Abstract 3124: The Magnitude of Reclassification Indices for Individual Predictors of Global Cardiovascular Risk

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Nancy R Cook ◽  
Paul M Ridker
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Goodness Of Fit ◽  
Absolute Risk ◽  
Health Study ◽  
Intermediate Risk ◽  
Goodness Of Fit Test ◽  
Parental History ◽  
Net Reclassification Improvement ◽  
Predicted Risk

Methods based on risk stratification have recently been proposed to evaluate and compare predictive risk models, but their performance in clinically relevant populations has not been demonstrated, including for well-known cardiovascular risk predictors. We fit models including traditional risk factors as well as high-sensitivity C-reactive protein (hsCRP) and parental history of myocardial infarction in prospective data from 24,558 women in the Women’s Health Study who experienced 766 cardiovascular events over an average 10-year follow-up. Fit of models with and without each risk factor was evaluated using both traditional methods, including the C index and goodness-of-fit test, and newly proposed methods for reclassification, which compare predicted risk strata for two models. Reclassification calibration compares observed to predicted risk for each model within reclassified risk strata; the net reclassification improvement (NRI) estimates the net proportion of cases moving to higher vs. lower risk strata; the clinical NRI estimates the NRI among those at intermediate risk; and the integrated discrimination improvement (IDI) compares the mean difference in predicted probabilities between cases and controls for two models. For each model set, the reclassification calibration statistic showed a significant lack of fit in models excluding each of these predictors, indicating that the predicted risk did not fit that observed in reclassified strata. Values of the NRI were 20% for age, 8–11% for hemoglobin A1c in diabetics, smoking, and systolic blood pressure, and 3–5% for lipids, hsCRP, and parental history. The clinical NRI for those initially at intermediate risk was 46% for age and ranged from 9–29% for other risk factors. The IDI was less than 2% for all predictors, including age. These data demonstrate the magnitude of several newly proposed reclassification measures for well-known cardiovascular risk factors. These measures can demonstrate the potential of new models and markers to change risk strata and alter treatment decisions, and should be considered as another means to compare models and assess the accuracy of absolute risk estimates and risk strata.

An absolute risk-guided approach to cardiovascular risk management within a chest pain clinic: the ARCPAC randomized trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.A Black ◽  
J Campbell ◽  
J Sharman ◽  
M Nelson ◽  
S Parker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Chest Pain ◽  
Smoking Status ◽  
Absolute Risk ◽  
Pain Clinic ◽  
Risk Scores ◽  
Cardiovascular Risk Management ◽  
Risk Factor Management

Abstract Background The majority of patients attending chest pain clinics are found not to have a cardiac cause of their symptoms, but have a high burden of cardiovascular risk factors that may be opportunistically addressed. Absolute risk calculators are recommended to guide risk factor management, although it is uncertain to what extent these calculations may assist with patient engagement in risk factor modification. Purpose We sought to determine the usefulness of a proactive, absolute risk-based approach, to guide opportunistic cardiovascular risk factor management within a chest pain clinic. Methods This was a prospective, open-label, blinded-endpoint study in 192 enhanced risk (estimated 5-year risk ≥8%, based on Australian Absolute Risk Calculator) patients presenting to a tertiary hospital chest pain clinic. Patients were randomized to best practice usual care, or intervention with development of a proactive cardiovascular risk management strategy framed around a discussion of the individual's absolute risk. Patients found to have a cardiac cause of symptoms were excluded as they constitute a secondary prevention population. Primary outcome was 5-year absolute cardiovascular risk score at minimum 12 months follow up. Secondary outcomes were individual modifiable risk factors (lipid profile, blood pressure, smoking status). Results 192 people entered the study; 100 in the intervention arm and 92 in usual care. There was no statistical difference between the two groups' baseline sociodemographic and clinical variables. The intervention group showed greater reduction in 5-year absolute risk scores (difference −2.77; p<0.001), and more favourable individual risk factors, although only smoking status and LDL cholesterol reached statistical significance (table). Conclusion An absolute risk-guided proactive risk factor management strategy employed opportunistically in a chest pain clinic significantly improves 5-year cardiovascular risk scores. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Tasmanian Community Fund

scholarly journals Risk factors for peripheral venous catheter failure: A prospective cohort study of 5345 patients

