Absolute and relative risk prediction in cardiovascular primary prevention with a modified SCORE chart incorporating ceramide-phospholipid risk score and diabetes mellitus

Abstract Aims A risk score, CERT2, based on distinct ceramide and phosphatidylcholine species has shown robust performance in predicting cardiovascular risk in secondary prevention. Here, our aim was to investigate the predictive value of CERT2 in primary prevention compared to classical lipid biomarkers and its compatibility with clinical characteristics used in the SCORE risk chart. Methods and Results Four ceramides [Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/24:0), Cer(d18:1/24:1))] and three phosphatidylcholines [PC(14:0/22:6), PC(16:0/22:5), PC(16:0/16:0)] were analysed by targeted tandem liquid chromatography-mass spectrometry method in FINRISK 2002, which is a population-based risk factor survey investigating men and women aged 25-74 years. Primary prevention subjects (N = 7,324) were followed up for 10 years for the following outcomes: incident coronary heart disease (CHD), cardiovascular disease (CVD), major adverse cardiovascular event (MACE), stroke and heart failure (HF). Hazard ratios per standard deviation obtained from adjusted Cox proportional hazard models were significant for all these endpoints, and the highest for fatal ones, i.e. fatal CHD [1.45 (95% confidence interval 1.07-1.97)], CVD [1.39 (1.06-1.83)] and MACE [1.39 (1.07-1.80)]. The categorical net reclassification improvement was 0.051 for 10-year risk of incident CVD. Incidence of fatal events was over 10-fold more frequent in the highest CERT2 category compared to the lowest risk category and modified SCORE risk charts, utilizing CERT2 and diabetes mellitus, increased granularity of risk assessment compared to a chart utilizing total cholesterol. Conclusion CERT2 is a significant predictor of incident cardiovascular outcomes and risk charts utilizing this score provide an easy tool to estimate relative and absolute risk for incident CVD.

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Implications of the ACC/AHA risk score for prediction of heart failure: the Rotterdam Study

BMC Medicine ◽

10.1186/s12916-021-01916-7 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Banafsheh Arshi ◽

Jan C. van den Berge ◽

Bart van Dijk ◽

Jaap W. Deckers ◽

M. Arfan Ikram ◽

...

Keyword(s):

Heart Failure ◽

Primary Prevention ◽

Risk Score ◽

Heart Association ◽

Risk Scores ◽

Study Cohort ◽

Rotterdam Study ◽

Cox Models ◽

Net Reclassification Improvement ◽

C Statistic

Abstract Background Despite the growing burden of heart failure (HF), there have been no recommendations for use of any of the primary prevention models in the existing guidelines. HF was also not included as an outcome in the American College of Cardiology/American Heart Association (ACC/AHA) risk score. Methods Among 2743 men and 3646 women aged ≥ 55 years, free of HF, from the population-based Rotterdam Study cohort, 4 Cox models were fitted using the predictors of the ACC/AHA, ARIC and Health-ABC risk scores. Performance of the models for 10-year HF prediction was evaluated. Afterwards, performance and net reclassification improvement (NRI) for adding NT-proBNP to the ACC/AHA model were assessed. Results During a median follow-up of 13 years, 429 men and 489 women developed HF. The ARIC model had the highest performance [c-statistic (95% confidence interval [CI]): 0.80 (0.78; 0.83) and 0.80 (0.78; 0.83) in men and women, respectively]. The c-statistic for the ACC/AHA model was 0.76 (0.74; 0.78) in men and 0.77 (0.75; 0.80) in women. Adding NT-proBNP to the ACC/AHA model increased the c-statistic to 0.80 (0.78 to 0.83) in men and 0.81 (0.79 to 0.84) in women. Sensitivity and specificity of the ACC/AHA model did not drastically change after addition of NT-proBNP. NRI(95%CI) was − 23.8% (− 19.2%; − 28.4%) in men and − 27.6% (− 30.7%; − 24.5%) in women for events and 57.9% (54.8%; 61.0%) in men and 52.8% (50.3%; 55.5%) in women for non-events. Conclusions Acceptable performance of the model based on risk factors included in the ACC/AHA model advocates use of this model for prediction of HF risk in primary prevention setting. Addition of NT-proBNP modestly improved the model performance but did not lead to relevant discrimination improvement in clinical risk reclassification.

