Abstract P290: Stroke and Coronary Heart Disease - Predictive Power of Standard Risk Factors Until Old Age

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Wai Giang Kok ◽  
Lena M Bjorck ◽  
Masuma Novak ◽  
George Lappas ◽  
Annika Rosengren
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Old Age ◽  
Previous History ◽  
Cumulative Risk ◽  
Cumulative Effect ◽  
Risk Groups ◽  
Increased Risk ◽  
Score Model

Introduction and Aim: The SCORE model, based on age, sex, current smoking and systolic blood pressure, and serum cholesterol, was created to identify persons at increased risk for fatal cardiovascular disease (CVD) defined as death from coronary heart disease (CHD) or stroke within 10 years. We aimed to examine the short-term and long-term risk for CHD and stroke separately. Methods and Results: The Primary Prevention cohort study comprising 7174 men free from previous history of CHD, stroke and diabetes and aged 45 to 55 at baseline examination (1970–73) were followed up for 35 years. To estimate the cumulative effect of CHD and stroke, all participants were stratified into one of four risk groups defined by their burden of risk according to the SCORE factors. The 35 year relative risk (RR) for the men with the highest risk compared to those with the lowest was 3.38 (95 % CI 2.84–4.02) for CHD and 1.60 (95% CI 1.28–2.00) for stroke. When adjusted for competing risk the estimated 10 year cumulative risk for high risk individuals was 19.4% for CHD and 3.6% for stroke which increased substantially to 87% and 70% respectively after 35 years. Conclusions: The 10 year risk for CHD and stroke as calculated by the SCORE factors differs which indicates that the cumulative risk in middle age men based on the SCORE model can effectively be used to predict CHD but not stroke to the same extent. However, over an extended follow-up period until old age, the cumulative risk for stroke increased markedly such that high risk individuals developed a high cumulative risk for both CHD and stroke after 35 years.

The Preventive Effect of Alprostadil on the Contrast-Induced Nephropathy of Coronary Heart Disease Treated by Percutaneous Coronary Intervention in Moderate and High-Risk Population Stratified by Mehran Score

Angiology ◽  
2021 ◽  
pp. 000331972110155
Author(s):  
Xiaogang Liu ◽  
Peng Zhang ◽  
Jing Zhang ◽  
Xue Zhang ◽  
Shicheng Yang ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
High Risk ◽  
Risk Groups ◽  
Coronary Intervention ◽  
Preventive Effect ◽  
Moderate Risk ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary

The Mehran risk score (MRS) was used to classify patients with coronary heart disease and evaluate the preventive effect of alprostadil on contrast-induced nephropathy (CIN) after percutaneous coronary intervention. The patients (n = 1146) were randomized into an alprostadil and control group and then divided into 3 groups on the basis of the MRS: low-risk, moderate-risk, and high-risk groups. The primary end point was the occurrence of CIN (alprostadil + hydration vs simple hydration treatment); secondary end points included serum creatinine, blood urea nitrogen, creatinine clearance rate, cystatin C, interleukin-6, C-reactive protein, proteinuria, and differences in the incidence of major adverse events. In the low-risk, moderate-risk, and high-risk groups, the incidence of CIN in the control and alprostadil group was 2.9 versus 2.6% ( P = .832), 11.4 versus 4.9% ( P = .030), 19.1 versus 7.7% ( P = .041), respectively. Multivariate logistic regression analysis showed that alprostadil treatment was a favorable protective factor for moderate-risk and high-risk CIN patients (OR = 0.343, 95% CI: 0.124-0.951, P = .040). Alprostadil can be used as a preventive treatment for moderate- and high-risk CIN patients classified by the MRS. The reduction of CIN by alprostadil may be related to an anti-inflammatory effect.