2021 ◽  
pp. 112972982110150
Author(s):  
Ya-mei Chen ◽  
Xiao-wen Fan ◽  
Ming-hong Liu ◽  
Jie Wang ◽  
Yi-qun Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Goodness Of Fit ◽  
Insertion Site ◽  
Healthcare Providers ◽  
Venous Catheter ◽  
Goodness Of Fit Test ◽  
Peripheral Venous Catheter ◽  
Independent Risk Factors

Purpose: The objective of this study was to determine the independent risk factors associated with peripheral venous catheter (PVC) failure and develop a model that can predict PVC failure. Methods: This prospective, multicenter cohort study was carried out in nine tertiary hospitals in Suzhou, China between December 2017 and February 2018. Adult patients undergoing first-time insertion of a PVC were observed from catheter insertion to removal. Logistic regression was used to identify the independent risk factors predicting PVC failure. Results: This study included 5345 patients. The PVC failure rate was 54.05% ( n = 2889/5345), and the most common causes of PVC failure were phlebitis (16.3%) and infiltration/extravasation (13.8%). On multivariate analysis, age (45–59 years: OR, 1.295; 95% CI, 1.074–1.561; 60–74 years: OR, 1.375; 95% CI, 1.143–1.654; ⩾75 years: OR, 1.676; 95% CI, 1.355–2.073); department (surgery OR, 1.229; 95% CI, 1.062–1.423; emergency internal/surgical ward OR, 1.451; 95% CI, 1.082–1.945); history of venous puncture in the last week (OR, 1.298, 95% CI 1.130–1.491); insertion site, number of puncture attempts, irritant fluid infusion, daily infusion time, daily infusion volume, and type of sealing liquid were independent predictors of PVC failure. Receiver operating characteristic curve analysis indicated that a logistic regression model constructed using these variables had moderate accuracy for the prediction of PVC failure (area under the curve, 0.781). The Hosmer-Lemeshow goodness of fit test demonstrated that the model was correctly specified (χ2 = 2.514, p = 0.961). Conclusion: This study should raise awareness among healthcare providers of the risk factors for PVC failure. We recommend that healthcare providers use vascular access device selection tools to select a clinically appropriate device and for the timely detection of complications, and have a list of drugs classified as irritants or vesicants so they can monitor patients receiving fluid infusions containing these drugs more frequently.

scholarly journals Diastolic dysfunction in individuals with and without heart failure with preserved ejection fraction

2021 ◽  
Author(s):  
Jan-Per Wenzel ◽  
Ramona Bei der Kellen ◽  
Christina Magnussen ◽  
Stefan Blankenberg ◽  
Benedikt Schrage ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiovascular Risk ◽  
General Population ◽  
Diastolic Dysfunction ◽  
Cardiovascular Risk Factors ◽  
Population Based ◽  
Left Ventricular ◽  
Health Study ◽  
Common Finding

Abstract Aim Left ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection faction (HFpEF). Here we evaluate the prevalence and correlates of DD in subjects with and without HFpEF in a middle-aged sample of the general population. Methods and results From the first 10,000 participants of the population-based Hamburg City Health Study (HCHS), 5913 subjects (mean age 64.4 ± 8.3 years, 51.3% females), qualified for the current analysis. Diastolic dysfunction (DD) was identified in 753 (12.7%) participants. Of those, 11.2% showed DD without HFpEF (ALVDD) while 1.3% suffered from DD with HFpEF (DDwHFpEF). In multivariable regression analysis adjusted for major cardiovascular risk factors, ALVDD was associated with arterial hypertension (OR 2.0, p < 0.001) and HbA1c (OR 1.2, p = 0.007). Associations of both ALVDD and DDwHFpEF were: age (OR 1.7, p < 0.001; OR 2.7, p < 0.001), BMI (OR 1.2, p < 0.001; OR 1.6, p = 0.001), and left ventricular mass index (LVMI). In contrast, female sex (OR 2.5, p = 0.006), atrial fibrillation (OR 2.6, p = 0.024), CAD (OR 7.2, p < 0.001) COPD (OR 3.9, p < 0.001), and QRS duration (OR 1.4, p = 0.005) were strongly associated with DDwHFpEF but not with ALVDD. Conclusion The prevalence of DD in a sample from the first 10,000 participants of the population-based HCHS was 12.7% of whom 1.3% suffered from HFpEF. DD with and without HFpEF showed significant associations with different major cardiovascular risk factors and comorbidities warranting further research for their possible role in the formation of both ALVDD and DDwHFpEF.

