.1 %). Finally, in our study population the pulse wave velocity directly correlates with CVR estimated by ‘‘Progetto Cuore’’, FRS, and ESH/ESC algorithms, but not with CVR estimated by Euro- SCORE. Similar data were obtained for Augmentation Index. Conclusions: Stratification of patients in the different CVR categories is significantly affected by the algorithms used, with potential effects in clinical management of patients in primary prevention. Unlike the EuroSCORE, the CVR estimated by ‘‘Progetto Cuore’’, ESH/ESC Guidelines and FRS significantly correlate with arterial stiffness. These data suggest the need of unify the approach to CVR esti- mation among the guidelines.