Polygenic Risk Score to Identify Subclinical Coronary Heart Disease Risk in Young Adults

2021 ◽  
Author(s):  
Quinn S. Wells ◽  
Minoo Bagheri ◽  
Aaron W. Aday ◽  
Deepak K. Gupta ◽  
Christian M. Shaffer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Young Adults ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Coronary Atherosclerosis ◽  
Modifiable Risk Factors ◽  
C Statistic ◽  
Integrated Discrimination Improvement

Background: Polygenic risk scores (PRS) may enhance risk stratification for coronary heart disease among young adults. Whether a coronary heart disease PRS improves prediction beyond modifiable risk factors in this population is not known. Methods: Genotyped adults aged 18 to 35 years were selected from the CARDIA study (Coronary Artery Risk Development in Young Adults; n=1132) and FOS (Framingham Offspring Study; n=663). Systolic blood pressure, total and HDL (high-density lipoprotein) cholesterol, triglycerides, smoking, and waist circumference or body mass index were measured at the visit 1 exam of each study, and coronary artery calcium, a measure of coronary atherosclerosis, was assessed at year 15 (CARDIA) or year 30 (FOS). A previously validated PRS for coronary heart disease was computed for each subject. The C statistic and integrated discrimination improvement were used to compare Improvements in prediction of elevated coronary artery calcium between models containing the PRS, risk factors, or both. Results: There were 62 (5%) and 93 (14%) participants with a coronary artery calcium score >20 (CARDIA) and >300 (FOS), respectively. At these thresholds, the C statistic changes of adding the PRS to a risk factor–based model were 0.015 (0.004–0.028) and 0.020 (0.001–0.039) in CARDIA and FOS, respectively. When adding risk factors to a PRS-based model, the respective changes were 0.070 (0.033–0.109) and 0.051 (0.017–0.079). The integrated discrimination improvement, when adding the PRS to a risk factor model, was 0.027 (−0.006 to 0.054) in CARDIA and 0.039 (0.0005–0.072) in FOS. Conclusions: Among young adults, a PRS improved model discrimination for coronary atherosclerosis, but improvements were smaller than those associated with modifiable risk factors.

scholarly journals Association of Abdominal Aorta Calcium and Coronary Artery Calcium with Incident Cardiovascular and Coronary Heart Disease Events in Black and White Middle‐Aged People: The Coronary Artery Risk Development in Young Adults Study

2021 ◽  
Author(s):  
Paul T. Jurgens ◽  
John J. Carr ◽  
James G. Terry ◽  
Jamal S. Rana ◽  
David R. Jacobs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Young Adults ◽  
Heart Disease ◽  
Coronary Artery ◽  
Abdominal Aorta ◽  
Coronary Artery Calcium ◽  
Middle Aged ◽  
Black And White

Background Assessing coronary artery calcium (CAC) is among AHA/ACC prevention guidelines for people at least 40 years old at intermediate risk for coronary heart disease (CHD). To study enhanced risk stratification, we investigated the predictive value of abdominal aorta calcium (AAC) relative to CAC for cardiovascular disease (CVD) and CHD events in Black and White early middle‐aged participants, initially free of overt CVD. Methods and Results In the CARDIA (Coronary Artery Risk Development in Young Adults) study, a multi‐center, community‐based, longitudinal cohort study of CVD risk, the CAC and AAC scores were assessed in 3011 participants in 2010–2011 with follow‐up until 2019 for incident CVD and CHD events. Distributions and predictions, overall and by race, were computed. During the 8‐year follow‐up, 106 incident CVD events (55 were CHD) occurred. AAC scores tended to be much higher than CAC scores. AAC scores were higher in Black women than in White women. CAC predicted CVD with HR 1.77 (1.52–2.06) and similarly for AAC, while only CAC predicted CHD. After adjustment for risk factors and calcium in the other arterial bed, the association of CAC with CVD was independent of risk factors and AAC, while the association of AAC with CVD was greatly attenuated. However, AAC predicted incident CVD when CAC was 0. Prediction did not vary by race. Conclusions AAC predicted CVD nearly as strongly as CAC and could be especially useful as a diagnostic tool when it is an incidental finding or when no CAC is found.

Coronary artery calcium score, risk factors, and incident coronary heart disease events

2007 ◽  
Vol 190 (1) ◽  
pp. 224-231 ◽  
Author(s):  
Timothy S. Church ◽  
Benjamin D. Levine ◽  
Darren K. McGuire ◽  
Michael J. LaMonte ◽  
Shannon J. FitzGerald ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Incident Coronary Heart Disease ◽  
Score Risk

Optical coherent tomography for the diagnostic of non-obstructive coronary artery myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Leonova ◽  
S Boldueva ◽  
V Feoktistova ◽  
D Evdokimov
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Atherosclerotic Plaque ◽  
St Elevation ◽  
Spontaneous Dissection

Abstract Funding Acknowledgements Type of funding sources: None. The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process.  The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT. Materials and methods 160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data. Results in 2 cases (22%) patients had ST-elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non-ST-elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, the atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of the hypertensive crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatous, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, antiplatelets were prescribed, patients with spontaneous dissection of CA had the recommendation of examination in the medical-genetic center. Conclusion Based on the results of the study, in most cases, the cause of IMBOC development was an atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.

