The Framingham Risk Score underestimates the extent of subclinical atherosclerosis in patients with psoriatic disease

Abstract Background People with HIV (HIV+) may have increased cardiovascular event rates compared with HIV-negative (HIV-) persons. Cross-sectional data from the United States and Switzerland, based on coronary artery calcium scan (CAC) and coronary computed tomography angiography (CCTA), suggest, respectively, increased and similar prevalence of subclinical atherosclerosis in HIV+ vs HIV- persons. Methods We repeated CAC/CCTA in 340 HIV+ and 90 HIV- study participants >2 years after baseline CAC/CCTA. We assessed the association of HIV infection, Framingham risk score (FRS), and HIV-related factors with the progression of subclinical atherosclerosis. Results HIV+ were younger than HIV- participants (median age, 52 vs 56 years; P < .01) but had similar median 10-year FRS (8.9% vs 9.0%; P = .82); 94% had suppressed HIV viral load. In univariable and multivariable analyses, FRS was associated with the incidence rate ratio (IRR) of new subclinical atherosclerosis at the follow-up CAC/CCTA, but HIV infection was not: any plaque (adjusted IRR for HIV+ vs HIV- participants, 1.21; 95% CI, 0.62–2.35), calcified plaque (adjusted IRR for HIV+ vs HIV- participants, 1.06; 95% CI, 0.56–2), noncalcified/mixed plaque (adjusted IRR for HIV+ vs HIV- participants, 1.24; 95% CI, 0.69–2.21), and high-risk plaque (adjusted IRR for HIV+ vs HIV- participants, 1.46; 95% CI, 0.66–3.20). Progression of CAC score between baseline and follow-up CAC/CCTA was similar in HIV+ (median annualized change [interquartile range {IQR}], 0.41 [0–10.19]) and HIV- participants (median annualized change [IQR], 2.38 [0–16.29]; P = .11), as was progression of coronary segment severity score (HIV+: median annualized change [IQR], 0 [0–0.47]; HIV-: median annualized change [IQR], 0 [0–0.52]; P = .10) and coronary segment involvement score (HIV+: median annualized change [IQR], 0 [0–0.45]; HIV-: median annualized change [IQR], 0 [0–0.41]; P = .25). Conclusions In this longitudinal CAC/CCTA study from Switzerland, Framingham risk score was associated with progression of subclinical atherosclerosis, but HIV infection was not.

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High Prevalence of Ultrasound Detected Carotid Atherosclerosis in Subjects with Low Framingham Risk Score: Potential Implications for Screening for Subclinical Atherosclerosis

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2010.05.005 ◽

2010 ◽

Vol 23 (8) ◽

pp. 809-815 ◽

Cited By ~ 44

Author(s):

Tasneem Z. Naqvi ◽

Fernando Mendoza ◽

Farhad Rafii ◽

Heidi Gransar ◽

Maria Guerra ◽

...

Keyword(s):

Risk Score ◽

Framingham Risk Score ◽

Carotid Atherosclerosis ◽

Subclinical Atherosclerosis ◽

Framingham Risk ◽

High Prevalence

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Abstract 3299: Association Of The Metabolic Syndrome, Diabetes And Framingham Risk Score With Coronary Artery Calcium

Circulation ◽

10.1161/circ.116.suppl_16.ii_743-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Uzoma N Ibebuogu ◽

nathan D Wong ◽

Jessica Ramirez ◽

SongShou Mao ◽

Fereshteh Hajsadeghi ◽

...

Keyword(s):

Metabolic Syndrome ◽

Risk Factor ◽

Coronary Artery ◽

Risk Score ◽

Coronary Artery Calcium ◽

Framingham Risk Score ◽

Subclinical Atherosclerosis ◽

The Metabolic Syndrome ◽

Framingham Risk ◽

Risk Factor Burden

INTRODUCTION: Coronary artery calcium (CAC) is a sensitive marker for the detection of subclinical coronary heart disease (CHD), and can be accurately quantified using cardiac computed tomography. Few studies have examined the relation between the metabolic syndrome (MetS), MetS risk factor burden, diabetes, and CAC. HYPOTHESIS: To examine the relation between MetS, as defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), MetS risk factor burden, diabetes and CAC. METHODS: We studied 356 consecutive, asymptomatic men and women aged 58 ± 11 years who underwent CAC testing, 116 had MetS, 61 had diabetes, and the remainder had neither. MetS was defined according to the NCEP ATP III guidelines with ≥ 3 risk factors. The prevalence and odds of CAC among these groups were determined by multivariable logistic regression analysis. Receiver operating characteristic curves were used to determine if MetS or diabetes added to 10-year CHD estimated by the Framingham risk score (FRS) in predicting CAC. RESULTS: The prevalence of CAC >0 for those with diabetes, MetS and neither condition was 73%, 69% and 60% respectively, while the prevalence of CAC ≥ 100 for the 3 groups was 64%, 43% and 24% respectively. Risk factor-adjusted odds for the presence of CAC ≥ 100 were 2.26 (95% CI 1 to 4.4, p=0.0001) among those with MetS and 3.46 (95% CI 1.6 to 7.4, p=0.0001) among those with diabetes, versus neither condition. ROC analysis for CAC ≥ 100 showed an area under the curve of 0.61 (95% CI 0.54 – 0.68) for FRS, 0.72 (95% CI 0.61– 0.83) for diabetes, 0.67 (95% CI 0.56 – 0.77) for the metabolic syndrome, 0.78 (95% CI 0.7– 0.85) when the MetS is added to the FRS (p<0.0001 compared to FRS alone), and 0.90 (95% CI 0.85– 0.95) when diabetes is added to the FRS (p<0.0001 compared to FRS alone). The CAC score showed a trend towards a progressive increase across the metabolic score ranging from 0 to 5 (p=0.0001). CONCLUSIONS: Those with MetS or diabetes have an increased likelihood of subclinical atherosclerosis (measured by CAC) compared to those with neither condition, and they also add to prediction of CAC over FRS, suggesting the importance of these factors in clinical assessment of CHD risk.

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