A comparison of Framingham and SCORE-based cardiovascular risk estimates in participants of the German National Health Interview and Examination Survey 1998

2005 ◽  
Vol 12 (5) ◽  
pp. 442-450 ◽  
Author(s):  
Hannelore K. Neuhauser ◽  
Ute Ellert ◽  
Bärbel-Maria Kurth
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
National Health ◽  
Absolute Risk ◽  
Previous History ◽  
Mortality Statistics ◽  
Fatal Coronary Heart Disease ◽  
Health Interview

Background Overestimation of risk by Framingham risk functions not only in southern but also in northern European populations including Germany, has led to the development of the SCORE risk estimation model. Design Data of the German National Health Interview and Examination Survey 1998 was used to determine whether SCORE leads to lower estimates of the 10-year absolute risk of fatal cardiovascular disease and fatal coronary heart disease than a Framingham model. Predicted numbers of events were compared with approximations based on national mortality statistics. Methods Inclusion criteria followed the recommendations for the use of SCORE: age 30 to 69 years, no previous history of cardiovascular disease and no markedly raised levels of single risk factors (leaving 1811 men and 1955 women for analysis). Results The SCORE model for high-risk regions (SCORE-HIGH, which is recommended for Germany pending calibration with national data) predicted the highest number of events, followed by the estimations with mortality statistics, the Framingham model and SCORE-LOW (87 fatal cardiovascular disease events versus 77, 62 and 47; fatal coronary heart disease events 62 versus 46, 46 and 30). Agreement on high-risk status, defined as the 10-year risk of fatal cardiovascular disease of 5% or higher now or if extrapolated to age 60, was moderate for both men and women (≤ 0.52 and 0.42 for Framingham and SCORE-HIGH). Conclusions Our results suggest that SCORE-HIGH may overestimate absolute risk of fatal coronary heart disease and cardiovascular disease in Germany and may need calibration. Furthermore, the limitations of current risk prediction tools emphasize the ongoing need for comprehensive, high-quality and timely European cohort data.

Identification of the high-risk groups in familial coronary heart disease

1984 ◽  
Vol 53 (1) ◽  
pp. 37-46 ◽  
Author(s):  
Aila M. Rissanen ◽  
Esko A. Nikkilä
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Risk Groups

scholarly journals The importance of stratifying ischemic risk by using the Duke score in women with ischemic heart disease and hypothyroidism before inclusion in cardiovascular rehabilitation programs

2021 ◽  
Vol 12 (3) ◽  
pp. 248-254
Author(s):  
Diana Andrada GURZĂU ◽  
Bogdan CALOIAN ◽  
Horaţiu COMŞA ◽  
Adela SITAR-TĂUT ◽  
Dumitru ZDRENGHEA ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Ischemic Heart Disease ◽  
Thyroid Function ◽  
Ischemic Heart ◽  
Exercise Stress ◽  
Rehabilitation Programs ◽  
Cardiovascular Rehabilitation ◽  
Increased Risk

Introduction: The relationship between abnormal thyroid function and coronary heart disease has been known for a long time, and particularly, hypothyroidism is associated with an increased risk of cardiovascular disease. The aim of this study was to evaluate the ischemic risk by using the Duke score in women with ischemic heart disease and associated hypothyroidism before inclusion in cardiovascular rehabilitation program. Materials and methods: We included in the study 150 female patients admitted to the Cardiology Department of the Clinical Rehabilitation Hospital Cluj-Napoca. All the patients included had ischemic heart disease and performed an exercise stress testing to evaluate the effort capacity and also to stratify the ischemic risk by calculating the Duke Score. After dosing the thyroid stimulating hormone (TSH) we divided the patients in two groups: with hypothyroidism and a control group. Results: Patients with hypothyroidism were more frequently hypertensive, (98% vs 87%, p-0.035), and they had diabetes mellitus in a higher proportion (51% vs 22%, p-0.005). HDL cholesterol was significantly decreased in the group of patients with hypothyroidism: 40.36±10.39mg/dl vs 44.85±10.29mg/dl (p-0.01). Regarding the ischemic risk assessed by the Duke score, the statistically significant differences between the two groups were registered only for the category of high-risk patients, 5.55% vs 18% (p-0.048). Also, the TSH value was higher in the group with high-risk Duke score, 4.21±3.73µIU/ml, compared to the moderate-risk score group, 1.95±1.12µIU/ml(p-0.05). Conclusion: In women with ischemic heart disease, assessing thyroid function can be useful to identify patients at high risk of ischemia. Patients with hypothyroidism tend to have a higher prevalence of cardiovascular risk factors, a higher ischemic risk objectified by the Duke score and more commonly multivascular coronary lesions. For these patients, the inclusion in cardiovascular rehabilitation programs is essential, but it is very important that the programs to be customized for each patient. Keywords: coronary heart disease in women, exercise ECG, Duke score, ischemic risk, hypothyroidism, cardiovascular rehabilitation programs

