[36]. Similar results were also reported in a Chinese population that the Framingham score overestimated the risk of coronary artery disease [57]. In addition, a study by Alenazi et al. (2022) found that the Framingham score detected more moderate or higher cardiovascular risk in South Asians; when compared with tools such as the ACC/AHA equation, the SCORE score, and the WHO/ISH score; however, the authors expressed doubts about the accuracy of this result and emphasized the need to develop a specialized risk assessment tool for this population [16]. A study by Rajib et al. (2021) on a group of type 2 diabetic patients in Bangladesh suggested that the Framingham score was more useful than the WHO/ISH or other scores because it estimated the largest number of high and very high risk subjects [64]. In addition, some studies have suggested that the WHO/ISH score underestimates cardiovascular risk. Otgontuya et al. (2013) used this score to study the population of 3 Asian countries, including Cambodia, Malaysia and Mongolia and found that although the score brings many benefits because it is simple and easy to use, it needs to be adjusted for some risk factors to avoid underestimating the cardiovascular risk of an individual, and each country should have its own specialized score [66]. A 2014 study concluded that the WHO/ISH score cannot stratify cardiovascular risk in Malaysians, while the Framingham score can be used in clinical practice to screen high-risk patients [78]. Liew et al. (2011) concluded that if treatment factors such as the use of antihypertensive and lipid-lowering drugs are not taken into account, cardiovascular risk may be underestimated [ 56] . As in our own study, there were some patients with good blood pressure and lipid control, while with advanced age (over 60) and diabetes status, the patient had at least an average risk level according to the Framingham score, but could be at a low risk level using the WHO/ISH scale.
Our study has limitations in that the sample size is small and the study design is cross-sectional, making it difficult to draw conclusions about trends and causal relationships. Estimating cardiovascular risk too high or too low is detrimental because it may miss subjects who need treatment or
causing patients to worry more than their actual condition. Both the Framingham and WHO/ISH scores have their own advantages and limitations when used on patients with type 2 diabetes. Our study cannot conclude which score is more reliable in estimating cardiovascular risk in patients with diabetes in particular and in Vietnamese people in general. Therefore, we recommend using both scores together to avoid overestimation or underestimation of cardiovascular risk. In addition, the results of this study indicate the need to develop a specialized cardiovascular risk estimation tool in the future for Vietnamese people. We recommend that in the future, we continue to conduct research on a larger sample size, and at the same time, conduct prospective studies and follow-up over a long period of time to more accurately assess cardiovascular risk for patients with type 2 diabetes in Vietnam in particular, thereby developing a specific cardiovascular risk assessment tool for Vietnamese people in general.
CONCLUDE
Studying the application of two scales Framingham and WHO/ISH in estimating 10-year cardiovascular risk in 90 type 2 diabetes patients, we came to the following conclusions:
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- The proportion of patients in the low, medium, high and very high risk groups were 7.78%; 22.22%; 24.44%; 45.56% (according to the Framingham scale) and 21.11%; 34.45%; 14.44%; 30.00% (according to the WHO/ISH scale), respectively.
- In the Framingham score, age, gender, HATT, HDL-C and in the WHO/ISH score, age, HATT and cholesterol are the scoring factors that account for a large proportion when assessing cardiovascular risk.
- The Framingham and WHO/ISH scales had poor agreement with kappa index = 0.259; p < 0.001.
REFERENCES
1. Tran Thi Truc Linh (2016), "Study on the relationship between cardiac manifestations and targets according to ESC-EASD recommendations in patients with type 2 diabetes and hypertension" , editor-in-chief, Doctoral Thesis in Medicine: University of Medicine and Pharmacy - Hue University.
2. Vietnam Heart Association (2010), " Recommendations on both sides
heart attack
mac h and phase transformation
Hanoi , Hanoi
2006-2010" , Hanoi Medical Publishing House
3. Ho Huynh Quang Tri Nguyen Thi Ngoc Thanh (2018), "Assessing 10-year cardiovascular risk in hypertensive patients using the ACC/AHA equation and WHO/ISH score" , Vietnam Journal of Cardiology, 61 - 66.
