Abstract
The current trend is toward a comprehensive view of cardiovascular risk, cardiovascular risk functions are instruments for classification that are useful in prioritizing preventive intervention and the risk functions should be update and improved. Objective To determine the coronary heart disease risk and global cardiovascular risk, through the application of cardiovascular risk reference tables in primary health care. Methods A transversal study was carried out, was taken a sample of 308 cases, between 34-75 years, without history of cardiovascular disease, whose demographic, anthropometric and clinical data were available, the study examined the prevalence of cardiovascular risk factors, for the prediction of coronary risk was utilized the Framingham-Wilson coronary risk prediction score(1998) and for the prediction of the global cardiovascular risk was used the Framingham- D´Agostino general cardiovascular risk score(2008). Results The average age of participants was 57.7 ± 12.5 years and 65 % were women, the prevalence of arterial hypertension was of 61%, the diabetic was 22.1 %, smokers a 26.6 % and 34.7 % were obese, the coronary heart disease reference table determined as low risk(<10%) the 51.6 % of the population, a 30.8 % as intermediate risk ( 10-20%) and 17.6 % as high risk(>20%), the global cardiovascular risk table determined a 39.6 %, a 27.6 % and 32.8 % as low, intermediate and high risk respectively. Concordance value of coronary heart disease risk table compared with global cardiovascular risk table was 0.54 (IC 95 % 0.46-0.62). Conclusion The use of tables to determine coronary and global cardiovascular risk and their recommendations should be considered in the preventive decision making in primary health care in Cuba.

Introduction
Cardiovascular diseases are the principal cause of death all over the world, every year more people die due to cardiovascular diseases than due to any other causes, the deaths caused by cardiovascular diseases affect equally both sexes and over 82 % of them occur in underdeveloped or developing countries. [1]

The cardiovascular risk is defined as the probability to suffer a cardiovascular episode in a determined period of time, generally in 5 or 10 years, the best tool to establish priorities in the primary prevention of cardiovascular diseases is the estimation of cardiovascular risk through the risk function. [2, 3]

The cardiovascular risk function should be updated and improved, because current tendency is toward a comprehensive view of cardiovascular risk, these functions are tools for the classification and stratification of the risk by family doctors, especially in patients without cardiovascular disease, that is as part of primary prevention, which is fundamental to establish the intensity of intervention, the need to establish pharmacologic treatment and the periodicity of follow-up visits [4]

Objective
To determine the coronary heart disease risk and global cardiovascular risk, through the application of cardiovascular risk reference tables in primary health care.

Methods
A transversal study was carried out at Velasco’s Teaching Policlinic, It was taken a sample of 308 cases, between 34-75 years, without previous history of cardiovascular disease, whose demographic, anthropometric and clinical data were available, the study examined the prevalence of cardiovascular risk factors, a statistical analysis was carried out assigning  a value to each variable according to the cardiovascular risk reference tables, for the prediction of global coronary risk  in 10 years  the Framingham-Wilson’s coronary risk prediction score was used(1998)[5] and to determine the global cardiovascular risk in 10 years  Framingham- D´Agostino’s general cardiovascular risk score was used (2008)[6], < 10 % was considered low risk, between 10-20 % as intermediate risk and > 20 % as high risk, the concordance of risk obtained was compared with both tables by means of the calculation of Cohen kappa coefficient to reach a significance level of 0.05.

Results
The average age of participants was 57.7 ± 12.5 years and 65% of them were women (Table 1), the prevalence of blood hypertension was of 61%, of diabetes 22.1%, of smokers 26.6% and of obese 34.7%, an increase in the prevalence of hypertrigliceridemia was observed (58.1%) (Table 2), the coronary heart disease reference table determined as low risk (<10%) 51.6% of the population, 30.8% as intermediate risk (10-20%) and 17.6% as  high risk (>20%), the global cardiovascular risk table determined 39.6%, 27.6% and 32.8% as low, intermediate and high risk respectively (Graphic 1). Concordance value of coronary heart disease risk table compared with global cardiovascular risk table was 0.54 (IC 95 % 0.46-0.62) for the total sample (Table 3).