scholarly journals Coronary risk reduction intervention for siblings and offspring of patients with premature coronary heart disease: the CRISO study protocol for a randomised controlled pilot study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Justin Lee Mifsud ◽  
John Stephenson ◽  
Felicity Astin ◽  
Joseph Galea
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Pilot Study ◽  
High Risk ◽  
Control Group ◽  
Preventive Cardiology ◽  
Premature Coronary Heart Disease ◽  
First Degree Relatives ◽  
Increased Risk ◽  
Randomised Controlled

Abstract Background Research has consistently demonstrated that preventive cardiology programs have limited success, and healthy practices among high-risk individuals remain suboptimal. Furthermore, there are no current programmes in Malta that offer support to first-degree relatives of patients with premature coronary heart disease. This internal pilot study will determine the feasibility, acceptability, and potential effectiveness of a preventative intervention. Methods/design We are conducting a 12-month single-centre, two-armed group randomised controlled trial (RCT), recruiting a sample of 100 asymptomatic first-degree relatives of patients with premature coronary heart disease (CHD). The study seeks to test an evidence-based intervention to reduce modifiable risk and determine its feasibility and acceptability. The Intervention will be delivered at an outpatient office based in a large acute academic hospital. It will comprise risk communication using an online risk calculator, a counselling style adapted from motivational interviewing, and 12 weekly telephone goal reinforcement calls (3 months). Control subjects will receive verbal lifestyle advice only. Feasibility will be assessed through recruitment and retention. Qualitative evaluation interviews will be conducted with a subsample of 24 purposefully selected participants at 12 months. Assessment for risk factor changes will be measured at pre-intervention and 6 and 12 months. Associations between variables will also be assessed descriptively. Discussion Preventive cardiology guidelines highlighted the importance of lifestyle interventions, and lifestyle intervention adherence was proven to reduce atherosclerotic cardiovascular disease (ASCVD) risk, regardless of the individual's genetic risk. Preventive cardiology programmes may fail to adequately support persons in modifying risky behaviours, and research demonstrates that healthy practices among high-risk individuals can remain suboptimal. Siblings and offspring of patients with premature CHD are at increased risk of ASCVD. Despite this, there is no process in place for routine screening and support to modify risk. It is hypothesised that participants assigned to the intervention arm will show more cardio-protective lifestyle-related improvement from the baseline than those in the control group. To date, this is the first trial being conducted amongst Maltese first-degree relatives. This study addresses the needed research, and the results will inform a definitive trial. The funding institution is the University of Malta. Trial registration ISRCTN, ISRCTN21559170; Registered 06/08/2020,

scholarly journals Antibodies Against SARS-CoV-2 among High-Risk Groups: Findings from Serosurveys in 6 Urban Areas of Odisha, India

2021 ◽  
Author(s):  
Srikanta Kanungo ◽  
Sidhartha Giri ◽  
Debdutta Bhattacharya ◽  
Jaya Singh Kshatri ◽  
Subrata Kumar Palo ◽  
...  
Keyword(s):  
Health Care ◽  
High Risk ◽  
Health Care Workers ◽  
Previous History ◽  
Risk Groups ◽  
Suspected Case ◽  
Care Workers ◽  
Increased Risk ◽  
Police Personnel ◽  
History Of