4. Nguyen The Quyen Nguyen Van Tri (2015), "Cardiovascular risk of Vietnamese hypertensive patients under treatment - using the 10-year cardiovascular risk assessment table according to Who/Ish" , Cardiology Topic.
5. Do Thi Quynh, Vu Van Nga, Le Thi Hoa, et al (2019), "Applying Framingham Risk Score 2008 to Predict the 10-Year Risk of Cardiovascular Disease in a Group of Office Workers in Hanoi, Vietnam" , VNU Journal of Science: Medical and Pharmaceutical Sciences; Vol 35 No 1DO - 10.25073/2588-1132/vnumps.4164.
6. Thua Nguyen Tran, Minh Pham (2021), "Predicting the risk of coronary artery disease in the next 10 years according to the Framingham score in patients with type 2 diabetes" , Vietnam Journal of Diabetes and Endocrinology, (44), 33-42.
7. Nguyen Nguyen Trang (2021), "Blood glucose control and its association with cardiovascular risk factors in patients with type 2 diabetes" , Vietnam Journal of Diabetes and Endocrinology, (49), 25-37.
8. Vu Van Nga, Ha Thi Thu Thuong, Do Thi Quynh, et al (2021), "PROJECT
PREDICTING THE RISK OF CARDIOVASCULAR DISEASE IN 10 YEARS ACCORDING TO
FRAMINGHAM SCALE IN DIABETES
TYPE 2" , Vietnam Medical Journal, 505(1).
9. Gregory A. Roth, George A. Mensah, Catherine O. Johnson, et al (2020), "Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study" , Journal of the American College of Cardiology, 76(25), 2982-3021.
10. The top 10 causes of death" (2020), " accessed May 30, 2021, at https:// www.who.int/news-room/fact-sheets/detail/the-top-10- causes-of-death .
11. "10. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes-2018" (2018), Diabetes Care, 41(Suppl 1), S105-s118.
12. 2018 Prevention Guidelines Tool CV Risk Calculator" , accessed October 17, 2021, at http://static.heart.org/riskcalc/app/index.html#!/baseline-risk .
13. About the Framingham Heart Study" , accessed October 17, 2021, at https://framinghamheartstudy.org/fhs-about/.
14. M. Afkarian, L.R. Zelnick, YN Hall, et al (2016), "Clinical Manifestations of Kidney Disease Among US Adults With Diabetes, 1988-2014" , Jama, 316(6), 602-10.
15. JA Al-Lawati, MN Barakat, NA Al-Lawati, et al (2013), "Cardiovascular risk assessment in diabetes mellitus: comparison of the general Framingham risk profile versus the World Health Organization/International Society of Hypertension risk prediction charts in Arabs--clinical implications" , Angiology, 64(5), 336-42.
16. TSS Alenazi, AAS Alhuiti, P. Amirthalingam, et al (2022), "Comparison of Cardiac Risk Scores among the East Mediterranean and South Asian Population" , Ethiop J Health Sci, 32(1), 65-72.
17. E. Alonso-Morán, JF Orueta, JI Fraile Esteban, et al (2014), "The prevalence of diabetes-related complications and multimorbidity in the population with type 2 diabetes mellitus in the Basque Country" , BMC Public Health, 14 , 1059.
18. D. Aronson, E.R. Edelman (2014), "Coronary artery disease and diabetes mellitus" , Cardiol Clin, 32(3), 439-55.
19. A. Avogaro, GP Fadini (2019), "Microvascular complications in diabetes: A growing concern for cardiologists" , Int J Cardiol, 291, 29- 35.
20. E. Banks, G. Joshy, RJ Korda, et al (2019), "Tobacco smoking and risk of 36 cardiovascular disease subtypes: fatal and non-fatal outcomes in a large prospective Australian study" , BMC Med, 17(1) ), 128.
