Integration of absolute cardiovascular disease risk assessment into routine blood cholesterol testing at pathology services

Abstract Background Absolute cardiovascular disease (CVD) risk assessment is recommended for primary prevention of CVD, yet uptake in general practice is limited. Cholesterol requests at pathology services provide an opportunity to improve uptake by integrating absolute CVD risk assessment with this service. Objective This study aimed to assess the feasibility of such an additional service. Methods Two-hundred and ninety-nine patients (45–74 years) referred to pathology services for blood cholesterol had measurement of all variables required to determine absolute CVD risk according to Framingham calculator (blood pressure, age, sex, smoking and diabetes status via self-report). Data were recorded via computer-based application. The absolute risk score was communicated via the report sent to the referring medical practitioner as per usual practice. Evaluation questionnaires were completed immediately post visit and at 1-, 3- and 6-month follow-up via telephone (n = 262). Results Absolute CVD risk reports were issued for 90% of patients. Most patients (95%) reported that the length of time for the pathology service assessment was acceptable, and 91% that the self-directed computer-based application was easy to use. Seventy-eight per cent reported a preference for pathology services to conduct absolute CVD risk assessment. Only 2% preferred a medical practitioner. Of follow-up patients, 202 (75%) had a consultation with a medical practitioner, during which, aspects of CVD risk prevention were discussed (cholesterol and blood pressure 74% and 69% of the time, respectively). Conclusions Measurement of absolute CVD risk in pathology services is feasible, highly acceptable among middle-to-older adults and may increase uptake of guideline-directed care in general practice.

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Management of High Blood Pressure in Those without Overt Cardiovascular Disease Utilising Absolute Risk Scores

International Journal of Hypertension ◽

10.4061/2011/595791 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3

Author(s):

Mark R. Nelson

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Events ◽

Absolute Risk ◽

Risk Scores ◽

Cvd Risk ◽

Adverse Cardiovascular Event ◽

Single Measure ◽

Usual Practice ◽

Single Risk Factor

Increasing blood pressure has a continuum of adverse risk for cardiovascular events. Traditionally this single measure was used to determine who to treat and how vigorously. However, estimating absolute risk rather than measurement of a single risk factor such as blood pressure is a superior method to identify who is most at risk of having an adverse cardiovascular event such as stroke or myocardial infarction, and therefore who would most likely benefit from therapeutic intervention. Cardiovascular disease (CVD) risk calculators must be used to estimate absolute risk in those without overt CVD as physician estimation is unreliable. Incorporation into usual practice and limitations of the strategy are discussed.

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Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy

Heart ◽

10.1136/heartjnl-2018-313453 ◽

2019 ◽

Vol 105 (16) ◽

pp. 1273-1278 ◽

Cited By ~ 19

Author(s):

Laura Benschop ◽

Johannes J Duvekot ◽

Jeanine E Roeters van Lennep

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Assessment ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Hypertensive Disorder ◽

Cardiovascular Risk Assessment ◽

Increased Risk

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.

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Experiences of a National Web-Based Heart Age Calculator for Cardiovascular Disease Prevention: User Characteristics, Heart Age Results, and Behavior Change Survey (Preprint)

10.2196/preprints.19028 ◽

2020 ◽

Author(s):

Carissa Bonner ◽

Natalie Raffoul ◽

Tanya Battaglia ◽

Julie Anne Mitchell ◽

Carys Batcup ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Experimental Studies ◽

