Baseline 10-Year Cardiovascular Risk Scores Predict Cognitive Function in Older Persons, and Particularly Women, Living With Human Immunodeficiency Virus Infection

Abstract Background Cardiovascular disease (CVD) and associated comorbidities increase the risk of cognitive impairment in persons living with human immunodeficiency virus (PLWH). Given the potential composite effect of multiple cardiovascular risk factors on cognition, we examined the ability of the Atherosclerotic Cardiovascular Disease (ASCVD) risk score and the Framingham Heart Study Global CVD risk score (FRS) to predict future cognitive function in older PLWH. Methods We constructed linear regression models evaluating the association between baseline 10-year cardiovascular risk scores and cognitive function (measured by a summary z-score, the NPZ-4) at a year 4 follow-up visit. Results Among 988 participants (mean age, 52 years; 20% women), mean 10-year ASCVD risk score at entry into the cohort was 6.8% (standard deviation [SD], 7.1%) and FRS was 13.1% (SD, 10.7%). In models adjusted only for cognitive function at entry, the ASCVD risk score significantly predicted year 4 NPZ-4 in the entire cohort and after stratification by sex (for every 1% higher ASCVD risk, year 4 NPZ-4 was lower by 0.84 [SD, 0.28] overall, P = .003; lower by 2.17 [SD, 0.67] in women, P = .001; lower by 0.78 [SD, 0.32] in men, P = .016). A similar relationship was observed between FRS and year 4 NPZ-4. In multivariable models, higher 10-year ASCVD risk and FRS predicted lower NPZ-4 in women. Conclusions Baseline 10-year ASCVD risk and FRS predicted future cognitive function in older PLWH with well-controlled infection. Cardiovascular risk scores may help to identify PLWH, especially women, who are at risk for worse cognition over time.

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Prediction of cardiovascular risk among male patients infected with human immunodeficiency virus in Vojvodina, Serbia: A single centre study

Medicinski pregled ◽

10.2298/mpns1910286d ◽

2019 ◽

Vol 72 (9-10) ◽

pp. 286-290

Author(s):

Vanja Drljevic-Todic ◽

Andrej Preveden ◽

Daniela Maric ◽

Vanja Andric ◽

Bozidar Dejanovic ◽

...

Keyword(s):

Cardiovascular Disease ◽

Human Immunodeficiency Virus ◽

Cardiovascular Risk ◽

Data Collection ◽

Adverse Events ◽

Disease Risk ◽

Prediction Algorithm ◽

Atherosclerotic Cardiovascular Disease ◽

Heart Score ◽

Immunodeficiency Virus

Introduction. Human immunodeficiency virus infection is a disease of the modern era and it is estimated that there are more than 30 million infected individuals worldwide. Although the major cause is still unclear, patients infected with human immunodeficiency virus are at higher risk of ardiovascular diseases by 61% compared to general population. Material and Methods. This study included 111 male patients infected with human immunodeficiency virus treated at the Clinic of Infectious Diseases, Novi Sad, Serbia from January 2008 to December 2018. Five cardiovascular risk scores were used: Data Collection on Adverse Events of Antihuman immunodeficiency virus Drugs, Framingham 10-year Heart Score, Framingham 5-year Heart Score, prediction algorithm for cardiovascular disease and atherosclerotic cardiovascular disease risk estimator, at the beginning of the treatment, whereas cardiovascular events were recorded during the following 10 years. Results. Data Collection on Adverse Events of Anti-human immunodeficiency virus Drugs, Framingham 10-year Heart Score, Framingham 5-year Heart Score, and prediction algorithm for cardiovascular disease are tools that can identify individuals infected with human immunodeficiency virus at cardiovascular risk with statistical significance. The prediction algorithm for cardiovascular disease provides superior risk estimation compared to other scores. The atherosclerotic cardiovascular disease risk estimator did not show to be a marker of cardiovascular risk prediction among this population of patients. Conlusion. The above mentioned cardiovascular risk prediction algorithms, developed for general population, and Data Collection on Adverse Events of Anti-human immunodeficiency virus Drugs score, specific for population infected with human immunodeficiency virus, allow accurate cardiovascular risk estimation. Until the development of more specific algorithms, these scores are adequate tools for identification of patients at risk, providing prevention measures and treatment of cardiovascular disease.