21. L. Barua, M. Faruque, PC Banik, et al (2019), "Concordance between two versions of world health organization/international society of hypertension risk prediction chart and framingham risk score among postmenopausal women in a rural area of Bangladesh" , Indian J Public Health, 63(2), 101-106.
22. WT Cade (2008), "Diabetes-related microvascular and macrovascular diseases in the physical therapy setting" , Phys Ther, 88(11), 1322-35.
23. MC Calle,ML Fernandez (2012), "Inflammation and type 2 diabetes" , Diabetes Metab, 38(3), 183-91.
24. Cardiovascular Disease (10-year risk)" , accessed October 17, 2021, at https://framinghamheartstudy.org/fhs-risk- functions/cardiovascular-disease-10-year-risk/.
25. CR Cardoso, NC Leite,GF Salles (2016), "Prognostic Importance of C-Reactive Protein in High Cardiovascular Risk Patients With Type
2 Diabetes Mellitus: The Rio de Janeiro Type 2 Diabetes Cohort Study" , J Am Heart Assoc, 5(11).
26. AH Chen,CH Tseng (2013), "The role of triglycerides in cardiovascular disease in Asian patients with type 2 diabetes--a systematic review" , Rev Diabet Stud, 10(2-3), 101-9.
27. G. Chen, FA McAlister, RL Walker, et al (2011), "Cardiovascular outcomes in framingham participants with diabetes: the importance of blood pressure" , Hypertension, 57(5), 891-7.
28. J. Chen, Y. Zhang, J. Liu, et al (2015), "Role of lipoprotein(a) in predicting the severity of new on-set coronary artery disease in type 2 diabetics: A Gensini score evaluation" , Diabetes Vasc Dis Res, 12(4), 258- 64.
29. MT Cooney, AL Dudina, IM Graham (2009), "Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians" , J Am Coll Cardiol, 54(14), 1209-27.
30. S. Costantino, F. Paneni,F. Cosentino (2016), "Ageing, metabolism and cardiovascular disease" , J Physiol, 594(8), 2061-73.
31. RB D'Agostino, Sr., MJ Pencina, JM Massaro, et al (2013), "Cardiovascular Disease Risk Assessment: Insights from Framingham" , Glob Heart, 8(1), 11-23.
32. RB D'Agostino, Sr., RS Vasan, MJ Pencina, et al (2008), "General cardiovascular risk profile for use in primary care: the Framingham Heart Study" , Circulation, 117(6), 743-53.
33. TJ Deori, M. Agarwal, J. Masood, et al (2020), "Estimation of cardiovascular risk in a rural population of Lucknow district using WHO/ISH risk prediction charts" , J Family Med Prim Care, 9(9) , 4853-4860.
34. B. Draznin, VR Aroda, G. Bakris, et al (2022), "8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes-2022" , Diabetes Care, 45 (Suppl 1), S113-s124.
35. TR Einarson, A. Acs,C. Ludwig (2018), "Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature."
review of scientific evidence from across the world in 2007-2017" , 17(1), 83.
36. S. Ettiappan,M. Ponnusamy (2020), "Cardiovascular Risk Scores in Women Undergoing Stress Myocardial Perfusion Scan and Comparison with Scan-Predicted Risk" , Indian J Nucl Med, 35(4), 305-309.
37. C. Faselis, A. Katsimardou, K. Imprialos, et al (2020), "Microvascular Complications of Type 2 Diabetes Mellitus" , Curr Vasc Pharmacol, 18(2), 117-124.
38. M. Femlak, A. Gluba-Brzózka, A. Ciałkowska-Rysz, et al (2017), "The role and function of HDL in patients with diabetes mellitus and the related cardiovascular risk" , Lipids Health Dis, 16(1 ), 207.
39. "FHS Cardiovascular Disease (10-year risk)" , accessed May 5, 2021, at https:// www.framinghamheartstudy.org/fhs-risk- functions/cardiovascular-disease-10-year- risk/ .
