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Vol. 153. Issue 9.
Pages 351-356 (November 2019)
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Vol. 153. Issue 9.
Pages 351-356 (November 2019)
Original article
Reclassification by applying the Framingham equation 30 years to subjects with intermediate cardiovascular risk. MARK study
Reclasificación utilizando la ecuación de Framingham a 30 años a sujetos con riesgo cardiovascular intermedio. Estudio MARK
Leticia Gomez-Sancheza,b, Manuel A. Gomez-Marcosa,b,c,
Corresponding author

Corresponding author.
, Maria C. Patino-Alonsoa,b,d, Jose I. Recio-Rodrigueza,b,e, Marta Gomez-Sancheza, Jesús González-Sáncheza,f, Rosario Alonso-Domíngueza,g, Natalia Sánchez-Aguaderoa,g, Jose A. Maderuelo-Fernandeza,b, Rafel Ramosh,i, Luis Garcia-Ortiza,j, Emiliano Rodriguez-Sancheza,b,c, MARK Group k
a Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Salamanca, Spain
b Health Service of Castilla y León (SACyL), Salamanca, Spain
c Department of Medicine, University of Salamanca, Salamanca, Spain
d Department of Statistics, University of Salamanca, Salamanca, Spain
e Faculty of Health Sciences, University of Burgos, Spain
f Department of Nursing, University of Extremadura, Plasencia, Cáceres, Spain
g Department of Nursing and Physical Therapy, University of Salamanca, Salamanca, Spain
h Girona Research Unit, Primary Care Research Institute Jordi Gol (IDIAP Jordi Gol), Biomedical Research Institute of Girona Dr. Josep Trueta (IDBGI), Girona, Spain
i Department of Medical Sciences, University of Girona, Girona, Spain
j Department of Biomedical Sciences and Diagnosis, University of Salamanca, Salamanca, Spain
k redIAPP: Research Network in Preventive Activities and Health Promotion, Spain
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Figures (2)
Tables (2)
Table 1. General characteristics of the analyzed subjects.
Table 2. Reclassification of cardiovascular risk with the two FS30 models by age group and sex.
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Background and objective

The estimation of cardiovascular risk (CVR) with scores at 30 years old has a special interest in reclassifying in a suitable way <60 year subjects with intermediate CVR. This study analyzes what percentage of patients with intermediate CVR included in the MARK study is reclassified by applying the 30-year Framingham score (FS30). It also analyzes the degree of agreement between the two equations to classify high risk subjects.

Patients and methods

Cross-sectional study of 966 subjects included in the MARK study. The CVR was calculated with the two versions of the FS30 (based on lipids and body mass index) for “hard” cardiovascular events in subjects with intermediate CVR.


The 59% and 61% of the subjects with intermediate CVR would be classified as if they had high CVR to undergo a hard event if we used the FS30 in both versions. 70% of men and 35% of women would be classified as high CVR (p<0.01). The agreement percentage, measured with the Kappa index, between the equations FS30L and FS30BMI to classify the high-risk subjects was 67.9% (in men 67.4% and in women 68.7%).


In subjects with intermediate CVR the FS30 reclassifies more than the half as high RCV, 2 out of 3 men and 1 out of 3 women.

Cardiovascular risk
30-year Framingham
Primary care
General practice
Risk assessment
Antecedentes y objetivo

La estimación del riesgo cardiovascular (RCV) con ecuaciones a 30 años tienen un interés especial para reclasificar de manera adecuada los sujetos de 60 años con RCV intermedio. Este estudio analiza qué porcentaje de pacientes con RCV intermedio incluido en el estudio MARK se reclasifica aplicando la puntuación de Framingham a 30 años (FS30) y grado de concordancia entre las 2 ecuaciones para clasificar a los sujetos de riesgo alto.

Pacientes y métodos

Estudio transversal de 966 sujetos incluidos en el estudio MARK. El RCV se calculó con las 2 versiones del FS30 (basado en los lípidos y el índice de masa corporal) para eventos cardiovasculares «duros» en sujetos con RCV intermedio.


El 59 y el 61% de los sujetos con RCV intermedio se clasificarían como si tuvieran un RCV alto para sufrir un evento difícil si utilizáramos el FS30 en ambas versiones. El 70% de los varones y el 35% de las mujeres se clasificarían como RCV alto (p<0,01). El porcentaje de concordancia, medido con el índice Kappa, entre las ecuaciones FS30L y FS30BMI para clasificar a los sujetos de alto riesgo fue del 67,9% (en varones 67,4% y en mujeres 68,7%).


En sujetos con RCV intermedio, el FS30 reclasifica más de la mitad como RCV alto, 2 de cada 3 varones y una de cada 3 mujeres.

Palabras clave:
Riesgo cardiovascular
Framingham de 30 años
Atención primaria
Práctica general
Evaluación de riesgos


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