Cardiac biomarkers for cardiovascular risk prediction among women and men from the general population

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
F Zhu ◽  
B Arshi ◽  
E Aribas ◽  
MA Ikram ◽  
MK Ikram ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Predictive Value ◽  
Troponin T ◽  
Cardiac Biomarkers ◽  
C Statistic ◽  
Cardiovascular Risk Prediction ◽  
Traditional Risk Factors

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): the Erasmus Medical Center and Erasmus University Rotterdam; the Netherlands Organization for Health Research and Development (ZonMw); Purpose To evaluate the sex-specific predictive value of two cardiac biomarkers; N-terminal pro B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT), alongside traditional cardiovascular risk factors, for 10-year cardiovascular risk prediction in general population. Methods A total of 5430 participants (mean age 68.1 years; 59.9% women) free of cardiovascular disease (CVD), with blood sample measurements between 1997 and 2001 were included. We developed a ‘base’ model using cardiovascular risk factors used in the Pooled Cohort Equation (includes age, sex, systolic blood pressure, treatment of hypertension, total and high-density lipoprotein cholesterol levels, smoking, and diabetes) and then extended the ‘base’ model with NT-proBNP or hs-cTnT. These models were developed for coronary heart disease (CHD), stroke, and heart failure (HF) and also for composite CVD outcomes. To evaluate biomarkers’ added predictive value, c-statistic, and net reclassification improvement index (NRI) for events and non-events were calculated. NRI was calculated using cutoffs of 5%, 7.5% and 20% to categorize participants as low, borderline, intermediate, or high risk. Results Adding NT-proBNP to the ‘base’ model significantly improved c-statistic for all outcomes (increases ranged between 0.012-0.047), with the largest improvement in HF [0.026 (95% CI, 0.013, 0.040) for women and 0.047 (95% CI, 0.026, 0.069) for men]. Adding hs-TnT to ‘base’ model increased the c-statistic for CHD in women by 0.040 (95% CI, 0.013, 0.067) and for HF in men by 0.032 (95% CI, 0.005, 0.059). Improvments in reclassification by both biomarkers were mostly limited to modest improvemetns in reclassification of non-events [largest non-event NRI for global CVD in women (NT-proBNP: 11.8%; hs-cTnT: 10.5%) and for HF in men (NT-proBNP: 9.6%; hs-cTnT: 8.4%)]. Conclusion NT-proBNP improved model performance for prediction of all cardiovascular outcomes, in particular for HF, beyond traditional risk factors for both women and men. Hs-cTnT showed modest added predictive value beyond traditional risk factors for CHD among women and for HF among men. Imropovements in reclassification by both biomarkers were modest and not clinically relevant. Improvements of 10-year risk predictions Events Adding NT-proBNP Adding troponin T Delta c-statistic* Event NRI, % Non-event NRI, % Delta c-statistic* Event NRI, % Non-event NRI, % WomenASCVD Global CVD 0.012 (0.004, 0.020) 0.018 (0.010, 0.026) -1.7 (-5.0, 1.5)-0.8 (-3.8, 2.2) 5.4 (3.5, 7.2)11.8 (9.6, 14.1) 0.028 (0.009, 0.048)0.025 (0.009, 0.040) -0.4 (-7.1, 6.2)2.9 (-2.4, 8.3) 6.9 (3.9, 9.9)10.5 (7.3, 13.8) MenASCVD Global CVD 0.016 (0.005, 0.027)0.023 (0.012, 0.033) 0.7 (-2.3, 3.7)-0.3 (-3.0, 2.4) 5.2 (3.2, 7.2)7.2 (4.9, 9.4) 0.007 (-0.002, 0.016)0.011 (0.000, 0.021) -1.1 (-5.0, 2.7)-1.6 (-6.0, 2.8) 4.0 (1.2, 6.9)6.4 (3.1, 9.7) ASCVD comprises coronary heart disease and stroke; Global CVD comprises coronary heart disease, stroke and heart failure.

