Cardiovascular risk functions, and their practical relevance: to be trusted or not to be trusted

The practical reliability of the 20% risk threshold is examined, as fixed by the Italian Health Ministry using the European Joint Task Force(JES) 'chart of coronary risk'. Two different risk functions, one derived from the Framingham study and one from the PROCAM study, are compared. The comparison has been carried out in a homogeneous way. The data base is represented by 4584 Italian subjects (2067 males, 2517 females) on primary prevention, who participated in the RAI (Registro ANCE Ipertensione) study. The results show that there are 131 subjects (out of 271; 48.3%) who have a larger that 20% risk using the JES/Framingham algorithm, but are below threshold using the PROCAM one. Although any cut introduces a subjective measure, the choice of different risk functions is relevant in a high percentage of borderline cases, thus changing the status from 'high risk' to lower risk and vice versa.