Table 1. Characteristics of the population.

Table 2. Prevalence of the cardiovascular risk factors.

Graphic 1. Prediction of global and cardiovascular risk factors.

Table 3. Concordance of the coronary and  global cardiovascular risk tables.

Discussion
The primary prevention of cardiovascular disease is centered in the control of risk factors, elements linked to the incidence and mortality due to these diseases, the high prevalence of hypertension, diabetes, hyperlipidemia, smoking and obesity found out in this research coincides with those found out in other studies[7,8,9].

The risk tables are simplified methods of estimation, based on mathematical functions which model the risk of individuals of different cohorts of populations studied generally during a 10-year period, These functions allow estimating the overexposure to risks by the individual in respect to the average population they belong to; that is to say, from the information on the prevalence of  cardiovascular risk factors  in a population representative sample, a mathematical algorithm is established in order to obtain the percentage of people with each combination of factors, that trigger a cardiovascular event in 10 years[2].

For many years Framingham’s cardiovascular risk equation has been the most favored method for the evaluation of cardiovascular risk; however, more recently it has been warned that Framingham’s equation should be just considered as one acceptable method, despite the fact that the clinical guidelines advocate the use of cardiovascular risk tables to calculate global risk, instead of focusing on the only modification of risk, the adoption of their use has been slow [10, 11].

Coronary risk is more frequently calculated  than cardiovascular risk in the guidelines that cover both the treatment of blood hypertension and the hypercholesterolemia, because the first one is a reasonable approximation to the second one in clinical practice, an easy way to calculate cardiovascular risk departing from coronary risk is multiplying the coronary risk for 1.3 [3], If the cardiovascular risk function predicts the probability that, in a specified period of time, an individual may experience an ischaemic event circumscribed to the coronary area, then coronary risk is inferred, however, more and more  often we talk of total or global cardiovascular risk since coronary heart disease is only part of the atherosclerotic disease, which also includes cerebral vascular disease  and peripheral artery disease , among others[12], the most recently-developed cardiovascular risk functions tend to predict cardiovascular risk comprehensively[6]

It is well known that there exist limitations when these cardiovascular risk tables are used, and perhaps the more important one may be that  the absolute risk of Framingham's population does not have to be exactly the same as the one of other populations, it is also known that this function can overestimate or underestimate the risk in other populations[3,12], another drawback is that they do not include other risk factors as body mass index, waist circumference, family history of cardiovascular disease, renal function and lifestyle, among others, yet another shortcoming is that most of cardiovascular events will take place in patients with low or intermediate risk levels, since  most of the  population fall within these two groups, and this may be derived from an inaccurate classification of risk[12]

Concordance was moderate when comparing the prediction of cardiovascular risk in both tables, consequently it is recommendable to adapt them to the epidemiologic realities of every country to guarantee their applicability [13, 14], the prevention of cardiovascular diseases is based on the opportune examination that takes place during medical consultation for a more accurate identification of the population in risk of cardiovascular diseases [14].

The prediction of cardiovascular risk has become, in the last few years, the cornerstone in the clinical guidelines of cardiovascular prevention, and it turns into a useful tool for the family doctor to establish priorities in primary health care, the different methods of calculation of cardiovascular risk indicate that there is still a long way to go before being able to accurately predict the probability of occurrence of a cardiovascular event, and although the calculation using quantitative methods is more accurate than the one resulting from qualitative methods, it is  recommended that, beyond their advantages and inconveniences, it is better to use either of them than none of them[15]

Conclusion
The use of tables to determine coronary and global cardiovascular risk and their recommendations should be considered in the preventive decision making in primary health care in Cuba.

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Publication: October 2011