Emotional Responses ◽

Lifestyle Changes ◽

Small Samples ◽

Cvd Risk ◽

Web Based ◽

Heart Age

BACKGROUND Heart age calculators are used worldwide to engage the public in cardiovascular disease (CVD) prevention. Experimental studies with small samples have found mixed effects of these tools, and previous reports of population samples that used web-based heart age tools have not evaluated psychological and behavioral outcomes. OBJECTIVE This study aims to report on national users of the Australian heart age calculator and the follow-up of a sample of users. METHODS The heart age calculator was launched in 2019 by the National Heart Foundation of Australia. Heart age results were calculated for all users and recorded for those who signed up for a heart age report and an email follow-up over 10 weeks, after which a survey was conducted. CVD risk factors, heart age results, and psychological and behavioral questions were analyzed using descriptive statistics and chi-square tests. Open responses were thematically coded. RESULTS There were 361,044 anonymous users over 5 months, of which 30,279 signed up to receive a heart age report and 1303 completed the survey. There were more women (19,840/30,279, 65.52%), with an average age of 55.67 (SD 11.43) years, and most users knew blood pressure levels (20,279/30,279, 66.97%) but not cholesterol levels (12,267/30,279, 40.51%). The average heart age result was 4.61 (SD 4.71) years older than the current age, including (23,840/30,279, 78.73%) with an older heart age. For the survey, most users recalled their heart age category (892/1303, 68.46%), and many reported lifestyle improvements (diet 821/1303, 63.01% and physical activity 809/1303, 62.09%). People with an older heart age result were more likely to report a doctor visit (538/1055, 51.00%). Participants indicated strong emotional responses to heart age, both positive and negative. CONCLUSIONS Most Australian users received an older heart age as per international and UK heart age tools. Heart age reports with follow-up over 10 weeks prompted strong emotional responses, high recall rates, and self-reported lifestyle changes and clinical checks for more than half of the survey respondents. These findings are based on a more engaged user sample than previous research, who were more likely to know blood pressure and cholesterol values. Further research is needed to determine which aspects are most effective in initiating and maintaining lifestyle changes. The results confirm high public interest in heart age tools, but additional support is needed to help users understand the results and take appropriate action.

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Abstract P256: Stability of Obesity and Metabolic Health and the Risk of Cardiovascular Disease

Circulation ◽

10.1161/circ.137.suppl_1.p256 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Todd Sponholtz ◽

Justin B Echouffo-Tcheugui ◽

Ramachandran S Vasan

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Cox Proportional Hazards ◽

Metabolic Health ◽

Lipid Lowering ◽

Cvd Risk ◽

High Blood Glucose ◽

Coronary Insufficiency ◽

Metabolically Healthy

Introduction: Metabolic syndrome (MetSyn) reportedly confers higher risk of cardiovascular disease (CVD) than its individual components. Although typically defined as a binary exposure, each of its component factors can vary over time. Little is known about whether CVD risk differs according to MetSyn stability. Methods: We defined longitudinal states of obesity and metabolic health among 2,952 Framingham Offspring Study participants for whom we had sufficient data to define MetSyn at ≥4 exams between Exams 2 (1979-1983) and 9 (2011-2014). Obesity was defined as BMI ≥30 kg/m 2 , high triglycerides as ≥150 mg/dL/taking lipid-lowering medication, low HDL as <40 mg/dL for males/ <50 mg/dL for females; high blood pressure as systolic blood pressure ≥130 mm Hg/diastolic blood pressure ≥85 mm Hg/taking antihypertensive medication, and high blood glucose as ≥100 mg/dL/taking antidiabetic medication. Metabolic health was defined as having <2 metabolic conditions. Obesity and metabolic health were classified as unstable if there was a change from one state to the other in ≥33% of observations occurring before a CVD event or end of follow-up, stable obese/metabolically unhealthy if not unstable and >50% of observations were classified as stable obese/metabolically unhealthy, or stable non-obese/metabolically healthy otherwise. CVD was defined as any of the following coronary death, myocardial infarction, coronary insufficiency, angina pectoris, stroke, transient ischemic attack, intermittent claudication, or congestive heart failure. We estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) using Cox proportional hazards regression with age as the time scale. Results: We classified 332 participants (11.3%) as having unstable metabolic health, and 130 (4.4%) as having unstable obesity. We observed 1,206 events in 75,673 person-years of follow-up (median 30 years). Participants classified as stable metabolically unhealthy had the highest CVD risk (HR 1.77, 95% CI 1.47, 2.13, compared to stable metabolically healthy). Stable obesity was associated with a 48% (95% CI 24, 80) increase in CVD risk relative to stable non-obese. Unstable metabolic health and obesity were associated with moderate increases in risk compared to stable metabolically healthy and stable non-obese (HRs: 1.32, 95% CI 1.03, 1.71 and 1.25, 95% CI 0.88, 1.77, respectively). There was no interaction between obesity- and metabolic health stability (p interaction =0.23). Conclusions: In our sample, stability of obesity and of metabolic health influenced CVD risk, with the highest risk of CVD observed among stable metabolically unhealthy participants. Instability of both obesity and metabolic health convey a risk intermediate between the stable obese/metabolically healthy and stable non-obese/metabolically unhealthy conditions.