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COMPARISON OF A FRAILTY INDEX WITH CARDIOVASCULAR RISK SCORES IN PREDICTING CARDIOVASCULAR DISEASE MORTALITY

Innovation in Aging ◽

10.1093/geroni/igz038.2944 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S800-S800

Author(s):

Dustin S Kehler ◽

Olga Theou ◽

Kenneth Rockwood

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Risk Score ◽

Mortality Risk ◽

Disease Risk ◽

Frailty Index ◽

Risk Scores ◽

Atherosclerotic Cardiovascular Disease ◽

Cvd Risk ◽

Cvd Mortality

Abstract We compared the predictive and discriminative ability of frailty with traditional cardiovascular risk scores to estimate 10-year cardiovascular disease (CVD) mortality risk. Individuals aged 20-79 years old from the National Health and Nutrition Examination Survey who were free from CVD were included (n= 32,066). A 33-item frailty index (FI) which excluded CVD and diabetes-related variables was calculated. We calculated the Framingham Disease Risk (FDR) Hard Coronary Heart Disease and General CVD risk scores, the American Heart Association/American College of Cardiology (AHA/ACC) atherosclerotic cardiovascular disease risk equation, and the European Systematic Coronary Risk Estimation tool. A total of 322 individuals died (1.0%) from CVD. There was a low correlation between the FI and CVD risk scores (spearman’s r= 0.19-0.33; p<0.0001) and a weak to strong correlation between CVD risk scores (spearman’s r=0.19-0.88; p<0.0001). The competing-risks hazard ratio for CVD mortality for every 1% increase in the FI was 1.040 (95% CI: 1.032-1.048; p<0.0001) in an age and sex-adjusted model. The FI was independently predictive of CVD mortality when the other CVD risk scores were added to the model. The area under the receiving operating characteristic (ROC) curve was 0.800 (95% CI: 0.789-0.808; p<0.0001) for the FI. ROC values for the CVD risk scores ranged from 0.710 (95% CI: 0.700-0.721; p<0.0001) for the AHA/ACC risk score to 0.779 (95% CI: 0.770-0.789; p<0.0001) for the FDR General CVD risk score. An FI calculated with non-CVD and diabetes variables can predict 10-year CVD mortality risk independently of traditional CVD risk scores.

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Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk

Journal of the American Heart Association ◽

10.1161/jaha.121.021901 ◽

2021 ◽

Author(s):

Deepak Palakshappa ◽

Edward H. Ip ◽

Seth A. Berkowitz ◽

Alain G. Bertoni ◽

Kristie L. Foley ◽

...

Keyword(s):

Mental Health ◽

Cardiovascular Disease ◽

High Risk ◽

Food Insecurity ◽

Access To Care ◽

Risk Score ◽

Equation Modeling ◽

Care Pathways ◽

Atherosclerotic Cardiovascular Disease ◽

Ascvd Risk

Background Food insecurity (FI) has been associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk; however, the pathways by which FI leads to worse cardiovascular health are unknown. We tested the hypothesis that FI is associated with ASCVD risk through nutritional/anthropometric (eg, worse diet quality and increased weight), psychological/mental health (eg, increased depressive symptoms and risk of substance abuse), and access to care pathways. Methods and Results We conducted a cross‐sectional study of adults (aged 40–79 years) using the 2007 to 2016 National Health and Nutrition Examination Survey. Our primary exposure was household FI, and our outcome was 10‐year ASCVD risk categorized as low (<5%), borderline (≥5% –<7.5%), intermediate (≥7.5%–<20%), and high risk (≥20%). We used structural equation modeling to evaluate the pathways and multiple mediation analysis to determine direct and indirect effects. Of the 12 429 participants, 2231 (18.0%) reported living in a food‐insecure household; 5326 (42.9%) had a low ASCVD risk score, 1402 (11.3%) borderline, 3606 (29.0%) intermediate, and 2095 (16.9%) had a high‐risk score. In structural models, we found significant path coefficients between FI and the nutrition/anthropometric (β, 0.130; SE, 0.027; P <0.001), psychological/mental health (β, 0.612; SE, 0.043; P <0.001), and access to care (β, 0.110; SE, 0.036; P =0.002) pathways. We did not find a significant direct effect of FI on ASCVD risk, and the nutrition, psychological, and access to care pathways accounted for 31.6%, 43.9%, and 15.8% of the association, respectively. Conclusions We found that the association between FI and ASCVD risk category was mediated through the nutrition/anthropometric, psychological/mental health, and access to care pathways. Interventions that address all 3 pathways may be needed to mitigate the negative impact of FI on cardiovascular disease.

