Abstract P195: The Relative Contribution of Systolic Blood Pressure in Cardiovascular Risk Prediction Declines

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Susanne Rospleszcz ◽  
Barbara Thorand ◽  
Tonia de las Heras Gala ◽  
Christa Meisinger ◽  
Rolf Holle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Risk Prediction ◽  
Performance Measures ◽  
Population Attributable Risk ◽  
Attributable Risk ◽  
Cvd Risk ◽  
Relative Contribution ◽  
Cardiovascular Risk Prediction

Background: The Framingham Risk Score (FRS) is an established tool for the prediction of cardiovascular disease (CVD) risk. The established CVD risk factors age, HDL cholesterol, total cholesterol, systolic blood pressure (SBP), antihypertensive treatment, diabetes mellitus and smoking are used in the calculation of the FRS. The prevalence and distribution of these risk factors in the population have changed within the last decades and especially average levels of SBP have declined. However, the impact of this change on the risk prediction performance of the FRS has not been investigated. Hypothesis: We assessed the hypothesis that the relative contribution of SBP to CVD risk prediction within the FRS framework has changed from 1985 to 2000. Methods: We used N = 11 760 participants aged 30 - 65 years from four prospective population-based cohort studies enrolled in Southern Germany in 1985, 1990, 1995, and 2000. CVD risk was calculated by recalibrated equations of the original FRS. Predicted CVD risks using the actual SBP values were compared to predicted CVD risks using optimal (SBP < 120 mmHg) values for each participant. We assessed the relative contribution of SBP with three performance measures: First, the median difference in predicted risks with actual and optimal SBP, second, the relative positive predictive value of the FRS using actual compared to optimal SBP values and third, the population attributable risk fraction of SBP using Levin’s formula. Results: CVD events occurred in 6.3% of male participants in 1985 and 6.2% in 2000; in women, event rates were 2.4% and 2.3%, respectively. Mean SBP levels decreased from 134 mmHg (Standard Deviation: 17 mmHg) to 132 (SD: 17) mmHg in men and from 127 (SD: 19) mmHg to 121 (SD: 18) mmHg in women. The difference in median predicted risk declined from 1.21 [Interquartile range 0.52, 3.38] in 1985 to 0.93 [0.35, 2.44] in 2000 in men and from 0.26 [-0.05, 1.45] to -0.07 [-0.19, 0.89] in women. The relative positive predictive value dropped from 0.88 to 0.73 in men and from 0.61 to 0.53 in women. The population attributable risk fraction of SBP decreased from 70.2% (95% CI: 42.1, 89.6) to 29.71% (-6.4, 64.7) in men and from 85.7% (62.9, 93.1) to 57.9% (28.0, 82.0) in women. Given the results from 1990 and 1995, the declining trend was nonlinear for all three performance measures. Conclusion: In conclusion, the relative contribution of blood pressure to cardiovascular risk prediction has decreased within the last decades. This affects the future development of CVD risk prediction methods which will have to consider the changing relative importance of SBP. Furthermore, this might also influence public health policies focusing on the management of SBP and hypertension in order to effectively prevent CVD.

Cardiovascular Risk Prediction using JBS3 Tool: A Kerala based Study

2020 ◽  
Vol 16 ◽  
Author(s):  
Paulin Paul ◽  
Noel George ◽  
B. Priestly Shan
Keyword(s):  
Logistic Regression ◽  
Cardiovascular Risk ◽  
Risk Prediction ◽  
Goodness Of Fit ◽  
Significant Risk ◽  
Lifetime Risk ◽  
British Society ◽  
Cvd Risk ◽  
South Indian ◽  
Cardiovascular Risk Prediction