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Experiences of a National Web-Based Heart Age Calculator for Cardiovascular Disease Prevention: User Characteristics, Heart Age Results, and Behavior Change Survey

Journal of Medical Internet Research ◽

10.2196/19028 ◽

2020 ◽

Vol 22 (8) ◽

pp. e19028

Author(s):

Carissa Bonner ◽

Natalie Raffoul ◽

Tanya Battaglia ◽

Julie Anne Mitchell ◽

Carys Batcup ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Experimental Studies ◽

Emotional Responses ◽

Lifestyle Changes ◽

Small Samples ◽

Cvd Risk ◽

Web Based ◽

Heart Age

Background Heart age calculators are used worldwide to engage the public in cardiovascular disease (CVD) prevention. Experimental studies with small samples have found mixed effects of these tools, and previous reports of population samples that used web-based heart age tools have not evaluated psychological and behavioral outcomes. Objective This study aims to report on national users of the Australian heart age calculator and the follow-up of a sample of users. Methods The heart age calculator was launched in 2019 by the National Heart Foundation of Australia. Heart age results were calculated for all users and recorded for those who signed up for a heart age report and an email follow-up over 10 weeks, after which a survey was conducted. CVD risk factors, heart age results, and psychological and behavioral questions were analyzed using descriptive statistics and chi-square tests. Open responses were thematically coded. Results There were 361,044 anonymous users over 5 months, of which 30,279 signed up to receive a heart age report and 1303 completed the survey. There were more women (19,840/30,279, 65.52%), with an average age of 55.67 (SD 11.43) years, and most users knew blood pressure levels (20,279/30,279, 66.97%) but not cholesterol levels (12,267/30,279, 40.51%). The average heart age result was 4.61 (SD 4.71) years older than the current age, including (23,840/30,279, 78.73%) with an older heart age. For the survey, most users recalled their heart age category (892/1303, 68.46%), and many reported lifestyle improvements (diet 821/1303, 63.01% and physical activity 809/1303, 62.09%). People with an older heart age result were more likely to report a doctor visit (538/1055, 51.00%). Participants indicated strong emotional responses to heart age, both positive and negative. Conclusions Most Australian users received an older heart age as per international and UK heart age tools. Heart age reports with follow-up over 10 weeks prompted strong emotional responses, high recall rates, and self-reported lifestyle changes and clinical checks for more than half of the survey respondents. These findings are based on a more engaged user sample than previous research, who were more likely to know blood pressure and cholesterol values. Further research is needed to determine which aspects are most effective in initiating and maintaining lifestyle changes. The results confirm high public interest in heart age tools, but additional support is needed to help users understand the results and take appropriate action.

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Abstract P346: Cohort Identification to Harness the Electronic Health Record for Cardiovascular Disease Prediction

Circulation ◽

10.1161/circ.141.suppl_1.p346 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Sheila M Manemann ◽

Jennifer St Sauver ◽

Janet E Olson ◽

Nicholas B Larson ◽

Paul Y Takahashi ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Heart Rate ◽

Electronic Health Record ◽

Risk Prediction ◽

Health Record ◽

Next Generation ◽

Cvd Risk ◽

Electronic Health

Background: Current cardiovascular disease (CVD) risk scores are derived from research cohorts and are particularly inaccurate in women, older adults, and those with missing data. To overcome these limitations, we aimed to develop a cohort to capitalize on the depth and breadth of clinical data within electronic health record (EHR) systems in order to develop next-generation sex-specific risk prediction scores for incident CVD. Methods: All individuals 30 years of age or older residing in Olmsted County, Minnesota on 1/1/2006 were identified. We developed and validated algorithms to define a variety of risk factors, thus building a comprehensive risk profile for each patient. Outcomes including myocardial infarction (MI), percutaneous intervention (PCI), coronary artery bypass graft (CABG), and CVD death were ascertained through 9/30/2017. Results: We identified 73,069 individuals without CVD (Table). We retrieved a total of 14,962,762 lab results; 14,534,466 diagnoses; 17,062,601 services/procedures; 1,236,998 outpatient prescriptions; 1,079,065 heart rate measurements; and 1,320,115 blood pressure measurements. The median number of blood pressure and heart rate measurements ascertained per individuals were 11 and 9, respectively. The five most prevalent conditions were: hypertension, hyperlipidemia, arthritis, depression, and cardiac arrhythmias. During follow-up 1,455 MIs, 1,581 PCI, 652 CABG, and 2,161 CVD-related deaths occurred. Conclusions: We developed a cohort with comprehensive risk profiles and follow-up for each patient. Using sophisticated machine learning approaches, this electronic cohort will be utilized to develop next-generation sex-specific CVD risk prediction scores. These approaches will allow us to address several challenges with use of EHR data including the ability to 1) deal with missing values, 2) assess and utilize a large number of variables without over-fitting, 3) allow non-linear relationships, and 4) use time-to-event data.