OBSTRUCTIVE SLEEP APNEA / HYPOPNEA SYNDROME IN RAILWAY WORKERS WITH RISK FACTORS FOR CORONARY HEART DISEASE

2021 ◽  
Author(s):  
S. Gorokhova ◽  
◽  
N. Belozerova ◽  
M. Buniatyan ◽  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Obstructive Sleep ◽  
Railway Workers ◽  
Artery Disease ◽  
Step Algorithm ◽  
Hypopnea Syndrome

Abstract: Obstructive sleep apnea/hypopnea syndrome (OSA) is a common condition that may lead to excessive daytime sleepiness, cognitive disturbance, and a decreased concentration that are associated with the risk of workplace accidents and injuries. It is difficult to diagnose OSA due to low severity and specificity of its symptoms and special requirements in respect of medical resources. We assumed that it would be more effective and cost-efficient to diagnose OSA in railway workers with such risk factors f coronary heart disease as arterial hypertension and metabolic disorders since this group receives comprehensive medical attention. However, no studies on the prevalence of OSA in railway workers specifically considered the risk factors for coronary artery disease. The aim of the study was to assess the prevalence of OSA in railway workers with confirmed cardiovascular and metabolic disorders that did not disqualify them from their job. Material and methods. The study included 967 railway workers (locomotive drivers and their assistants). On Stage 1, a group of participants suspected OSA was selected; and on Stage 2, a group of participants with confirmed OSA was formed. Polysomnography or cardiorespiratory monitoring were used to diagnose OSA. Results. We developed a two-step algorithm of OSA diagnosis that included a preliminary assessment of the probability of OSA. 236 (24.4%) participants with a probability of OSA were selected among the initial 967 persons with risk factors for coronary artery disease. Further assessment confirmed OSA in 141 (60%) participants in this group. The analysis of distribution of risk factors for coronary artery disease and OSA showed that 125 (53.0%) of patients with BMI ≥ 30 kg/m², 115 (48.7%) of patients with AH, and 26 (11.0%) of patients with type 2 diabetes had OSA; most of them had some combination of these risk factors. Conclusions: OSA is prevalent in the group of professionally active locomotive drivers and their assistants with risk factors for coronary heart disease; every second worker in a target group with BMI ≥ 30 kg/m², AH or with both risk factors was diagnosed with OSA. The proposed two-step algorithm with a pre-test assessment of OSA probability and subsequent instrumental examination (cardiorespiratory monitoring, polysomnography) allows to accurately diagnosis OSA and allocate medical resources in a cost-effective manner.

Abstract 031: Diastolic Blood Pressure, Coronary Artery Calcium, and Cardiac Outcomes in the Multi-ethnic Study of Atherosclerosis

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
John W McEvoy ◽  
Faisal Rahman ◽  
Mahmoud Al Rifai ◽  
Michael Blaha ◽  
Khurram Nasir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Confidence Interval ◽  
Diastolic Blood Pressure ◽  
Coronary Artery Calcium ◽  
J Curve ◽  
Increased Risk ◽  
All Cause Mortality

Diastolic blood pressure (BP) has a J-curve relationship with coronary heart disease and death. Because this association is thought to reflect reduced coronary perfusion at low diastolic BP, our objective was to test whether the J-curve is most pronounced among persons with coronary artery calcium. Among 6,811 participants from the Multi-Ethnic Study of Atherosclerosis, we used Cox models to examine if diastolic BP category is associated with coronary heart disease events, stroke, and mortality. Analyses were conducted in the sample overall and after stratification by coronary artery calcium score. In multivariable-adjusted analyses, compared with diastolic BP of 80 to 89 mmHg (reference), persons with diastolic BP <60 mmHg had increased risk of coronary heart disease events (HR 1.69 [95% confidence interval 1.02-2.79]) and all-cause mortality (HR 1.48 [95% confidence interval 1.10-2.00]), but not stroke. After stratification, associations of diastolic BP <60 mmHg with events were present only among participants with coronary artery calcium >0. Diastolic BP <60 mmHg was not associated with events when coronary artery calcium was zero. We also found no interaction in the association between low diastolic BP and events based on race. In conclusion, diastolic blood pressure <60 mmHg was associated with increased risk of coronary heart disease events and all-cause mortality in the sample overall, but this association appeared strongest among individuals with elevated CAC; suggesting that added caution may be needed when pursuing intensive BP treatment targets among persons with subclinical atherosclerosis.

Modifiable risk factors for coronary heart disease in women

1994 ◽  
Vol 3 (3) ◽  
pp. 177-184 ◽  
Author(s):  
MJ Hanson
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Disease Risk ◽  
Synergistic Effects ◽  
Modifiable Risk Factors ◽  
Additional Risk ◽  
Heart Disease Risk Factors ◽  
The Individual ◽  
Heart Disease Risk

Research in human coronary heart disease has been conducted primarily on males; however, investigators have begun to focus research efforts on female subjects as well. A literature review that identified studies on women and coronary heart disease was done to describe modifiable risk factors for coronary heart disease in women. Several modifiable risk factors such as smoking, hypertension, and disorders of lipid metabolism previously identified for men are also risk factors for women. However, the mechanisms by which some of these risk factors work in women are different from those in men. Moreover, women have additional risk factors related to menopause and, in some cases, the use of oral contraceptives. Significant initial information has been gained concerning women and coronary heart disease risk factors. However, gaps persist in information regarding the individual and synergistic effects of risk factors for CHD in women.

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