Background: The accuracy of Joint British Society calculator3 (JBS3) cardiovascular risk prediction may vary within Indian population, and is not yet studied using south Indian Kerala based population data. Objectives: To evaluate the cardiovascular disease (CV) risk estimation using the traditional CVD risk factors (TRF) in Kerala based population. Methods: This cross sectional study has 977 subjects aged between 30 and 80 years. The traditional CVD risk markers are recorded from the medical archives of clinical locations at Ernakulum district, in Kerala The 10 year risk categories used are low (<7.5%), intermediate (≥7.5% and <20%), and high (≥20%). The lifetime classifications low lifetime (≤39%) and high lifetime (≥40%) are used. The study was evaluated using statistical analysis. Chi-square test was done for dependent and categorical CVD risk variable comparison. Multivariate ordinal logistic regression for 10-year risk model and odds logistic regression analysis for lifetime model was used to identify significant risk variables. Results: The mean age of the study population is 52.56±11.43 years. The risk predictions has 39.1% in low, 25.0% in intermediate, and 35.9% had high 10-year risk. The low lifetime risk had 41.1% and 58.9% is high lifetime risk. Reclassifications to high lifetime are higher from intermediate 10-year risk category. The Hosmer-Lemeshow goodness-of-fit statistics indicates a good model fit. Conclusion: The risk prediction and timely intervention with appropriate therapeutic and lifestyle modification is useful in primary prevention. Avoiding short-term incidences and reclassifications to high lifetime can reduce the CVD mortality rates.

scholarly journals Standardised measurement of coronary inflammation using cardiovascular CT: integration in clinical care as a prognostic medical device

2021 ◽  
Author(s):  
Evangelos K Oikonomou ◽  
Alexios S Antonopoulos ◽  
David Schottlander ◽  
Mohammad Marwan ◽  
Chris Mathers ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Medical Device ◽  
Risk Prediction ◽  
Clinical Care ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Cardiovascular Risk Prediction ◽  
Perivascular Fat

Abstract Aims Coronary CT angiography (CCTA) is a first-line modality in the investigation of suspected coronary artery disease (CAD). Mapping of perivascular Fat Attenuation Index (FAI) on routine CCTA enables the non-invasive detection of coronary artery inflammation by quantifying spatial changes in perivascular fat composition. We now report the performance of a new medical device, CaRi-Heart®, which integrates standardised FAI mapping together with clinical risk factors and plaque metrics to provide individualised cardiovascular risk prediction. Methods and Results The study included 3912 consecutive patients undergoing CCTA as part of clinical care in the United States (n = 2040) and Europe (n = 1872). These cohorts were used to generate age-specific nomograms and percentile curves as reference maps for the standardised interpretation of FAI. The first output of CaRi-Heart® is the FAI-Score of each coronary artery, which provides a measure of coronary inflammation adjusted for technical, biological and anatomical characteristics. FAI-Score is then incorporated into a risk prediction algorithm together with clinical risk factors and CCTA-derived coronary plaque metrics to generate the CaRi-Heart® Risk that predicts the likelihood of a fatal cardiac event at 8 years. CaRi-Heart® Risk was trained in the US population and its performance was validated externally in the European population. It improved risk discrimination over a clinical risk factor-based model (Δ[C-statistic] of 0.085, P = 0.01 in the US Cohort and 0.149, P &lt; 0.001 in the European cohort) and had a consistent net clinical benefit on decision curve analysis above a baseline traditional risk factor-based model across the spectrum of cardiac risk. Conclusion CaRi-Heart® reliably improves cardiovascular risk prediction by incorporating traditional cardiovascular risk factors along with comprehensive CCTA coronary plaque and perivascular adipose tissue phenotyping. This integration advances the prognostic utility of CCTA for individual patients and paves the way for its use as a screening tool among patients referred for CCTA. Translational Perspective Mapping of perivascular Fat Attenuation Index (FAI) on coronary computed tomography angiography (CCTA) enables the non-invasive detection of coronary artery inflammation by quantifying spatial changes in perivascular fat composition. We now report the performance of a new medical device, CaRi-Heart®, which integrates standardised FAI mapping together with clinical risk factors and plaque metrics to provide age-standardised reference maps and individualised cardiovascular risk prediction. This integration advances the prognostic value of CCTA and paves the way for its use as a screening tool among patients referred for CCTA.

scholarly journals The use of repeated blood pressure measures for cardiovascular risk prediction: a comparison of statistical models in the ARIC study

2016 ◽  
Vol 36 (28) ◽  
pp. 4514-4528 ◽  
Author(s):  
Michael J. Sweeting ◽  
Jessica K. Barrett ◽  
Simon G. Thompson ◽  
Angela M. Wood
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Risk Prediction ◽  
Statistical Models ◽  
Cardiovascular Risk Prediction ◽  
Aric Study

scholarly journals Use of Long-term Cumulative Blood Pressure in Cardiovascular Risk Prediction Models