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Thai CV risk score and primary prevention in impaired fasting plasma glucose or diabetes mellitus versus normoglycemia in patients with metabolic syndrome

International Journal of Preventive Medicine ◽

10.4103/ijpvm.ijpvm_12_19 ◽

2020 ◽

Vol 11 (1) ◽

pp. 139

Author(s):

Duangjai Duangrithi ◽

Ruja Wattanasermkit ◽

Sudarat Rungwijee ◽

Natthanicha Khunsom

Keyword(s):

Diabetes Mellitus ◽

Metabolic Syndrome ◽

Primary Prevention ◽

Risk Score ◽

Plasma Glucose ◽

Fasting Plasma Glucose ◽

Fasting Plasma

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410Heart failure risk stratification and efficacy of dapagliflozin in patients with type 2 diabetes mellitus

European Heart Journal ◽

10.1093/eurheartj/ehz747.0105 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Berg ◽

S Wiviott ◽

B Scirica ◽

Y Gurmu ◽

O Mosenzon ◽

...

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

Risk Score ◽

Absolute Risk ◽

Sglt2 Inhibitor ◽

Risk Indicators ◽

Clinical Risk Score ◽

Clinical Risk ◽

Risk Patients

Abstract Background Patients with type 2 diabetes mellitus (T2DM) are at increased risk of developing heart failure (HF). Treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors reduces the risk of hospitalization for HF (HHF) in patients with T2DM. Purpose To develop and validate a practical, multivariable clinical risk score for HHF in patients with T2DM and assess whether this score can identify high-risk patients with T2DM who have the greatest reduction in risk for HHF with an SGLT2 inhibitor. Methods We developed a clinical risk score for centrally-adjudicated HHF using independent clinical risk indicators of HHF in 8212 patients with T2DM in the placebo arm of SAVOR-TIMI 53. Candidate variables were assessed using multivariable Cox regression and independent clinical risk indicators achieving statistical significance of p<0.001 were included in the risk score and given weights proportional to the regression coefficients. We externally validated the score in 8578 patients with T2DM in the placebo arm of DECLARE-TIMI 58. Discrimination was assessed using Harrell's c-index. The relative and absolute risk reductions in HHF with the SGLT2 inhibitor dapagliflozin were assessed by baseline HHF risk. Results The 5 independent clinical risk indicators were prior heart failure, atrial fibrillation, coronary artery disease, estimated glomerular filtration rate (eGFR), and urine albumin/creatinine ratio (UACR) (Figure, left). A simple integer-based scheme using these predictors identified a strong >16-fold gradient of HHF risk (p-trend <0.001) in both the derivation and validation cohorts, with c-indices of 0.81 and 0.78, respectively. Whereas relative risk reductions were similar across the risk score (25–34%), absolute risk reductions were greater in those at higher baseline risk (interaction p-value for absolute risk reduction <0.01), with high-risk (2 points) and very high-risk patients (≥3 points) having 1.5% and 2.7% absolute risk reductions in HHF at 4 years with dapagliflozin, translating into NNTs of only 65 and 36, respectively (Figure, right). Conclusion(s) Risk stratification using a novel clinical risk score for HHF in patients with T2DM identifies patients at higher risk for HHF who derive greater benefit from treatment with the SGLT2 inhibitor dapagliflozin. Acknowledgement/Funding SAVOR-TIMI 53 and DECLARE-TIMI 58 were sponsored by AstraZeneca.

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Abstract 15173: Association of Specific Statins With Cardiovascular Disease, All-cause Mortality, and Disability-free Survival in Initially Healthy Older Adults

Circulation ◽

10.1161/circ.142.suppl_3.15173 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Zhen Zhou ◽

richard ofori asenso ◽

Enayet K Chowdhury ◽

Andrea J Curtis ◽

Monique Breslin ◽

...