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The metabolic syndrome: setting the scene. The cons

Diabetes and Vascular Disease Research ◽

10.3132/dvdr.2007.018 ◽

2007 ◽

Vol 4 (2_suppl) ◽

pp. S4-S6 ◽

Cited By ~ 2

Author(s):

Naveed Sattar

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Assessment ◽

Metabolic Syndrome ◽

Elevated Blood ◽

Diabetes Screening ◽

Cvd Risk ◽

Treatment Benefit ◽

The Metabolic Syndrome

Conclusion: Metabolic syndrome is conceptually useful. It has encouraged thought about the pathology of diabetes and cardiovascular disease, has facilitated research and has brought together cardiologists and diabetologists. But the criteria are neither needed nor additive for CVD risk assessment or diabetes screening or prediction. Neither are they needed to determine treatment benefit. Better options would be to measure and target established risk factors such as lipids, smoking and elevated blood pressure. We should also be thinking about obesity and its prevention, and to do this we need changes in food, activity and fiscal environments.

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Abstract P391: Clinically Significant Blood Pressure Reduction Among Participants of a Lifestyle intervention Improvement Program strongly associated with Reduced Systemic Inflammation in a High Risk Working Population

Circulation ◽

10.1161/circ.129.suppl_1.p391 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Henry Guzman ◽

Maribeth Rouseff ◽

Thinh Tran ◽

Khurram Nasir ◽

Josette Bou-Khalil ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Lifestyle Intervention ◽

Systemic Inflammation ◽

South Florida ◽

Working Population ◽

Cvd Risk ◽

Short Period ◽

Clinically Significant

Background: In this study we aim to assess the short term effects of clinically significant Blood Pressure (BP) reduction after a behavioral intervention on systemic inflammation, measured by elevated high sensitivity c-reactive protein (HSCRP), in a high cardiovascular disease (CVD) risk cohort. Methods: The study was conducted among 180 employees of Baptist Health South Florida who had 2 or more CVD risk factors such as obesity, diabetes, hypertension or elevated total cholesterol and was involved in a three-month workplace lifestyle intervention. The intervention focused on nutritional and physical activity modifications. At baseline and at 3 months follow-up, anthropometric, clinical, and laboratory measures were obtained. Significant BP reduction was defined as systolic blood pressure (SBP) reduction ≥ 10mmHg or diastolic blood pressure (DBP) reduction ≥ 5mmHg at 3 months of follow-up. A HSCRP >3mg/L was considered elevated. Results: Over the 3-month study period the median SBP decline was 16mmHg (IQR 4 -23mmHg) while the median reduction in DBP was 10mmHg (IQR 6 -16mmHg). 87% (156 participants) experienced significant BP reduction. Among those without significant BP reduction, the prevalence of elevated HSCRP at baseline was 58% and at follow-up it was 75% (p = 0.125). However, among those who had significant BP reduction, there was significant reduction in the prevalence of elevated HSCRP from 66.7% to 57.1% (p<0.001). In unadjusted conditional logistic regression analyses significant BP reduction was associated with 94% reduction in the risk of elevated HSCRP at follow-up. In a fully adjusted model, this association persisted. Conclusion: Clinically significant reduction in blood pressure over a short period in a high cardiovascular disease risk working population is independently associated with markedly diminished risk of elevate hs-CRP. Longer follow-up intervention studies are required to further understand if these effects are sustained.