On the HUNT for cardiovascular risk factors and disease in patients with psoriatic arthritis: population-based data from the Nord-Trøndelag Health Study

2015 ◽  
Vol 75 (5) ◽  
pp. 819-824 ◽  
Author(s):  
Agnete Malm Gulati ◽  
Anne Grete Semb ◽  
Silvia Rollefstad ◽  
Pål R Romundstad ◽  
Arthur Kavanaugh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Psoriatic Arthritis ◽  
Cardiovascular Risk Factors ◽  
Population Based ◽  
Health Study

Cardiovascular risk factors and endothelial dysfunction

2004 ◽  
Vol 107 (6) ◽  
pp. 609-615 ◽  
Author(s):  
Anthony S. WIERZBICKI ◽  
Philip J. CHOWIENCZYK ◽  
John R. COCKCROFT ◽  
Sally E. BRETT ◽  
Gerald F. WATTS ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Endothelial Dysfunction ◽  
Ldl Cholesterol ◽  
Disease Risk ◽  
Absolute Risk ◽  
Density Lipoprotein ◽  
Cholesterol Concentration ◽  
Individual Risk ◽  
Multiple Risk Factor

Endothelial dysfunction is a feature of atherosclerosis and is associated with CHD (coronary heart disease) risk factors. This study aimed to determine the relationship between the degree of endothelial dysfunction and calculated cardiovascular risk. Endothelial function, as determined by the ACh/NP (acetycholine/sodium nitroprusside response) ratio on brachial plethysmography, was compared with cardiovascular risk as calculated from the Framingham, PROCAM (Prospective Cardiovascular Munster) and MRFIT (Multiple Risk Factor Intervention Trial) algorithms in 246 (187 male) patients, including 44 (22%) with established CHD. Endothelial dysfunction correlated with the total number of risk factors (r2=0.22; P=0.002) and was related to LDL (low-density lipoprotein)-cholesterol in men and triacylglycerols (triglycerides) in women. The ACh/NP ratio correlated with the occurrence of diabetes, CHD and the LDL-cholesterol concentration (r2=0.58; P<0.001). Endothelial dysfunction was associated with presence of CHD on receiver-operating characteristic plot analysis (area=0.706±0.04; P=0.001). There was no correlation between ACh/NP ratio and CHD risk calculated with the Framingham algorithm in men, although both ACh and NP response correlated separately with risk in women. The endothelial ACh/NP ratio correlated with absolute risk in the PROCAM algorithm (r2=0.41; P<0.005). Intermediate results were obtained with MRFIT. Individual risk factors make different contributions to endothelial dysfunction compared with their role in risk calculators. The stronger relationship of endothelial dysfunction with PROCAM risk reflects the contribution of male sex, LDL-cholesterol and triacylglycerols to risk calculated by this algorithm.

scholarly journals Cardiovascular Risk Factors and Dehydroepiandrosterone Sulfate Among Latinos in the Boston Puerto Rican Health Study

2018 ◽  
Vol 3 (1) ◽  
pp. 291-303 ◽  
Author(s):  
Monik C Jiménez ◽  
Katherine L Tucker ◽  
Fátima Rodriguez ◽  
Bianca C Porneala ◽  
James B Meigs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Total Cholesterol ◽  
Cardiovascular Risk Factors ◽  
Puerto Rican ◽  
Dehydroepiandrosterone Sulfate ◽  
Health Study ◽  
High Risk Population ◽  
Cvd Risk ◽  
Age Related