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Primary Prevention ◽

Significant Risk ◽

Major Adverse Cardiovascular Event ◽

Adverse Cardiovascular Event ◽

Cox Models ◽

Free Survival ◽

Healthy Older Adults ◽

All Cause Mortality

Background: The effectiveness of specific statins for the primary prevention of cardiovascular disease (CVD) in older adults is not well-characterized. Objective: To assess whether specific statin subclasses according to type, potency and solubility are associated with lower risk of CVD, all-cause mortality and improved disability-free survival in older adults. Methods: The cohort included 18,090 subjects from a primary prevention trial of aspirin, aged ≥70 years, initially free of CVD, disability and dementia, and followed for a median of 4.7 years. Outcomes included major adverse cardiovascular event (MACE, definition see Table ), all-cause mortality and disability-free survival (a composite of persistent physical disability, all-cause mortality or dementia). Three multivariable Cox models were used to estimate hazard ratios (HRs) for each outcome comparing participants taking specific statin subclasses at baseline with baseline statin nonusers. Results: At baseline, participants’ median age was 74.2 years and 5,623 were using statins (31%). Atorvastatin (38%) was the most widely used, followed by simvastatin (30%), rosuvastatin (26%) and other statins (7%, mainly pravastatin). Compared with nonusers, the risk of MACE was significantly lower for atorvastatin (HR: 0.68, 95% CI: 0.48-0.96) and rosuvastatin users (0.59, 0.37-0.94), but not for simvastatin (0.82, 0.57-1.17) or other statin users (1.02, 0.54-1.93). A significant risk reduction in MACE was also seen for high-potency statin users and for both lipophilic and hydrophilic statin users but not for low/moderate-potency statin users. None of the specific statin subclasses was associated with improved disability-free survival or reduced all-cause mortality. ( Table ) Conclusions: In healthy older adults, specific statin subclasses were associated with varying cardiovascular benefits but none was associated with improved disability-free survival or reduced all-cause mortality.

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A Biomarker-Based Score for Risk of Hospitalization for Heart Failure in Patients With Diabetes

10.2337/figshare.16451109 ◽

2021 ◽

Author(s):

David D. Berg ◽

Stephen D. Wiviott ◽

Benjamin M. Scirica ◽

Thomas A. Zelniker ◽

Erica L. Goodrich ◽

...

Keyword(s):

Heart Failure ◽

Risk Score ◽

Cox Regression ◽

Troponin T ◽

Absolute Risk ◽

High Sensitivity ◽

Risk Groups ◽

Risk Category ◽

Clinical Factor ◽

Patients With Diabetes

Objective: Heart failure (HF) is an impactful complication of type 2 diabetes mellitus (T2DM). We aimed to develop and validate a risk score for hospitalization for HF (HHF) incorporating biomarkers and clinical factor(s) in patients with T2DM. Research Design and Methods: We derived a risk score for HHF using clinical data, high-sensitivity troponin T (hsTnT), and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) from 6,106 placebo-treated patients with T2DM in SAVOR-TIMI 53. Candidate variables were assessed using Cox regression. The strongest indicators of HHF risk were included in the score using integer weights. The score was externally validated in 7,251 placebo-treated patients in DECLARE-TIMI 58. The effect of dapagliflozin on HHF was assessed by risk category in DECLARE-TIMI 58. Results: The strongest indicators of HHF risk were NT-proBNP, prior HF, and hsTnT (each p<0.001). A risk score using these 3 variables identified a gradient of HHF risk (p-trend<0.001) in the derivation and validation cohorts, with c-indices of 0.87 (95%CI, 0.84-0.89) and 0.84 (0.81-0.86), respectively. Whereas there was no significant effect of dapagliflozin vs. placebo on HHF in the low-risk group (hazard ratio [HR] 0.98[0.50-1.92]), dapagliflozin significantly reduced HHF in the intermediate-, high-, and very high-risk groups (HR 0.64[0.43-0.95], 0.63[0.43-0.94], and 0.72[0.54-0.96], respectively). Correspondingly, absolute risk reductions increased across these latter 3 groups: 1.0%(0.0%-1.9%), 3.0%(0.7%-5.3%), and 4.4%(-0.2%-8.9%) (p-trend<0.001). Conclusions: We developed and validated a risk score for HHF in T2DM that incorporated NT-proBNP, prior HF, and hsTnT. The risk score identifies patients at higher risk of HHF who derive greater absolute benefit from dapagliflozin.

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A Biomarker-Based Score for Risk of Hospitalization for Heart Failure in Patients With Diabetes

10.2337/figshare.16451109.v1 ◽

2021 ◽

Author(s):

David D. Berg ◽

Stephen D. Wiviott ◽

Benjamin M. Scirica ◽

Thomas A. Zelniker ◽

Erica L. Goodrich ◽

...

