scholarly journals Cardiovascular risk assessment in multiple myeloma patients undergoing carfilzomib therapy: a new risk prediction model for cardiovascular adverse events

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Astarita ◽  
G Mingrone ◽  
L Airale ◽  
F Vallelonga ◽  
C Catarinella ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular adverse events (CVAEs) are closely related to Carfilzomib (CFZ) therapy in multiple myeloma (MM), but validated management protocols are lacking. Moreover, the incidence, nature and risk factors for each type of CVAEs are incompletely characterized. Purpose To assess if the European Myeloma Network Guidelines (EMN) protocol is effective on cardiovascular risk assessment before CFZ starting. A prediction model for estimating the probability of CVAEs was developed and validated. Major and hypertensive-related CVAEs were investigated. Methods A perspective study on 116 MM patients scheduled for CFZ therapy was conducted from 2015 to 2020. Before CFZ starting, a baseline evaluation, according to the EMN protocol, was performed; during the follow-up, the incidence of CVAEs was detected. The potential risk factors for CVAEs were identified and a risk score was developed. Results The rate of all-grade CVAEs was 44.8% (24.1% CTCAE≥3): 14.7% experienced major CVEAs (41.2% arrhythmias, 23.5% acute ischemic cardiopathy as most represented) and 30.2% hypertensive-related CVAEs. At baseline, five independent predictors for all-CVAEs were identified: office systolic blood pressure (p = 0.003), 24-hours blood pressure variability (p = 0.004), left ventricular mass (p = 0.015), pulse wave velocity (p = 0.002) and global longitudinal strain (p = 0.033). The resulting CVAEs risk score allows to define the low- and high-risk groups, obtaining a sensibility of 94% in predicting CVAEs (AUC 0.76). Conclusions The comprehensive evaluation of EMN Guidelines is effective in CVAEs prediction. The use of CVAEs risk score will identify the higher risk patients, targeting appropriate follow-ups and organizing effective risk mitigation strategies. Instrumental determinants with CVAEs Parameters No CVAEs N = 64 [N (%)] CVAEs N = 52[N (%)] P value LV mass/BSA 85.30 ± 19.72 95.14 ± 21.75 0.013 LV hypertrophy [> = 95 g/m2 F > = 115 g/m2 M] 8 (12.7) 16 (30.8) 0.018 LV dilation 5 (9.3) 4 (8.9) 0.949 LV EF % 63.03 ± 6.56 61.96 ± 7.13 0.414 GLS % -22.37 ± 2.56 -21.3 ± 2.46 0.029 LV Diastolic dysfunction 1 (1.6) 0(0) 0.362 PWV 7.41 ± 1.63 8.55 ± 1.855 0.002 PWV ³ 8.75 m/s 10 (17.5) 24 (54.2) 0.000 SBP Systolic Blood Pressure; ABPM Ambulatory Blood Pressure Monitoring; BPV Blood Pressure Variability; BSA Body Surface Area; SD Standard Deviation; EF Ejection Fraction; GLS Global Longitudinal Strain; LV Left Ventricle; PWV Pulse Wave Velocity Abstract Figure. CVAEs risk score

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Palmieri ◽  
S Vannucchi ◽  
C Lo Noce ◽  
A Di Lonardo ◽  
B Unim ◽  
...  

Abstract Background Italian National Prevention Plan 2005-08 included 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE Project risk score. GPs were encouraged to perform 10-CR and send data to the Cardiovascular Risk Observatory (CRO). Aim To show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population. Methods Data were collected using the cuore.exe software, freely downloadable by GPs from the CUORE Project website (www.cuore.iss.it). The CRO provides a web-platform to compare data on 10-CR and risk factors at regional/national level. For persons examined at least twice, variations in risk factors from baseline to follow-up and 95% confidence intervals (C.I.) were calculated using methods for matched pair samples. Results Up to February 2019, about 3,500 GPs downloaded cuore.exe; about 300,000 CR assessments on about 140,000 persons were sent to CRO. Mean CR was 3.1% in women (W), 8.5% in men (M); 28% of M, 64% of W were at low risk (CR < 3%); 9.9% of M, 0.4% of W were at high risk (CR ≥ 20%); 26% of M, 16% of W were current smokers; 13% of M, 10% of W were diabetic; 33% of hypertensive M, 35% of hypertensive W were under specific treatment. Among those with at least two risk assessments (31% of the sample), 11% shifted to a lower risk class after one year (14% of M, 7% of W). Systolic blood pressure mean levels decreased by 0.6 mmHg (95%-C.I. 0.3-0.8 mmHg), diastolic blood pressure by 0.5 mmHg (0.2-0.7 mmHg), total cholesterol by 4.1 mg/dl (3.0-5.2 mg/dl), smokers prevalence by 3.1% (2.3%-4.0%); HDL-cholesterol increased in W by 0.3 mg/dl (0.1-0.5 mg/dl). Conclusions Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. Individual risk score is a useful tool for GPs to assess CR and promote primary prevention focusing on the adoption of healthy lifestyles. Data can be used to support health policy decision process. Key messages The cuore.exe software, freely downloadable from the CUORE Project website-www.cuore.iss.it, allows GPs to assess the CUORE Project risk score, to collect and to send data to the CVD Risk Observatory. 10 year Cardiovascular Risk assessment in the general adult population can be an effective first step to implement preventive actions in primary care.


Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1631
Author(s):  
Anna Astarita ◽  
Giulia Mingrone ◽  
Lorenzo Airale ◽  
Fabrizio Vallelonga ◽  
Michele Covella ◽  
...  

Cardiovascular adverse events (CVAEs) are linked to Carfilzomib (CFZ) therapy in multiple myeloma (MM); however, no validated protocols on cardiovascular risk assessment are available. In this prospective study, the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment was investigated, identifying major predictors of CVAEs. From January 2015 to March 2020, 116 MM patients who had indication for CFZ therapy underwent a baseline evaluation (including blood pressure measurements, echocardiography and arterial stiffness estimation) and were prospectively followed. The median age was 64.53 ± 8.42 years old, 56% male. Five baseline independent predictors of CVAEs were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ distinguished a low- and a high-risk group, obtaining a negative predicting value for the high-risk group of 90%. 52 patients (44.9%) experienced one or more CVAEs: 17 (14.7%) had major and 45 (38.7%) had hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is crucial. The EMN protocol and the risk score proved to be useful to estimate the baseline risk for CVAEs during CFZ therapy, allowing the identification of higher-risk patients.


Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Luigi Palmieri ◽  
Rita Rielli ◽  
Chiara Donfrancesco ◽  
Patrizia De Sanctis Caiola ◽  
Francesco Dima ◽  
...  

Background: The Italian National Prevention Plan 2005–2008 included a 10-year cardiovascular risk assessment (10-CR) for the general population aged 35–69 years using the CUORE-Project risk score. GPs were encouraged to collect data on risk factors, perform a 10-CR and send these data to the Cardiovascular Risk Observatory (CRO). Aim: The aim of this study is to show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population, a first step to implement primary preventive actions at individual level. Methods: A training plan for GPs was launched by the Ministry of Health. Data were collected using the cuore.exe software, easily and freely downloadable by GPs from the CUORE-Project website ( www.cuore.iss.it ). The CRO provides a web-platform to analyze and compare data on 10-CR and risk factors at both regional and national level. In the subgroup of persons examined at least twice a year, variations in continuous risk factors mean levels and categorical risk factors prevalences between baseline and follow-up and their 95% confidence intervals (C.I.) were calculated using methods for matched pair samples. Results: By October 2011, more than 3,000 GPs downloaded cuore.exe ; 146,322 CR assessments on 137,773 persons were sent to CRO. CR mean was 3.0% in women, 8.4% in men; 30% of men and 65% of women were at lower risk (CR<3%), 9.3% of men and 0.4% of women were at high risk (CR≥20%). Thirty-four percent of men and 19% of women were current smokers, 13% of men and 10% of women were diabetic, and 33% of hypertensive men and 35% of hypertensive women were under specific treatment. Among those with at least two risk assessments (n=8,495), 7% (95%–C.I. 6%–8%) shifted to a lower risk class after one year (9% of men and 5% of women respectively). Systolic blood pressure mean levels decreased by 1.3 mmHg (95%–C.I. 0.9–1.8 mmHg), diastolic blood pressure by 0.9 mmHg (95%–C.I. 0.5–1.3 mmHg), total cholesterol level by 5.7 mg/dl (95%–C.I. 4.4–6.9 mg/dl),6.6 mg/dl6 and smokers prevalence by 3.6% (95%–C.I. 2.6%–4.7%)6.6 mg/dl6; HDL-cholesterol increased in women by 0.8 mg/dl (95%–C.I. 0.4–1.2 mg/dl). Conclusions: Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. The individual risk score is becoming a useful tool for GPs to assess their patients’ CR and promote primary prevention by focusing attention on the adoption of healthy lifestyles. These encouraging data can be used to support health policy decision processes.


Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Luigi Palmieri ◽  
Serena Vannucchi ◽  
Cinzia Lo Noce ◽  
Anna Di Lonardo ◽  
Daniela Minutoli ◽  
...  