Abstract Low blood dehydroepiandrosterone sulfate (DHEAS) levels have strong positive associations with stroke and coronary heart disease. However, it is unclear whether DHEAS is independently associated with cardiovascular risk factors. Therefore, we examined the association between cardiovascular risk factors and DHEAS concentration among a high-risk population of Latinos (Puerto Ricans aged 45 to 75 years at baseline) in a cross-sectional analysis of the Boston Puerto Rican Health Study. Of eligible participants, 72% completed baseline interviews and provided blood samples. Complete data were available for 1355 participants. Associations between cardiovascular risk factors (age, sex, total cholesterol, high-density lipid cholesterol, triglycerides, and glucose) and log-transformed DHEAS (μg/dL) were assessed. In robust multivariable regression analyses, DHEAS was significantly inversely associated with age (β = −12.4; 95% CI: −15.2, −9.7; per 5 years), being female (vs. male) (β = −46; 95% CI: −55.3, −36.6), and plasma triglyceride concentration (β = −0.2; 95% CI: −0.3, −0.1; per 10 mg/dL) and was positively associated with total cholesterol and plasma glucose levels (β = 1.8; 95% CI: 0.6, 3 and β = 0.2; 95% CI: 0.04, 0.3, respectively, per 10 mg/dL) after adjustment for smoking, alcohol, and physical activity and for postmenopausal hormone use in women. Estimates were unchanged after adjustment for measures of chronic disease and inflammation. Women exhibited a stronger age-related decline in DHEAS and a positive association with glucose in contrast to findings among men (Pinteraction &lt; 0.05). In conclusion, in this large study of Latinos with a heavy cardiovascular risk factor burden, we observed significant associations between cardiovascular disease (CVD) risk factors and DHEAS, with variations by sex. These findings improve our understanding of the role DHEAS may play in CVD etiology.

scholarly journals Development and Validation of a Risk Scoring System for Cephamycin-Associated Hemorrhagic Events

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Tong-Ling Chien ◽  
Fei-Yuan Hsiao ◽  
Li-Ju Chen ◽  
Yu-Wen Wen ◽  
Shu-Wen Lin
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Scoring System ◽  
Goodness Of Fit ◽  
Bleeding Tendency ◽  
Multivariate Logistic Regression ◽  
Goodness Of Fit Test ◽  
Hemorrhagic Events ◽  
Risk Scoring ◽  
Risk Scoring System

Abstract Cephamycin-associated hemorrhages have been reported since their launch. This research aimed to determine risk factors for cephamycin-associated hemorrhagic events and produce a risk scoring system using National Taiwan University Hospital (NTUH) database. Patients who were older than 20 years old and consecutively used study antibiotics for more than 48 hours (epidode) at NTUH between January 1st, 2009 and December 31st, 2015 were included. The population was divided into two cohorts for evaluation of risk factors and validation of the scoring system. Multivariate logistic regression was used for the assessment of the adjusted association between factors and the outcome of interest. Results of the multivariate logistic regression were treated as the foundation to develop the risk scoring system. There were 46402 and 22681 episodes identified in 2009–2013 and 2014–2015 cohorts with 356 and 204 hemorrhagic events among respective cohorts. Use of cephamycins was associated with a higher risk for hemorrhagic outcomes (aOR 2.03, 95% CI 1.60–2.58). Other risk factors included chronic hepatic disease, at least 65 years old, prominent bleeding tendency, and bleeding history. A nine-score risk scoring system (AUROC = 0.8035, 95% CI 0.7794–0.8275; Hosmer-Lemeshow goodness-of-fit test p = 0.1044) was developed based on the identified risk factors, with higher scores indicating higher risk for bleeding. Use of cephamycins was associated with more hemorrhagic events compared with commonly used penicillins and cephalosporins. The established scoring system, CHABB, may help pharmacists identify high-risk patients and provide recommendations according to the predictive risk, and eventually enhance the overall quality of care.

Choroidal thickness is associated with cardiovascular risk factors and cardiac health: the Gutenberg Health Study

2019 ◽  
Vol 109 (2) ◽  
pp. 172-182 ◽  
Author(s):  
Alexander K. Schuster ◽  
Anja Leuschner ◽  
Constantin Feretos ◽  
Philipp Blumenstein ◽  
Sven-Oliver Troebs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Choroidal Thickness ◽  
Health Study ◽  
Cardiac Health ◽  
Gutenberg Health Study

Thrombophilia and Cardiovascular Risk Factors On the Absolute Risk of First and Recurrent Venous Thrombosis. Results From a Retrospective Family Cohort Study Involving 2097 Relatives.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2974-2974
Author(s):  
Anja B.U. MÄkelburg ◽  
Saskia Middeldorp ◽  
Karly Hamulyàk ◽  
Martin Prins ◽  
Harry R Büller ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Absolute Risk ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Recurrent Vte