Keyword(s):

Heart Failure ◽

Risk Score ◽

Cox Regression ◽

Troponin T ◽

Absolute Risk ◽

High Sensitivity ◽

Risk Groups ◽

Risk Category ◽

Clinical Factor ◽

Patients With Diabetes

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Correlation between Risk Score Systems and the extent of Coronary Artery Disease detected by Multislice Computed Tomography

QJM ◽

10.1093/qjmed/hcaa041.003 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S S Azab ◽

M M Farouk ◽

A M Almahmoudy ◽

A G Hasanin

Keyword(s):

Risk Score ◽

Calcium Score ◽

Low Risk ◽

Plaque Burden ◽

P Value ◽

Risk Category ◽

Great Incidence ◽

Artery Disease ◽

Score Systems ◽

Score Risk

Abstract Background Risk stratifying patients for cardiovascular diseases is crucial to formulate early effective prevention strategies. Risk scoring systems (RSS) as Framingham Risk Score (FRS) and the Systematic Coronary Risk Evaluation (SCORE) have been designed for early predictions of cardiovascular events in 10-year time. Objectives To study the correlation between Risk Score Systems and the extent of Coronary Artery Disease detected by Coronary CT angiography. Methods This analysis concluded 120 patients without known coronary disease referred to CCTA from January to June 2018. The extent of CAD, calcium score, coronary plaque burden, composition and distribution were assessed. The Framingham and SCORE risk scores were calculated, then correlation between them was done. Results This included 120 patients (mean age 54 + 9 years, 55% male patients). MSCT detected the presence of coronary lesions in 53.3% of the cases, 18.3% of them were with obstructive plaques (stenosis ≥ 50% in the LM or ≥ 70% in any other vessel). Both RSS had a good diagnostic value where SCORE was found to have a higher predictive value (area under ROC curves, 0.754 vs 0.711 for SCORE and FRS respectively). Low SCORE risk category showed the least number of patients with significant CAD (1/22 = 4.5%), compared to those with low risk using FRS (7/85 = 8.2%). High risk SCORE category included more patients with significant CAD (9/23 = 39%), compared to patients with FRS high risk category (3/10 = 30%). A high versus low risk SCORE was related to a higher plaque burden severity (mean burden 57.20=9.75 vs 50.17 + 9.75, respectively, P-value=0.008) and to a great incidence of Calcium Score (CS) > 100 (mean calcium 101.39 + 113.30 vs 3.18 + 13.40, respectively, P-value=0.000). A high versus low risk FRS was related to a higher plaque burden severity (mean burden 60.90 + 15.6 vs 54.06 + 8.04, respectively, P-value=0.039) and to a great incidence of Calcium Score (CS) > 100 (mean calcium 122.40 + 143.89 vs 26.84 + 81.75, respectively, P-value=0.001). Conclusion Risk score correlates well with the extent of CAD detected by MSCT where SCORE had a higher predictive value than FRS.

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A retrospective HEART risk score comparation of acute non-traumatic chest pain patients in an emergency department in Spain

Scientific Reports ◽

10.1038/s41598-021-02682-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Iris Nathalie San Román Arispe ◽

Josep Ramón Marsal Mora ◽

Oriol Yuguero Torres ◽

Marta Ortega Bravo

Keyword(s):

Emergency Department ◽

Chest Pain ◽

High Risk ◽

Risk Score ◽

Major Adverse Cardiovascular Event ◽

Risk Groups ◽

Low Risk ◽

Adverse Cardiovascular Event ◽

Heart Score ◽

Medium Risk

AbstractNon traumatic chest pain is the second most common cause of attention at the Emergency Departments (ED). The objective is to compare the effectiveness of HEART risk score and the risk of having a Major Adverse Cardiovascular Event (MACE) during the following 6 weeks in ‘Acute Non-traumatic Chest Pain’ (ANTCP) patients of an ED in Lleida (Spain). The ANTCP patient cohort was defined using medical data from January 2015 to January 2016. A retrospective study was performed among 300 ANTCP patients. Diagnostic accuracy to predict MACE, HEART risk score effectiveness and patient risk stratification were analysed on the ANTCP Cohort. HEART risk score was conducted on ANTCP Cohort data and patients were stratified as low-risk (n = 116, 38.7%), moderate-risk (n = 164, 54.7%) and high-risk (n = 20, 6.7%); differently from the assessment performed by 'Current Emergency Department Guidelines’ (CEDG) on the same patients: low risk and discharge (n = 56, 18.7%), medium risk and need of complementary tests (n = 137, 45.7%) and high risk and hospital admission (n = 107, 35.7%).The incidence of MACE was 2.5%, 20.7% and 100% in low, moderate and high-risk, respectively. Discrimination and accuracy indexes were moderate (AUC = 0.73, 95% confidence interval: 0.67–0.80). Clustering moderate-high risk groups by MACE incidence showed an 89.5% of sensitivity. Data obtained from this study suggests that HEART risk score stratified better ‘acute non-traumatic chest pain’ (ANTCP) patients in an Emergency Department (ED) compared with ‘Current Emergency Department Guidelines’ (CEDG) at the Hospital Universitari Arnau de Vilanova (HUAV). HEART score would reduce the number of subsequent consultations, unnecessary admissions and complementary tests.Trial registration: Retrospectively registered.

