Rev Esp Cardiol. 2007;60(7):693-702 693 Introduction and objectives. Although its incidence is low, cardiovascular disease is the most common cause of morbidity and mortality in Spain. A number of different algorithms can be used to calculate cardiovascular disease risk for primary prevention, but their ability to identify patients who will experience a cardiovascular event is not well understood. The objective of this study was to compare the results of using the original Framingham algorithm and two adaptations for low-risk countries: the REGICOR (Registre Gironí del COR) and SCORE (Systematic COronary Risk Evaluation) algorithms. Methods. All cardiovascular events during 5-year follow-up in a cohort of patients without coronary disease in nine autonomous Spanish regions were recorded. The levels of different cardiovascular risk factors were measured between 1995 and 1998. Participants were considered high-risk if their 10-year risk was ≥20% with the Framingham algorithm, ≥10%, ≥15% or ≥20% with REGICOR, and ≥5% with SCORE. Results. In total, 180 (3.1%) coronary events (112 in men and 68 in women) occurred among the 5732 (57.3% female) participants during follow-up. Of these, 43 died from Estimating Cardiovascular Risk in Spain Using Different Algorithms Eva Comín, a Pascual Solanas, b,c Carmen Cabezas, d Isaac Subirana, e Rafel Ramos, c,e Joan Gené-Badia, f Ferran Cordón, b María Grau, c,e Joan J. Cabré-Vila, g and Jaume Marrugat c,e a Institut Català de la Salut, Barcelona, Spain b Unitat Docent de Medicina de Familia de Girona, Institut Català de la Salut, Barcelona, Spain c Universitat Autònoma de Barcelona, Barcelona, Spain d Fundació Gol i Gurina and Institut Català de la Salut, Barcelona, Spain e Unitat de Lípids i Epidemiologia Cardiovascular, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain f Consorci d'Atenció Primària de l’Eixample, Universitat de Barcelona, Barcelona, Spain g EAP Reus-1, CAP Sant Pere, Barcelona, Spain ORIGINAL ARTICLE The VERIFICA study scientific committee (a full list of researchers is available at www.regicor.org/verifica_inv): Jaume Marrugat, Carles Brotons, Carmen Cabezas, Joan Josep Cabré, Arantxa Catalán, Ramon Ciurana, Eva Comín, Ferran Cordón, Joan Gené-Badia, Rafael Masiá, Ramón Morera, Clara Pujol, Rafel Ramos, Joan Sala, Pascual Solanas, and María-Concepció Violan. This study received unconditional financial support from Grupo Esteve. It was also part-financed by the Fondo de Investigación Sanitaria research network: Redes Temáticas RECAVA (FIS C03/01), RCESP (FIS C03/09), REDIAPP-Catalunya (FISG03/170), and HERACLES (FIS G03/045), and by the Spanish Ministry of Health and Consumer Affairs, the Instituto de Salud Carlos III, (Red HERACLES RD06/0009). Correspondence: Dr. J. Marrugat. Unitat de Lípids i Epidemiologia Cardiovascular. Institut Municipal d’Investigació Mèdica. Dr. Aiguader, 80. 08003 Barcelona. España. E-mail: jmarrugat@imim.es Received August 10, 2006. Accepted for publication April 3, 2007. cerebrovascular disease, and 24 had a non-coronary vascular event. The REGICOR algorithm had the highest positive predictive value for coronary and cardiovascular disease in all age groups. Moreover, with a 10-year risk limit of 10%, it classified less of the population aged 35-74 years as high-risk (i.e., 12.4%) than the Framingham algorithm (i.e., 22.4%). The SCORE and Framingham algorithms classified 8.4% and 16.6% of the population aged 35-64 years, respectively, as having a high cardiovascular disease risk; with REGICOR, the figure was 7.5%. Conclusions. The REGICOR adapted algorithm was the best predictor of cardiovascular events and classified a smaller proportion of the Spanish population aged 35-74 years as high risk than alternative algorithms. Key words: Coronary disease. Risk factors. Hypercho- lesterolemia. Cardiovascular risk. Rendimiento de la estimación del riesgo cardiovascular en España mediante la utilización de distintas funciones Introducción y objetivos. A pesar de que presentan una baja incidencia, las enfermedades cardiovasculares son la causa más frecuente de morbimortalidad en Espa- ña. Se dispone de diversas funciones para calcular el riesgo cardiovascular en la prevención primaria, cuya ca- pacidad para identificar a los pacientes que desarrollarán acontecimientos cardiovasculares es poco conocida. Comparamos el rendimiento de las funciones de Fra- mingham original, adaptada de REGICOR (Registre Giro- ní del COR) y SCORE (Systematic COronary Risk Eva- luation) para países de bajo riesgo. Métodos. Se registraron todos los acontecimientos car- diovasculares en un seguimiento de 5 años de una co- horte sin enfermedad coronaria en 9 comunidades autó- nomas. Se midieron los factores de riesgo cardiovascular entre 1995 y 1998. Se consideró que el riesgo era eleva- do a los 10 años en ≥ 20% para Framingham, ≥ 10, ≥ 15 y ≥ 20% para REGICOR y ≥ 5% para SCORE. SEE EDITORIAL ON PAGES 690-2 Document dowloaded from http://www.revespcardiol.org, day 24/01/2008. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. This early online article has been reviewed, accepted and posted on the Web before copyediting.