Abstract Abstract 2974 Poster Board II-951 Introduction: Arterial and venous thromboembolism (VTE) share or seem to share cardiovascular risk factors such as older age, overweight and obesity, and possibly also hypertension, diabetes mellitus, dyslipidemia, and smoking. Little is known if subjects with common thrombophilia, (i.e. factor V Leiden, prothrombin G20210A or high factor VIII levels) are at higher risk of first or recurrent VTE due to cardiovascular risk factors. For subjects with rare thrombophilia (i.e. antithrombin, protein C or protein S deficiency), or non-carriers of thrombophilia no information is currently available whether contribution of cardiovascular risk factors increases the risk of first or recurrent VTE. Methods: In a multi-center retrospective cohort study of families with thrombophilia, we performed a post-hoc analysis to identify if relatives with rare thrombophilia, common thrombophilia, and relatives without one of these thrombophilic defects were at increased risk of first or recurrent VTE due to cardiovascular risk factors. Known cardiovascular risk factors were recorded: hypertension, hyperlipidemia, the presence of diabetes mellitus, smoking habits and overweight/obesity defined by body mass index (BMI) ≥25-30 kg/m2 or ≥30 kg/m2, respectively. Observation time for first VTE started at the age of 15, and for recurrent VTE on the date when initial anticoagulant treatment was withdrawn. Observation time ended on the date of first VTE or recurrence, respectively, or at date of enrollment. First, the absolute risk of first VTE for cardiovascular risk factors was calculated for the whole cohort. Sensitivity analyses were performed to assess the effect of idiopathic or provoked classification of initial thrombotic event and type of event (deep vein thrombosis or pulmonary embolism). When a positive association was found, a further stratification was subsequently made to analyze whether relatives with rare, common, or no thrombophilia influenced these risks. A Cox-proportional hazards model was used to evaluate risks between groups for adjustments of age and sex. Results: Of a total of 2097 relatives, 55% were female, 180 (12%) had first VTE at a median age of 35 years and 52 (2%) had a recurrence at a median age of 40 years. Of relatives, 20% had hypertension, 13% dyslipidemia, 5% diabetes mellitus, 22% were previous smokers, 35% were overweight and 15% were obese. Point estimates of adjusted hazard ratios in relatives with hypertension, hyperlipidemia, diabetes mellitus or previous smokers, compared to their reference groups ranged between 0.9 and 1.1 and were not statistically significant. Relatives with VTE were heavier than relatives without VTE (mean BMI 27.0 vs 25.5 kg/m2, P< 0.001); adjusted hazard ratio for each 1-point increase in BMI was 1.035 (95% CI, 1.010-1.066). Absolute risk of first VTE in normal weight, overweight or obese subjects was 0.16% (95% CI, 0.12-0.20), 0.20% (95% CI, 0.16-0.25), and 0.26% (95% CI, 0.19-0.36), respectively. Sensitivity analyses did not change these outcomes. Annual incidences of first VTE in non-carriers of thrombophilia, common thrombophilia carriers and rare thrombophilia carriers were 0.04%, 0.20% and 0.97%. In the non-carrier group, adjusted hazard ratios for first VTE in overweight or obese relatives were 6.1 (95% CI, 1.3-28.1) and 6.7 (95% CI, 1.2-37.6), compared to non-carriers of normal weight. In common thrombophilia carriers these risks were 1.7 (95% CI, 1.0-2.9) and 2.1 (95% CI, 1.2-3.8) fold increased. In rare thrombophilia carriers, overweight or obesity was not associated with an increased risk of first VTE (adjusted hazard ratios 0.8; 95% CI, 0.5-1.4 and 0.8; 95% CI, 0.4-1.7, respectively). For recurrence, overweight and obese relatives with common or rare thrombophilia seemed to have a slightly higher risk of recurrence than normal weight relatives, but the overall 10 year recurrence rate in both groups was similar. Conclusion: Venous thrombotic risk increases with increasing BMI in non-carriers and common thrombophilia carriers. This effect is overruled in carriers of rare thrombophilia, where a deficiency itself irrespective of BMI apparently is sufficient to generate very high risk of thrombosis. Overweight and obesity seemed to increase the risk of recurrence in carriers of both common and rare thrombophilia. Other cardiovascular risk factors did not increase the risk of VTE in this thrombophilic family cohort. Disclosures: No relevant conflicts of interest to declare.

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