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A cross sectional study on assessment of risk of diabetes mellitus using Indian diabetic risk score in a medical college teaching hospital

International Journal of Pharmacometrics and Integrated Biosciences ◽

10.26452/ijpib.v5i2.1292 ◽

2020 ◽

Vol 5 (2) ◽

pp. 32-40

Author(s):

Singam Sivasankar Reddy ◽

Syeda Rahath ◽

Rakshitha H N ◽

Godson K Lal ◽

Swathy S ◽

...

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

Risk Score ◽

Hospital Setting ◽

College Teaching ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Cross Sectional ◽

Patient Counselling ◽

Related Quality

The objective of the study was to evaluate the risk of diabetes mellitus in elderlywith age above 20 years in a hospital setting using Indian Diabetes risk score and to provide patient counselling regarding their life style modifications and health related quality of life among participants with high risk of developing diabetes.A total of 125 non diabetic patients were interviewed with a pre designed selfstructured questionnaire (IDRS). Participants were chosen voluntarily and a written consent was obtained before the administration of the questionnaire from individual patients. In our study we observed that out of 125 patients,males 26[59%]and 18[41%] females were at high risk, males 39[58.2%] and 28[41.8%] females were at moderate risk, males 5[35.7%] and 9[64.3%] females were at low risk of developing diabetes mellitus.

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Evaluación del desempeño del Finnish Diabetes Risk Score (findrisc) como prueba de tamizaje para diabetes mellitus tipo 2

Atención Familiar ◽

10.22201/facmed.14058871p.2018.1.62925 ◽

2017 ◽

Vol 25 (1) ◽

Author(s):

Indira Rocío Mendiola Pastrana ◽

Irasema Isabel Urbina Aranda ◽

Alejandro Edgar Muñoz Simón ◽

Guillermina Juanico Morales ◽

Geovani López Ortiz

Keyword(s):

Diabetes Mellitus ◽

Risk Score ◽

Diabetes Risk ◽

De Medicina ◽

Diabetes Risk Score

Objetivo: evaluar el desempeño del Finnish Diabetes Risk Score (findrisc) como prueba de tamizaje para diabetes mellitus tipo 2 (dm2). Métodos: estudio de validación de prueba diagnóstica. Se seleccionaron 295 participantes sin diagnóstico de dm2, adscritos a una unidad de medicina familiar de Acapulco, Guerrero, México, mediante muestreo aleatorio simple. Se aplicó el cuestionario findrisc para calificar el nivel de riesgo para desarrollo de dm2. Se realizó toma de glucosa en ayuno como estándar de oro para diagnóstico de dm2. Se realizó prueba de χ2 de Mantel y Haenszel y cálculo de or para medir la asociación y la magnitud de ésta, así como el cálculo de sensibilidad, especificidad y valores predictivos para evaluar el desempeño del cuestionario. Resultados: se determinó que 156 pacientes (52.84%) presentaban alto riesgo para desarrollar dm2 en el cuestionario, 35 de los cuales fueron diagnosticados con dm2 y 49 con prediabetes. De los pacientes con riesgo bajo en el cuestionario, 26 presentaron prediabetes y 5 dm2. Un puntaje ≥15 por findrisc se asoció con glucosa alterada en ayuno ≥100mg/dl (or: 4.06, p=0.0001), prediabetes (or: 2.82, p=0.0002) y dm2 (or: 7.75, p=0.0001). La sensibilidad y especificidad del cuestionario para el diagnóstico de dm2 fue 87.50% y 52.55% respectivamente, con ic 95% estadísticamente significativos. Conclusión: el findrisc es una herramienta que potencialmente se puede ocupar para el tamizaje de dm2 en la población mexicana, es práctica, sencilla, rápida, no invasiva, económica y puede ser utilizada en la práctica diaria del médico familiar.

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