2018 ◽  
Vol 3 (11) ◽  
pp. 1096 ◽  
Author(s):  
Lindsay R. Pool ◽  
Hongyan Ning ◽  
John Wilkins ◽  
Donald M. Lloyd-Jones ◽  
Norrina B. Allen
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Risk Prediction ◽  
Prediction Models ◽  
Risk Prediction Models ◽  
Cardiovascular Risk Prediction

scholarly journals Changes to cardiovascular risk factors over 7 years: a prospective cohort study of in situ urbanised residents in the Chaoyang District of Beijing

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e033548
Author(s):  
Zhe Li ◽  
Shicheng Yu ◽  
Xiaoyan Han ◽  
Jianjun Liu ◽  
Hongyan Yao
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Overweight And Obesity ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Rural Residents

ObjectivesTo examine changes in cardiovascular risk factors of in situ urbanised residents between 2010 and 2017.DesignPopulation-based cohort study.SettingThe Chaoyang District of Beijing, China.ParticipantsA total of 942 in situ urbanised rural residents aged 35–64 who participated in the cardiovascular disease (CVD) risk factors study in China between 2010 and 2017.Main outcome measuresLifestyles (smoking, drinking and effective exercise) and medical history (diabetes, hypertension, dyslipidaemia, overweight and obesity) were self-reported. New cases of diabetes, hypertension, dyslipidaemia, overweight and obesity were confirmed by physical examination or blood biochemical tests. Multiple linear regression and log-binomial models analyses adjusted for sociodemographic confounders were conducted to evaluate any changes of clinical indexes and to estimate prevalence rate ratios (PRRs), respectively.ResultsDuring the study period of 2010–2017, diastolic blood pressure elevated by 3.55 mm Hg, central blood pressure increased by 4.39 mm Hg, total cholesterol decreased by 0.29 mmol/L and hypertension increased significantly (PRR=1.25, p<0.05) after adjusting for demographic, lifestyle and family history factors. Effective exercise rate (PRR=1.57), prevalence of diabetes (PRR=1.36) and dyslipidaemia (PRR=1.19) all increased from 2010 to 2017. However, these changes were not significant after adjusting for confounders (p>0.05). Prevalence of smoking, drinking, hypertension, overweight and obesity was significantly higher in males than females in both 2010 and 2017. In 2017, the 10-year risk of atherosclerotic CVD increased in 29.8% of participants and decreased in 6.1% of individuals.ConclusionsCVD risk factors augmented remarkably for in situ urbanised rural residents aged 35–64 in the Chaoyang District of Beijing, especially those indicators related to blood pressure. Awareness of the direction and magnitude of these risk factor changes may be beneficial in informing targeted strategies for preventing CVDs of in situ urbanised populations.

scholarly journals Does coronary calcium scoring adds value to cardiovascular risk prediction in asymptomatic population?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Serrao ◽  
M Temtem ◽  
A Pereira ◽  
J Monteiro ◽  
M Santos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Risk Prediction ◽  
Cardiovascular Events ◽  
Cardiovascular Risk Prediction ◽  
Traditional Risk Factors ◽  
The Impact

