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Kidney Int Suppl. 2004 Nov;(92):S111-4.

Framingham score and microalbuminuria: combined future targets for primary prevention?

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1
Department of Clinical Pharmacology, University of Groningen, Groningen, The Netherlands. f.w.asselbergs@thorax.azg.nl

Abstract

BACKGROUND:

Risk assessment is the cornerstone of primary prevention of cardiovascular disease. Our objective was to evaluate the prognostic value of the Framingham score in microalbuminuric subjects without a history of cardiovascular disease and whether this risk score can predict the benefit of treatment with fosinopril or pravastatin.

METHODS:

Subjects were randomized to fosinopril 20 mg or matching placebo, and to pravastatin 40 mg or matching placebo (mean age 51 +/- 12 years, 65% men, N = 830). Prediction of 10-year risk for coronary heart disease by the Framingham score was performed using the risk factor categories with LDL cholesterol.

RESULTS:

Albuminuria was correlated with Framingham score at baseline (P < 0.001). In the population with a Framingham risk score <20%, both albuminuria and Framingham risk score were independent predictors of the primary end point. A two-fold increase of albuminuria or the Framingham risk score was associated with a hazard ratio of 1.60 (95% CI 1.10-2.31), P = 0.013 and 3.00 (95% CI 1.40-6.44), P = 0.005, respectively. In contrast to fosinopril, pravastatin showed a significant beneficial effect on Framingham risk score after 4 years of follow-up (P < 0.001). Furthermore, the observed absolute risk reduction in cardiovascular events was greater than calculated by the Framingham risk score.

CONCLUSION:

The Framingham score is useful in microalbuminuric subjects as a prognostic tool. In addition, when considering the risk score as a target of intervention, the beneficial effects of therapies might be underestimated. Combining the Framingham score with the level of urinary albumin excretion is suggested as a primary prevention strategy with higher efficiency.

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