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Differential Plasma Protein Regulation and Statin Effects in Human Immunodeficiency Virus (HIV)-Infected and Non-HIV-Infected Patients Utilizing a Proteomics Approach

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa196 ◽

2020 ◽

Vol 222 (6) ◽

pp. 929-939 ◽

Cited By ~ 2

Author(s):

Chris deFilippi ◽

Mabel Toribio ◽

Lai Ping Wong ◽

Ruslan Sadreyev ◽

Ida Grundberg ◽

...

Keyword(s):

Cardiovascular Disease ◽

Human Immunodeficiency Virus ◽

Endothelial Function ◽

Immune Activation ◽

Atherosclerotic Cardiovascular Disease ◽

Type I ◽

Integrin Subunit ◽

Central Adiposity ◽

Proteomic Approach ◽

Immunodeficiency Virus

Abstract Background People with human immunodeficiency virus (PWH) demonstrate increased atherosclerotic cardiovascular disease (ASCVD). Statins are being studied to prevent ASCVD in human immunodeficiency virus (HIV), but little is known regarding the effects of statins on a broad range of inflammatory and cardiovascular proteins in this population. Methods We used a highly specific discovery proteomic approach (Protein Extension Assay), to determine statin effects on over 350 plasma proteins in relevant ASCVD pathways among HIV and non-HIV groups. Responses to pitavastatin calcium were assessed in 89 PWH in the INTREPID trial and 46 non-HIV participants with features of central adiposity and insulin resistance. History of cardiovascular disease was exclusionary for both studies. Results Among participants with HIV, PCOLCE (enzymatic cleavage of type I procollagen) significantly increased after pitavastatin therapy and PLA2G7 (systemic marker of arterial inflammation) decreased. Among participants without HIV, integrin subunit alpha M (integrin adhesive function) and defensin alpha-1 (neutrophil function) increased after pitavastatin therapy and PLA2G7 decreased. At baseline, comparing participants with and without HIV, differentially expressed proteins included proteins involved in platelet and endothelial function and immune activation. Conclusions Pitavastatin affected proteins important to platelet and endothelial function and immune activation, and effects differed to a degree within PWH and participants without HIV.

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Optimisation of lipids for prevention of cardiovascular disease in a primary care

BMJ Open Quality ◽

10.1136/bmjoq-2017-000071 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000071

Author(s):

Smita Bakhai ◽

Aishwarya Bhardwaj ◽

Parteet Sandhu ◽

Jessica L. Reynolds

Keyword(s):

Cardiovascular Disease ◽

Electronic Health Records ◽

Lipid Profile ◽

Statin Therapy ◽

Risk Score ◽

Completion Rate ◽

Atherosclerotic Cardiovascular Disease ◽

Health Records ◽

Ascvd Risk ◽

Electronic Health

The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines focus on atherosclerotic cardiovascular disease (ASCVD) risk reduction, using a Pooled Cohort Equation to calculate a patient’s 10-year risk score, which is used to guide initiation of statin therapy. We identified a gap of evidence-based treatment for hyperlipidaemia in the Internal Medicine Clinic. Therefore, the aim of this study was to increase calculation of ASCVD risk scores in patients between the ages of 40 and 75 years from a baseline rate of less than 1% to 10%, within 12 months, for primary prevention of ASCVD. Root cause analysis was performed to identify materials/methods, provider and patient-related barriers. Plan-Do-Study-Act cycles included: (1) creation of customised workflow in electronic health records for documentation of calculated ASCVD risk score; (2) physician education regarding guidelines and electronic health record workflow; (3) refresher training for residents and a chart alert and (4) patient education and physician reminders. The outcome measures were ASCVD risk score completion rate and percentage of new prescriptions for statin therapy. Process measures included lipid profile order and completion rates. Increase in patient wait time, and blood test and medications costs were the balanced measures. We used weekly statistical process control charts for data analysis. The average ASCVD risk completion rate was 14.2%. The mean ASCVD risk completion rate was 4.0%. In eligible patients, the average lipid profile completion rate was 18%. ASCVD risk score completion rate was 33% 1-year postproject period. A team-based approach led to a sustainable increase in ASCVD risk score completion rate. Lack of automation in ASCVD risk score calculation and physician prompts in electronic health records were identified as major barriers. Furthermore, the team identified multiple barriers to lipid blood tests and treatment of increased ASCVD risk based on ACC/AHA guidelines.