Abstract Background Despite being a controversial subject, multiple guidelines mention the use of Coronary Artery Calcification (CAC) scoring in the cardiovascular risk prediction, in asymptomatic population. The inclusion of CAC scoring in traditional risk models may help in decision-make providing better cardiovascular risk stratification. Purpose The aim of our study is to estimate the impact of CAC scoring in cardiovascular events risk prediction in a model based on traditional risk factors (TRFs). Methods and results The study consisted of 1052 asymptomatic individuals free of known coronary heart disease, enrolled from GENEMACOR study and referred for computed tomography for the CAC scoring assessment. A cohort of 952 was followed for a mean of 5.2±3.2 years for the primary endpoint of all-cause of cardiovascular events. The following traditional risk factors were considered: (1) current cigarette smoking, (2) dyslipidemia, (3) diabetes mellitus, (4) hypertension and (5) family history of coronary heart disease. Among this population, the extent of CAC differs significantly between men and women in the same age group. Therefore, the distribution of CAC score by age and gender was done by using the Hoff's nomogram (a). According to this nomogram, 3 categories were created: low CAC (0≤CAC&lt;100 and P&lt;50); moderate CAC (100≤CAC&lt;400 or P50–75) and high CAC (CAC≥400 or P&gt;75). Two Cox regression models were created, the first only with TRFs and the second adding the CAC severity categories. When including CAC categories to the TRFs, the higher severity level presented a significant risk of MACE occurrence with an HR of 4.39 (95% CI 1.83–10.52; p=0.001). Conclusion Our results point to the importance of the inclusion of CAC in both primary and secondary prevention to an improved risk stratification. Larger prospective multicentre cohorts with longer follow-up should reproduce and validate these findings. Funding Acknowledgement Type of funding source: None

scholarly journals Assessment of Cardiovascular Risk for Prevention and Control of Cardiovascular Disease in Ghana’s Northern Region A Cross-sectional Study of 4 Rural Districts using World Health Organization / International Society of Hypertension (WHO/ISH) Risk Prediction Charts

2021 ◽  
Vol 13 (6) ◽  
pp. 1
Author(s):  
Sandra M. Skerratt ◽  
Olivia G. Wilson
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Risk Prediction ◽  
Cardiovascular Event ◽  
Cross Sectional Study ◽  
Northern Region ◽  
Sectional Study ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Cross Sectional

Ghana is experiencing an increase in cardiovascular (CVD) -related mortality with poor rural communities suffering greater complications and premature deaths. The point of this exploratory research is to evaluate the prevalence of CVD risk factors and to calculate the cardiovascular risk among adults aged &gt; 40 years in Ghana&rsquo;s Northern Region. A cross-sectional study was performed with 536 subjects. A pre-tested questionnaire, anthropometric measurements, and standardized WHO/ISH risk prediction charts assessed for 10-year risk of a fatal or non-fatal major cardiovascular event according to age, sex, blood pressure, smoking status, and diabetes mellitus status. Low, moderate and high CVD prevalence risk in females was 88.4%, 7.1%, and 4.5% while in males the prevalence was 91.3%, 5.8%, and 2.9%, respectively. Hypertension was noted as a clinically significant risk factor with females at 37.3% versus males at 32%. The 10-year risk of a fatal or non-fatal cardiovascular event was statistically significant for females according to age group. A moderate to high CVD risk of a fatal or non-fatal cardiovascular event was found in 10.4% of subjects. Notable CVD risk factors included a high prevalence of hypertension. Decentralizing care to local village healthcare facilities is one way to tackle cardiovascular risk reduction. Task shifting of primary care duties from physicians to nurses in terms of cardiovascular (CV) risk assessment and management of uncomplicated CV risk factors is a potential solution to the acute shortage of trained health staffs for the control and prevention of CVD in Northern Ghana.

scholarly journals Cardiovascular risk prediction in type 2 diabetes: a comparison of 22 risk scores in primary care setting

2020 ◽  
Author(s):  
K Dziopa ◽  
F W Asselbergs ◽  
J Gratton ◽  
N Chaturvedi ◽  
A F Schmidt
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Risk Prediction ◽  
Risk Scores ◽  
Routine Practice ◽  
Cvd Risk ◽  
C Statistic ◽  
Cardiovascular Risk Prediction ◽  
Multiple Variables