Abstract Background: Personnel involved in essential services or residing in high risk areas during the COVID-19 pandemic are at increased risk of getting infected, and higher infection rates among such personnel can paralyze these services due to shortage of staff. Evaluating the proportion of personnel infected can be done using seroprevalence studies or serosurveys.Methods: During July to November, 2020, individuals from multiple high risk groups in 6 urban centres in the state of Odisha, India, which included health care workers, police personnel, municipality/ sanitation staff, residents of urban slums, vendors, press staff, and prisoners, were recruited into the study after obtaining written informed consent. Blood samples collected from the study participants were tested for IgG antibodies against COVID-19 in Roche Cobas e441. Information on socio-demographic variables, association with a confirmed or suspected case, symptoms profile of individuals within 30 days, travel and history of testing for COVID-19 were collected. All the statistical analyses were performed using STATA 16.0 (Stata corp., Texas). A P value ≤ 0.05 was considered statistically significant. Results: Of the 5434 individuals included in the final analysis, the overall COVID-19 seroprevalence was found to be 34.9% (95% CI 33.6-36.2). The seroprevalence varied from 21.8% (95% CI 19.6-24.1) in Rourkela to 54.9% (95% CI 51.5-58.2) in Bhubaneswar. Seropositivity was maximum among prisoners (47.7%, 138/289), followed by municipality/ sanitation staff (43.5%, 330/758), other office going staff (40.8%, 183/448), slum residents and vendors (39.8%, 252/633), police personnel (38.3%, 354/922), health care workers (27.1%, 536/1977), press staff (27.2%, 18/66) and residents of containment zones (25.2%, 86/341). On multivariate logistic regression, participants aged 18-29 years, 30-44 years, residents of slums and vending zone, municipality staffs, prisoners, residents of urban sites Malkangiri, Cuttack, Paralakhemundi and Bhubaneswar and those with previous history of confirmed COVID-19 were found to be independent co-relates of seropositivity.Conclusions: Risk of COVID-19 infection varied among the various high risk groups of Odisha. Periodic seroprevalence studies in future is essential to protect personnel involved in frontline activities during the ongoing pandemic.

scholarly journals Stroke and coronary heart disease: predictive power of standard risk factors into old age—long-term cumulative risk study among men in Gothenburg, Sweden

2013 ◽  
Vol 34 (14) ◽  
pp. 1068-1074 ◽  
Author(s):  
Kok Wai Giang ◽  
Lena Björck ◽  
Masuma Novak ◽  
Georgios Lappas ◽  
Lars Wilhelmsen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Old Age ◽  
Predictive Power ◽  
Cumulative Risk ◽  
Standard Risk

scholarly journals Joint association between education and polygenic risk score for incident coronary heart disease events: a longitudinal population-based study of 26 203 men and women

2021 ◽  
pp. jech-2020-214358
Author(s):  
Pekka Martikainen ◽  
Kaarina Korhonen ◽  
Aline Jelenkovic ◽  
Hannu Lahtinen ◽  
Aki Havulinna ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Risk Score ◽  
Density Lipoprotein ◽  
Population Based ◽  
Polygenic Risk Score ◽  
Genome Wide ◽  
Increased Risk ◽  
Region Of Residence

BackgroundGenetic vulnerability to coronary heart disease (CHD) is well established, but little is known whether these effects are mediated or modified by equally well-established social determinants of CHD. We estimate the joint associations of the polygenetic risk score (PRS) for CHD and education on CHD events.MethodsThe data are from the 1992, 1997, 2002, 2007 and 2012 surveys of the population-based FINRISK Study including measures of social, behavioural and metabolic factors and genome-wide genotypes (N=26 203). Follow-up of fatal and non-fatal incident CHD events (N=2063) was based on nationwide registers.ResultsAllowing for age, sex, study year, region of residence, study batch and principal components, those in the highest quartile of PRS for CHD had strongly increased risk of CHD events compared with the lowest quartile (HR=2.26; 95% CI: 1.97 to 2.59); associations were also observed for low education (HR=1.58; 95% CI: 1.32 to 1.89). These effects were largely independent of each other. Adjustment for baseline smoking, alcohol use, body mass index, igh-density lipoprotein (HDL) and total cholesterol, blood pressure and diabetes attenuated the PRS associations by 10% and the education associations by 50%. We do not find strong evidence of interactions between PRS and education.ConclusionsPRS and education predict CHD events, and these associations are independent of each other. Both can improve CHD prediction beyond behavioural risks. The results imply that observational studies that do not have information on genetic risk factors for CHD do not provide confounded estimates for the association between education and CHD.

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