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Cardiovascular Risk Scores in Axial Spondyloarthritis Versus the General Population: A Cross-sectional Study

The Journal of Rheumatology ◽

10.3899/jrheum.200188 ◽

2020 ◽

pp. jrheum.200188

Author(s):

Jean W. Liew ◽

John D. Reveille ◽

Maria Castillo ◽

Henna Sawhney ◽

Benjamin S. Naovarat ◽

...

Keyword(s):

General Population ◽

Risk Score ◽

Axial Spondyloarthritis ◽

Prevalence Ratio ◽

Cross Sectional Study ◽

Risk Scores ◽

Atherosclerotic Cardiovascular Disease ◽

Sectional Study ◽

Cross Sectional ◽

Ascvd Risk

Objective Cardiovascular (CV) morbidity and mortality are increased in axial spondyloarthritis (axSpA). We conducted a cross-sectional study evaluating the 10-year atherosclerotic cardiovascular disease (ASCVD) risk in axSpA compared to the general US population. Methods We included 211 adults, 40–75 years old with ankylosing spondylitis (AS) or nonradiographic axSpA from 2 sites, who had available data on comorbidities, medication use, blood pressure measures, and laboratory cholesterol values. General population comparators from the 2009–2014 National Health and Examination Survey (NHANES) cycles were matched 4:1 to subjects, on age, sex, and race. We estimated the prevalence ratio for a 10-year ASCVD risk score ≥ 7.5% comparing axSpA and matched NHANES comparators using conditional Poisson regression. Results Overall, subjects were 53.9 ± 11.2 years old, 69% were male, and 74% were White. The mean 10-year ASCVD risk score was 6.7 ± 6.9% for those with axSpA, and 9.0 ± 10.5% for NHANES comparators. Compared to those with axSpA, the prevalence of current smoking and diabetes was higher among NHANES comparators. The estimated prevalence ratio for a 10-year ASCVD risk score ≥ 7.5% comparing those with axSpA and their age-, sex-, and race-matched comparators was 0.96 (95% CI 0.74–1.24). Conclusion The prevalence of a 10-year ASCVD risk score ≥ 7.5% was not significantly different comparing axSpA patients and those drawn from the general population who were similar in terms of age, sex, and race. Future studies should focus on improved CV risk prediction in axSpA, because underestimation by a general population risk score may potentially explain these results.

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Abstract MP53: The Impact of the Obesity Epidemic on Atherosclerotic Cardiovascular Disease Risk Scores: The CARDIA Study

Circulation ◽

10.1161/circ.131.suppl_1.mp53 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Duke Appiah ◽

Pamela J Schreiner ◽

Raegan W Durant ◽

Sharina D Person ◽

Catarina I Kiefe ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Young Adults ◽

Disease Risk ◽

Risk Scores ◽

Atherosclerotic Cardiovascular Disease ◽

Cvd Risk ◽

Obesity Epidemic ◽

Ascvd Risk ◽

The Impact

Introduction: Cardiovascular disease (CVD) mortality has decreased over recent decades, in part, due to changes in the prevalence of risk factors. However, few studies have explored the impact of the obesity epidemic on CVD risk prediction in young adults. Hypothesis: We assessed the hypothesis that BMI trends are positively associated with changes in 10-year AHA/ACC atherosclerotic cardiovascular disease (ASCVD) risk scores from young adulthood to middle age beyond the effect of other CVD risk factors included in the scores (age, sex, race, lipids, blood pressure, hypertension medication, diabetes, smoking). METHODS: Data were obtained from 2437 black and white men and women aged 18-30 years at baseline (1985-1986) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study with follow-up exams at year 0, 5, 10, 15, 20 and 25 (ages 43-55 years). Repeated-measures regression was used to model the association between ASCVD risk scores and time-varying BMI measures. RESULTS: The average 10-year ASCVD risk increased from 0.6% at baseline (mean age: 25.3) to 3.9% at year 25 (mean age: 50.3) with the change higher for men (blacks: 1.0 to 8.2%, whites: 0.3 to 4.6%) than women (blacks: 0.5 to 3.6%, whites: 1.2 to 1.4%). The overall prevalence of obesity at baseline and year 25 was 10% and 42% respectively. BMI trends were positively associated with 10-year change in ASCVD risk scores (0.12% per 1 kg/m2 increase, p<0.001). BMI adjustment minimally reduced risk scores trends with the greatest change between unadjusted and adjusted risk scores observed among black women (0.1 to 3.0%) (Figures A and B). CONCLUSION: In young adults, BMI trends are associated positively with 10-year changes in ASCVD risk independent of other risk factors. This adds to the evidence that weight control in early adulthood is an important predictor of lower future CVD risk.