Background: The Italian National Prevention Plan 2005-2008 included a 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE-Project risk score. GPs were encouraged to collect data on risk factors, perform a 10-CR and send data to the Cardiovascular Risk Observatory (CRO). Aim: The aim of this study is to show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population, a first step to implement primary preventive actions at individual level. Methods: A training plan for GPs was launched by the Ministry of Health. Data were collected using the cuore.exe software, easily and freely downloadable by GPs from the CUORE-Project website (www.cuore.iss.it). The CRO provides a web-platform to analyze and compare data on 10-CR and risk factors at both regional and national level. In the subgroup of persons examined at least twice a year, variations in continuous risk factors mean levels and categorical risk factors prevalence between baseline and follow-up and their 95% confidence intervals (C.I.) were calculated using methods for matched pair samples. Results: By October 2019, about 3,500 GPs downloaded cuore.exe ; about 300,000 CR assessments on about 140,000 persons were sent to CRO. CR mean was 3.1% in women, 8.5% in men; 28% of men and 64% of women were at lower risk (CR<3%), 9.9% of men and 0.4% of women were at high risk (CR≥20%). Twenty-six percent of men and 16% of women were current smokers, 13% of men and 10% of women were diabetic, and 33% of hypertensive men and 35% of hypertensive women were under specific treatment. Among those with at least two risk assessments (31% of the sample), 11% shifted to a lower risk class after one year (14 of men and 7% of women respectively). Systolic blood pressure mean levels decreased by 0.6 mmHg (95%-C.I. 0.3-0.8 mmHg), diastolic blood pressure by 0.5 mmHg (95%-C.I. 0.2-0.7 mmHg), total cholesterol level by 3.1% (95%-C.I. 2.3%-4.0%)6.6 mg/dl6; HDL-cholesterol increased in women by 0.3 mg/dl (95%-C.I. 0.1-0.5 mg/dl). Conclusions: Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. The individual risk score is becoming a useful tool for GPs to assess their patients’ CR and promote primary prevention by focusing attention on the adoption of healthy lifestyles. These encouraging data can be used to support health policy decision processes.


Heart ◽  
2019 ◽  
Vol 105 (16) ◽  
pp. 1273-1278 ◽  
Author(s):  
Laura Benschop ◽  
Johannes J Duvekot ◽  
Jeanine E Roeters van Lennep

Hypertensive disorders of pregnancy (HDP), such as gestational hypertension and pre-eclampsia, affect up to 10% of all pregnancies. These women have on average a twofold higher risk to develop cardiovascular disease (CVD) later in life as compared with women with normotensive pregnancies. This increased risk might result from an underlying predisposition to CVD, HDP itself or a combination of both. After pregnancy women with HDP show an increased risk of classical cardiovascular risk factors including chronic hypertension, renal dysfunction, dyslipidemia, diabetes and subclinical atherosclerosis. The prevalence and onset of cardiovascular risk factors depends on the severity of the HDP and the coexistence of other pregnancy complications. At present, guidelines addressing postpartum cardiovascular risk assessment for women with HDP show a wide variation in their recommendations. This makes cardiovascular follow-up of women with a previous HDP confusing and non-coherent. Some guidelines advise to initiate cardiovascular follow-up (blood pressure, weight and lifestyle assessment) 6–8 weeks after pregnancy, whereas others recommend to start 6–12 months after pregnancy. Concurrent blood pressure monitoring, lipid and glucose assessment is recommended to be repeated annually to every 5 years until the age of 50 years when women will qualify for cardiovascular risk assessment according to all international cardiovascular prevention guidelines.


2016 ◽  
Vol 21 (5) ◽  
pp. 282-287 ◽  
Author(s):  
Murat Celik ◽  
Uygar Cagdas Yuksel ◽  
Erkan Yildirim ◽  
Erol Gursoy ◽  
Mustafa Koklu ◽  
...  

2007 ◽  
Vol 26 (2) ◽  
pp. 94-97 ◽  
Author(s):  
Snežana Jovičić ◽  
Svetlana Ignjatović ◽  
Nada Majkić-Singh