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Using run charts for cardiovascular disease risk assessments in general practice

Journal of Primary Health Care ◽

10.1071/hc15030 ◽

2016 ◽

Vol 8 (2) ◽

pp. 172 ◽

Cited By ~ 3

Author(s):

Susan Wells ◽

Natasha Rafter ◽

Kyle Eggleton ◽

Catherine Turner ◽

Ying Huang ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Assessment ◽

General Practice ◽

Disease Risk ◽

Intervention Group ◽

Mean Difference ◽

Risk Assessments ◽

Control Group ◽

Cvd Risk ◽

The Mean

Abstract INTRODUCTION Run charts are quality improvement tools. AIM To investigate the feasibility and acceptability of run charts displaying weekly cardiovascular disease (CVD) risk assessments in general practice and assess their impact on CVD risk assessments. METHODS A controlled non-randomised observational study in nine practices using run charts and nine control practices. We measured the weekly proportion of eligible patients with completed CVD risk assessments for 19 weeks before and after run charts were introduced into intervention practices. A random coefficients model determined changes in CVD risk assessment rates (slope) from pre- to post- intervention by aggregating and comparing intervention and control practices’ mean slopes. We interviewed staff in intervention practices about their use of run charts. RESULTS Seven intervention practices used their run chart; six consistently plotting weekly data for >12 weeks and positioning charts in a highly visible place. Staff reported that charts were easy to use, a visual reminder for ongoing team efforts, and useful for measuring progress. There were no significant differences between study groups: the mean difference in pre- to post-run chart slope in the intervention group was 0.03% more CVD risk assessments per week; for the control group the mean difference was 0.07%. The between group difference was 0.04% per week (95% CI: –0.26 to 0.35, P = 0.77). DISCUSSION Run charts are feasible in everyday general practice and support team processes. There were no differences in CVD risk assessment between the two groups, likely due to national targets driving performance at the time of the study.

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Skin autofluorescence predicts new cardiovascular disease and mortality in people with type 2 diabetes

BMC Endocrine Disorders ◽

10.1186/s12902-020-00676-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Henderikus E. Boersma ◽

Robert P. van Waateringe ◽

Melanie M. van der Klauw ◽

Reindert Graaff ◽

Andrew D. Paterson ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Fasting Blood Glucose ◽

Multivariable Analysis ◽

Oral Glucose ◽

Skin Autofluorescence ◽

Z Score

Abstract Background Skin autofluorescence (SAF) is a non-invasive marker of tissue accumulation of advanced glycation endproducts (AGE). Recently, we demonstrated in the general population that elevated SAF levels predict the development of type 2 diabetes (T2D), cardiovascular disease (CVD) and mortality. We evaluated whether elevated SAF may predict the development of CVD and mortality in individuals with T2D. Methods We included 2349 people with T2D, available baseline SAF measurements (measured with the AGE reader) and follow-up data from the Lifelines Cohort Study. Of them, 2071 had no clinical CVD at baseline. 60% were already diagnosed with diabetes (median duration 5, IQR 2–9 years), while 40% were detected during the baseline examination by elevated fasting blood glucose ≥7.0 mmol/l) and/or HbA1c ≥6.5% (48 mmol/mol). Results Mean (±SD) age was 57 ± 12 yrs., BMI 30.2 ± 5.4 kg/m2. 11% of participants with known T2D were treated with diet, the others used oral glucose-lowering medication, with or without insulin; 6% was using insulin alone. Participants with known T2D had higher SAF than those with newly-detected T2D (SAF Z-score 0.56 ± 0.99 vs 0.34 ± 0.89 AU, p < 0.001), which reflects a longer duration of hyperglycaemia in the former group. Participants with existing CVD and T2D had the highest SAF Z-score: 0.78 ± 1.25 AU. During a median follow-up of 3.7 yrs., 195 (7.6%) developed an atherosclerotic CVD event, while 137 (5.4%) died. SAF was strongly associated with the combined outcome of a new CVD event or mortality (OR 2.59, 95% CI 2.10–3.20, p < 0.001), as well as incidence of CVD (OR 2.05, 95% CI 1.61–2.61, p < 0.001) and death (OR 2.98, 2.25–3.94, p < 0.001) as a single outcome. In multivariable analysis for the combined endpoint, SAF retained its significance when sex, systolic blood pressure, HbA1c, total cholesterol, eGFR, as well as antihypertensive and statin medication were included. In a similar multivariable model, SAF was independently associated with mortality as a single outcome, but not with incident CVD. Conclusions Measuring SAF can assist in prediction of incident cardiovascular disease and mortality in individuals with T2D. SAF showed a stronger association with future CVD events and mortality than cholesterol or blood pressure levels.

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