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Abstract P360: Comparison of Screening Electrocardiogram and Transthoracic Echocardiogram Abnormalities With ASCVD Risk Score Among Community Dwelling Women

Circulation ◽

10.1161/circ.137.suppl_1.p360 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Arianne Clare Agdamag ◽

Joanne Gomez ◽

Kumar Rajan ◽

Emma Fleisher ◽

Isabel Kats ◽

...

Keyword(s):

Blood Pressure ◽

Heart Disease ◽

Risk Score ◽

Community Dwelling ◽

Screening Tools ◽

Risk Scores ◽

Atherosclerotic Cardiovascular Disease ◽

Lipid Panel ◽

Ascvd Risk ◽

Asymptomatic Women

Background: Increased detection of heart disease in women has been advocated nationally in recent years. The atherosclerotic cardiovascular disease (ASCVD) risk score was validated as determinant of the 10-year risk for first occurrence of nonfatal myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke in 2013. While measurement of blood pressure, glucose, and lipid levels are common in screening, the utility of non-traditional methods such as electrocardiogram (ECG) and transthoracic echocardiography (TTE) remains unknown. We examined the association of ECG and TTE abnormalities with ASCVD risk score among asymptomatic women from a community-based event. Methods: Data were gathered from 355 women (mean age 53±13 years, 24.2% African American, 59.7% Caucasian, 6.2% Hispanic, 9.9% Others) from a voluntary cardiovascular community screening event sponsored by the 2BigHearts Foundation and Rush University Medical Center in February 2007 and May 2008. Demographics, lipid panel, blood pressure, self- reported medication lists, co-morbidities, screening TTE, and ECG were obtained. The 10-year ASCVD risk score was ascertained for the cohort (283 persons, 79.7%). Chi-square testing was used to determine association of ECG and/or TTE abnormalities with ASCVD risk score. Results: The average ASCVD risk score for the entire cohort was 5.49%, with a range from 0.1-49.2. The mean ASCVD risk score was elevated in patients with either ECG or TTE abnormalities compared to those with normal findings (ECG: 7.59±9.46 vs. 4.62±5.39, p<0.0014; TTE: 8.19±10.12 vs. 4.81±5.73, p<0.037). The presence of both ECG and TTE abnormalities was associated with a higher mean ASCVD risk score compared to having either ECG or TTE abnormalities alone (ECG+TTE: 13.07±14.32 vs. ECG: 5.7±6.19 vs. TTE: 5.27±4.65, p<0.006). Conclusion: Detection of ECG and/or TTE abnormalities are associated with elevated ASCVD risk scores in this cohort of asymptomatic women and could potentially identify patients at higher risk for cardiovascular events, and facilitate aggressive risk factor modification. Further studies are needed to confirm ECG and TTE as viable additional screening tools to traditional risk screening.

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Abstract 024: Effects Of Diet On 10-year Atherosclerotic Cardiovascular Disease Risk Using The Pooled Cohort Equations Risk Calculator: Results From The Dash Trial

Circulation ◽

10.1161/circ.143.suppl_1.024 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Sun Young Jeong ◽

Lara Kovell ◽

Timothy B Plante ◽

Christina C Wee ◽

Edgar R Miller ◽

...