40. DS Freedman, M. Horlick, Professor Berenson (2013), "A comparison of the Slaughter skinfold-thickness equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in children" , Am J Clin Nutr, 98(6) , 1417-24.
41. LG Goh, TA Welborn, SS Dhaliwal (2014), "Independent external validation of cardiovascular disease mortality in women utilizing Framingham and SCORE risk models: a mortality follow-up study" , BMC Womens Health, 14, 118.
42. I. Gouni-Berthold,HK Berthold (2011), "Lipoprotein(a): current perspectives" , Curr Vasc Pharmacol, 9(6), 682-92.
43. SM Haffner, S. Lehto, T. Rönnemaa, et al (1998), "Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction" , N Engl J Med, 339( 4), 229-34.
44. RJ Henning (2018), "Type-2 diabetes mellitus and cardiovascular disease" , Future Cardiol, 14(6), 491-509.
45. Hien Ho, Tam Nguyen Minh, Huynh Van Minh, et al (2020), "Estimation of the cardiovascular risk using world health organization/international society of hypertension risk prediction charts in Central Vietnam" , PLoS ONE, 15.
46. RR Holman, SK Paul, MA Bethel, et al (2008), "10-year follow-up of intensive glucose control in type 2 diabetes" , N Engl J Med, 359(15), 1577-89.
47. https://framinghamheartstudy.org/participants/participant-cohorts/" , accessed October 17, 2021, at page.
48. IDF Western Pacific members" (2020), " accessed on May 30, 2021, at https://idf.org/our-network/regions-members/western-pacific/members/119-vietnam.html.
49. Y. Imai, T. Hirata, S. Saitoh, et al (2020), "Impact of hypertension stratified by diabetes on the lifetime risk of cardiovascular disease mortality in Japan: a pooled analysis of data from the Evidence for Cardiovascular Prevention from Observational Cohorts in Japan study" , Hypertens Res, 43(12), 1437-1444.
50. R. Jiang, MB Schulze, T. Li, et al (2004), "Non-HDL cholesterol and apolipoprotein B predict cardiovascular disease events among men with type 2 diabetes" , Diabetes Care, 27(8), 1991-7 .
51. A. Kibel, K. Selthofer-Relatic, I. Drenjancevic, et al (2017), "Coronary microvascular dysfunction in diabetes mellitus" , J Int Med Res, 45(6), 1901-1929.
52. P. King, I. Peacock,R. Donnelly (1999), "The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes" , Br J Clin Pharmacol, 48(5), 643-8.
53. H. Labazi,AJ Trask (2017), "Coronary microvascular disease as an early culprit in the pathophysiology of diabetes and metabolic syndrome" , Pharmacol Res, 123, 114-121.
54. N. Lascar, J. Brown, H. Pattison, et al (2018), "Type 2 diabetes in adolescents and young adults" , Lancet Diabetes Endocrinol, 6(1), 69- 80.
55. AS Levey, T Greene, JW Kusek, et al (2000), "A simplified equation to predict glomerular filtration rate from serum creatinine" , J Am Soc Nephrol, 11(Suppl 2), 155.
56. SM Liew, J. Doust,P. Glasziou (2011), "Cardiovascular risk scores do not account for the effect of treatment: a review" , Heart, 97(9), 689- 97.
57. J. Liu, Y. Hong, RB D'Agostino, Sr., et al (2004), "Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese Multi-Provincial Cohort Study" , Jama , 291(21), 2591-9.
58. X. Ma, L. Dong, Q. Shao, et al (2020), "Triglyceride glucose index for predicting cardiovascular outcomes after percutaneous coronary intervention in patients with type 2 diabetes mellitus and acute coronary syndrome" , Cardiovasc Diabetol, 19( 1), 31.
59. B. Martín-Fernández,R. Gredilla (2016), "Mitochondria and oxidative stress in heart aging" , Age (Dordr), 38(4), 225-238.