Comparison of Two Different Methods for Cardiovascular Risk Assessment:Framingham Risk ScoreandScoreSystemNumerous studies have shown that the major risk factors for coronary heart disease (cigarette smoking, hypertension, elevated serum total cholesterol and low-density lipoprotein cholesterol - LDL, low serum high-density lipoprotein cholesterol - HDL, diabetes mellitus and advancing age), are additive in predictive power. Accordingly, the total risk of a person can be estimated by summing up the risk imparted by each of the major risk factors. Using data obtained from population studies, various risk assessment algorithms have been developed. The aim of this study was to compare the two most common risk scores. Risk assessment for determining 10-year risk in 185 healthy, asymptomatic individuals of both sexes, 30-85 years old, was carried out according to both Framingham (FRS) and SCORE risk scoring. The risk factors included in the calculation of 10-year risk are gender, age, total cholesterol, HDL-cholesterol, systolic blood pressure, treatment for hypertension and cigarette smoking. The determinations of total cholesterol and HDL-cholesterol were made in sera collected after a 12h fasting period using an Olympus AU2700 automated analyzer. The Framingham risk score was determined using an electronic calculator - ATP III Risk Estimator, and the risk status according to SCORE was obtained using charts for the 10-year risk in populations at high risk. Among 185 participants, in 152 (82%) 10-year risk for Coronary Heart Disease (CHD) death was <10%, 24 (13%) had intermediate and 9 (5%) had high risk (⩾20%) according to FRS. According to SCORE, 110 (60%) participants had <1%, 56 (30%) had 1-5% and 19 (10%) had ⩾5% of 10-year risk for cardiovascular death. Different categories of risk were assigned to ~30% of individuals according to different risk assessment models. Differences in risk classification when using two different risk assessment algorithms can be explained with several important issues, including different endpoints, consideration of interactions and incorporation of antihypertensive use. It is important to note that neither FRS nor SCORE have been appropriately adjusted for our population, according to the national cardiovascular mortality rate.


2021 ◽  
pp. 089686082199692
Author(s):  
Vasilios Vaios ◽  
Panagiotis I Georgianos ◽  
Georgia Vareta ◽  
Dimitrios Divanis ◽  
Evangelia Dounousi ◽  
...  

Background: The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood. Methods: In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis. Results: In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age ( β: 0.883), 24-h systolic blood pressure (BP) ( β: 0.217) and 24-h heart rate ( β: −0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons. Conclusion: The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Salasyuk ◽  
S Nedogoda ◽  
I Barykina ◽  
V Lutova ◽  
E Popova

Abstract Background Metabolic syndrome (MetS) and abdominal obesity are one of the most common CVD risk factors among young and mature patients. However, the currently used CVD risk assessment scales may underestimate the CV risk in people with obesity and MS. Early vascular aging rather than chronological aging can conceptually offer better risk prediction. MetS, as accumulation of classical risk factors, leads to acceleration of early vascular aging. Since an important feature of MetS is its reversibility, an adequate risk assessment and early start of therapy is important in relation to the possibilities of preventing related complications. Purpose To derive a new score for calculation vascular age and predicting EVA in patients with MetS. Methods Prospective open cohort study using routinely collected data from general practice. The derivation cohort consisted of 1000 patients, aged 35–80 years with MetS (IDF,2005 criteria). The validation cohort consisted of 484 patients with MetS and carotid-femoral pulse wave velocity (cfPWV) values exceeding expected for average age values by 2 or more SD (EVA syndrome). Results In univariate analysis, EVA was significantly correlated with the presence of type 2 diabetes and clinical markers of insulin resistance (IR), body mass index (BMI), metabolic syndrome severity score (MetS z-score), uric acid (UA) level, hsCRP, HOMA-IR, total cholesterol (TC), triglycerides (TG), heart rate (HR), central aortic blood pressure (CBP), diastolic blood pressure (DBP). Multiple logistic regression shown, that presence of type 2 diabetes and IR were associated with greater risk of EVA; the odds ratios were 2.75 (95% CI: 2.34, 3.35) and 1.57 (95% CI: 1.16, 2.00), respectively. In addition, the risk of having EVA increased by 76% with an increase in HOMA-IR by 1 unit, by 17% with an increase in hsCRP by 1 mg/l, by 4% with an increase in DBP by 1 mm Hg, and by 1% with each 1 μmol / L increase in the level of UA. The area under the curve for predicting EVA in patients with MetS was 0,949 (95% CI 0,936 to 0,963), 0,630 (95% CI 0,589 to 0,671), 0,697 (95% CI 0,659 to 0,736) and 0,686 (95% CI 0,647 to 0,726), for vascular age, calculated from cfPWV, SCORE scale, QRISK-3 scale and Framingham scale, respectively. Diabetes mellitus and clinical markers of IR (yes/no), HOMA-IR and UA level were used to develop a new VAmets score for EVA prediction providing a total accuracy of 0.830 (95% CI 0,799 to 0,860). Conclusion cfPWV at present the most widely studied index of arterial stiffness, fulfills most of the stringent criteria for a clinically useful biomarker of EVA in patients with MetS. Although, parallel efforts for effective integration simple clinical score into clinical practice have been offered. Our score (VAmets) may accurately identify patients with MetS and EVA on the basis of widely available clinical variables and classic cardiovascular risk factors can prioritize using of vascular age in routine care. ROC-curves for predicting EVA in MetS Funding Acknowledgement Type of funding source: None


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