Keyword(s):

Cardiovascular Disease ◽

Disease Risk ◽

Control Diet ◽

Cardiovascular Disease Risk ◽

Hdl Cholesterol ◽

Risk Scores ◽

Atherosclerotic Cardiovascular Disease ◽

Cvd Risk ◽

Dash Diet ◽

Ascvd Risk

Background: The Dietary Approaches to Stop Hypertension (DASH) diet is known to reduce cardiovascular disease (CVD) risk factors, but its effects on 10-year CVD risk based on the pooled cohort estimating equation has not been reported. Objective: To determine the effects of adopting the DASH diet on 10-year atherosclerotic cardiovascular disease (ASCVD) risk compared to a typical American (control) diet or a diet rich fruit and vegetables (F/V), but otherwise similar to control. Methods: The DASH trial was a 3-arm, parallel-group, randomized controlled feeding trial of 459 adults aged 22 to 75 years without CVD and not taking anti-hypertensive or diabetes medications. These participants were randomized to a control diet, a F/V diet, or the DASH diet for 8 weeks. Weight was kept constant. Blood pressure (BP) and lipids were measured at baseline and at 8-weeks to compare 10-year ASCVD risk scores across dietary assignments. Comparisons were performed via linear regression adjusted for baseline ASCVD risk score. Results: The mean age of participants was 45 years; 49% were women, 60% were black, and 10% were current smokers. Mean systolic BP was 131.3±10.8 mm Hg, mean LDL cholesterol was 121±32 mg/dL, and mean HDL cholesterol was 48±14 mg/dL. Both DASH and F/V diets shifted the distribution of ASCVD risk scores downward compared to the control diet ( Figure, Panel A ). Compared to the control diet, the DASH and F/V diets reduced 10-year ASCVD risk by 10.0% (95% CI: -17.7, -1.5; P = 0.02) and 11.7% (95% CI: -19.3, -3.3; P = 0.007) respectively ( Figure, Panel B ). There was no difference between the DASH and F/V diets (-1.9%; 95% CI: -10.3, 7.4; P = 0.68). Conclusions: Compared to the control diet, the DASH and F/V diets reduced 10-year ASCVD risk, while the DASH and F/V had similar effects.

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Osteocalcin value to identify subclinical atherosclerosis over atherosclerotic cardiovascular disease (ASCVD) risk score in middle-aged and elderly Chinese asymptomatic men

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-0320 ◽

2018 ◽

Vol 56 (11) ◽

pp. 1962-1969 ◽

Cited By ~ 3

Author(s):

Yiting Xu ◽

Xiaojing Ma ◽

Qin Xiong ◽

Xueli Zhang ◽

Yun Shen ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Score ◽

Subclinical Atherosclerosis ◽

Recognition Rate ◽

Negative Relationship ◽

Atherosclerotic Cardiovascular Disease ◽

Serum Osteocalcin ◽

Middle Aged ◽

Elderly Men ◽

Ascvd Risk

Abstract Background: Our study examined whether osteocalcin contributed to identifying carotid intima-media thickness (C-IMT) over the atherosclerotic cardiovascular disease (ASCVD) risk score. Methods: We recruited 618 middle-aged and elderly men from communities in Shanghai. Serum osteocalcin levels were determined using an electrochemiluminescence immunoassay. C-IMT was measured by ultrasonography. Results: The study included 245 men with low ASCVD risk and 373 men with moderate-to-high ASCVD risk. Serum osteocalcin levels were lower in the moderate-to-high risk vs. low risk men (p=0.042). Multivariate stepwise regression analysis showed that body mass index (BMI) and glycated hemoglobin were predictors for reduced osteocalcin levels (both p<0.001). Among all subjects, the proportion with an elevated C-IMT was higher in the low-osteocalcin group than in the high-osteocalcin group (p=0.042), and the significance of this result was greater when considering only subjects with a moderate-to-high ASCVD risk (p=0.011). The recognition rate of elevated C-IMT was superior with both low osteocalcin and moderate-to-high ASCVD risk vs. either parameter alone (p<0.001 and p=0.015, respectively). Osteocalcin was independently and inversely associated with elevated C-IMT after adjusting for the 10-year ASCVD risk score (p=0.004). The negative relationship remained statistically significant in subjects with a moderate-to-high ASCVD risk in particular (standardized β=−0.104, p=0.044). Conclusions: In middle-aged and elderly men, serum osteocalcin levels strengthen identifying subclinical atherosclerosis over ASCVD risk score, especially among subjects with a moderate-to-high ASCVD risk.

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