AbstractObjectiveTo compare performance of general and diabetes specific cardiovascular risk prediction scores in type 2 diabetes patients (T2DM).DesignCohort study.SettingScores were identified through a systematic review and included irrespective of predicted outcome, or inclusion of T2DM patients. Performance was assessed using data from routine practice.ParticipantsA contemporary representative sample of 203,172 UK T2DM patients (age ≥ 18 years).Main outcome measuresCardiovascular disease (CVD i.e., coronary heart disease and stroke) and CVD+ (including atrial fibrillation and heart failure).ResultsWe identified 22 scores: 11 derived in the general population, 9 in only T2DM patients, and 2 that excluded T2DM patients. Over 10 years follow-up, 63,000 events occurred. The RECODE score, derived in people with T2DM, performed best for both CVD (c-statistic 0.731 (0.728,0.734), and CVD+ (0.732 (0.729,0.735)). Overall, neither derivation population, nor original predicted outcome influenced performance. Calibration slopes (1 indicates perfect calibration) ranged from 0.38 (95%CI 0.37;0.39) to 1.05 (95%CI 1.03;1.07). A simple, population specific recalibration process considerably improved performance, ranging between 0.98 and 1.03. Risk scores performed badly in people with pre-existing CVD (c-statistic ∼0.55). Scores with more predictors did not perform scores better: for CVD+ QRISK3 (19 variables) c-statistic 0.69 (95%CI 0.68;0.69), compared to CHD Basic (8 variables) 0.71 (95%CI 0.70; 0.71).ConclusionsCVD risk prediction scores performed well in T2DM, irrespective of derivation population and of original predicted outcome. Scores performed poorly in patients with established CVD. Complex scores with multiple variables did not outperform simple scores. A simple population specific recalibration markedly improved score performance and is recommended for future use.

Abstract P206: The Risk for Cardiovascular Disease Attributable to Traditional Risk Factors Increases

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Susanne Rospleszcz ◽  
Barbara Thorand ◽  
Tonia de las Heras Gala ◽  
Christa Meisinger ◽  
Rolf Holle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Systolic Blood Pressure ◽  
Population Attributable Risk ◽  
Temporal Trends ◽  
Cvd Risk ◽  
Traditional Risk Factors ◽  
The Impact

Background: Cardiovascular disease (CVD) is a major cause of mortality and morbidity. Traditional risk factors include systolic blood pressure, diabetes, adiposity, cholesterol and smoking. The prevalence and distribution of these risk factors in the population have changed within the last decades and CVD mortality rates have been declining. However, the impact of these changes on the contribution of the single risk factors to overall CVD risk remains to be investigated. Hypothesis: We assessed the hypothesis that the population attributable risk (PAR) of traditional risk factors changes from 1985 to 2000. Methods: The sample comprises N = 11 760 participants aged 30 - 65 years from four prospective population-based cohort studies enrolled in Southern Germany in 1985, 1990, 1995, and 2000. Participants were followed up for incident CVD events for ten years. We analyzed the traditional risk factors hypertension, defined as systolic blood pressure ≥ 140 mmHg or treatment with antihypertensive medication; diabetes mellitus; obesity, defined as a Body Mass Index ≥ 30 kg/m 2 ; hypercholesterolemia, defined as total cholesterol levels ≥ 200 mg/dL; and smoking. We calculated the PAR first according to Levin’s formula using both crude relative risks as well as adjusted hazard ratios and second as an average of all single sequential PARs according to the formulae by Ferguson. Results: Temporal trends in prevalence varied for the respective risk factors. The prevalence of hypertension decreased slightly for women (from 25.0% in 1985 to 23.0% in 2000) and increased slightly for men (32.3% to 33.3%), whereas the prevalence of diabetes and obesity increased for both women and men. Prevalence of hypercholesterolemia decreased slightly for women (from 73.4% to 71.4%) and more pronounced for men (80.5% to 74.5%). Prevalence of smoking increased for women (20% to 23.6%), but decreased for men (36.4% to 32.4%). CVD events occurred in 2.4% of women in 1985 and 2.3% in 2000; for men, event rates were and 6.2% and 6.3%, respectively. For both women and men the risk factor with the highest PAR in 1985 was hypertension (64.0% and 43.3%, respectively according to Levin’s formula). However, in 2000 the risk factor with the highest PAR was hypercholesterolemia (78.2% and 57.0%, respectively). The PAR for diabetes declined for women and increased for men. The PAR for smoking varied substantially between the studies without a discernible trend. According to Ferguson’s formulae, the PAR of all risk factors taken together increased from 74.3% to 84.2% in women and from 70.8% to 81.8% in men. Conclusion: In conclusion, the CVD risk attributable to traditional risk factors has increased within the last decades. However, different methods of calculating the PAR have to be taken into account. These trends might influence public health policies focusing on the management of these risk factors in order to effectively prevent CVD.

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