Does Adding Adverse Pregnancy Outcomes Improve the Framingham Cardiovascular Risk Score in Women? Data from the Tehran Lipid and Glucose Study

Background Limited and conflicting evidence is available regarding the predictive value of adding adverse pregnancy outcomes (APOs) to established cardiovascular disease (CVD) risk factors. Hence, the objective of this study was to determine whether adding APOs to the Framingham risk score improves the prediction of CVD events in women. Methods and Results Out of 5413 women who participated in the Tehran Lipid and Glucose Study, 4013 women met the eligibility criteria included for the present study. The exposure and the outcome variables were collected based on the standard protocol. Cox proportional hazard model was used to evaluate the association of APOs and CVDs. The variant of C‐statistic for survivals and reclassification of subjects into Framingham risk score categories after adding APOs was reported. Out of the 4013 eligible subjects, a total of 1484 (36.98%) women reported 1 APO, while 395 (9.84%) of the cases reported multiple APOs. Univariate proportional hazard Cox models showed the significant relations between CVD events and APOs. The enhanced model had a higher C‐statistic indicating more acceptable discrimination as well as a slight improvement in discrimination (C‐statistic differences: 0.0053). Moreover, we observed a greater risk of experiencing a CVD event in women with a history of multiple APOs compared with cases with only 1 APO (1 APO: hazard ratio [HR] = 1.22; 2 APOs: HR; 1.94; ≥3 APOs: HR = 2.48). Conclusions Beyond the established risk factors, re‐estimated CVDs risk by adding APOs to the Framingham risk score may improve the accurate risk estimation of CVD. Further observational studies are needed to confirm our findings.

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Abstract 376: Adverse Pregnancy Outcomes and Cardiovascular Risks Multi-disciplinary Awareness Project

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.376 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Venkata Sai Gogineni ◽

Ki Park ◽

Denise Manfrini ◽

Robert Egerman ◽

Sharon Aroda ◽

...

Keyword(s):

Risk Factors ◽

Pregnancy Outcomes ◽

Descriptive Analysis ◽

Primary Objective ◽

Adverse Pregnancy Outcomes ◽

Cardiovascular Risks ◽

Cvd Risk ◽

Adverse Pregnancy ◽

Traditional Risk Factors

Background: Cardiovascular disease (CVD) remains the number one cause of death amongst women. There has been much effort put forth over the past decade in reducing both the incidence and prevalence of this disease burden through screening and treating the traditional risk factors. Recent guidelines have shown that adverse pregnancy outcomes (APOs), including pre-eclampsia (PEC), gestational diabetes mellitus (GDM) and pre-term birth (PTB) have been associated with future maternal CVD risk. Much of the current literature focuses almost exclusively on PEC. Our investigation is more comprehensive, covering not only these other APOs but assessing whether providers of multiple specialties in our community are aware of the APO to CVD risk association. The primary objective of this study was to investigate if there exist any knowledge gaps regarding the progression from APO to CVD and if this knowledge varies by specialty. Methods: An anonymous voluntary survey through REDCap© was sent to providers in the fields of Internal medicine (IM, 21%), Family medicine (FM, 26%), Obstetrics-Gynecology (Ob-Gyn, 23%) and Cardiology (30%) who have been in practice for greater than five years in our local Gainesville community. This project was registered as a QI project and descriptive analysis was used to examine the responses. Results: A total of 53 providers responded to the survey. Despite having the majority of patients being women, Ob-Gyn was the least likely amongst all specialties to routinely screen for CV risk factors. However, when addressed, they were the most likely to ask about APOs. Cardiologists, despite declaring to be aware of the association between APOs and CV risk, were least likely to ask about APOs. All specialties recognized PEC and GDM as APOs linked to long-term maternal CV risk but failed to associate PTB as an APO. The majority of providers amongst IM, FM, and Cardiology did not ask about APOs and lacked the knowledge of how often to appropriately screen for secondary risk factors associated with APOs. Additionally, these providers outright admitted that they are not familiar with the current AHA and/or ACOG guidelines for screening and follow-up. Conclusion: Descriptive statistical analysis of our data suggests that there exists a notable knowledge gap between all four specialties investigated in our survey. Education concerning the link between APOs and future maternal CV risk is needed amongst all specialties, especially amongst the providers in Cardiology, IM, and FM. Targeted efforts at our institution to improve awareness of all APOs, their associated secondary risk factors, and appropriate screening is required in all specialties to help reduce CVD morbidity and mortality.

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Cardiovascular Risk Factors in HIV-Infected Adults in North-Central Nigeria: Prevalence, Associated Factors and Assessment of Risk Using the Framingham Risk Score – Preliminary Results from a Survey

Journal of BioMedical Research and Clinical Practice ◽

10.46912/jbrcp.208 ◽

2021 ◽

Vol 4 (1) ◽

pp. 71-83

Author(s):

GA Amusa ◽

G Osaigbovo ◽

L Imoh ◽

B Awokola

Keyword(s):

Risk Factors ◽

Risk Score ◽

Framingham Risk Score ◽

Local Environment ◽

University Teaching ◽

P Value ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Cross Sectional ◽

Framingham Risk

HIV/AIDS is an increasingly important cause of cardiovascular (CVD) morbidity world-wide. We sought to evaluate the prevalence of CVD risk factors in HIV positive (HIV+) adults and assessment of these risks using the Framingham risk score (FRS). A cross-sectional study of adult clients of the HIV clinic at Jos University Teaching Hospital. One hundred and fifty HIV+ selected randomly with 50 (age and sex matched) HIV negative (HIV-) participants were enrolled. Relevant history, physical examination and biochemical investigations and 12-lead electrocardiography were performed. Data was analyzed using Epi-info 7.2 statistical software and P value < 0.05 was considered significant. The prevalent major CVD risk factors were dyslipidaemia (30.0% versus 6.0%), hypertension (34.0% versus 10.0%) and diabetes mellitus (10.0% versus 2.0%) among the HIV+ and HIV- participants respectively. The FRS of the HIV+, 3 (IQR 3-28) were statistically significantly higher than that of the HIV- participants, 2 (IQR 1-13); P=0.001. Furthermore, 32% of the HIV+ had moderate-high FRS compared to 2% of HIV- participants. CD4 count ≤ 200 cells/ml, use of anti-retroviral (ART), ART use ≥ 2 years and use of protease inhibitors (PI) emerged as predictors of moderate-high FRS among the HIV+ participants. In conclusion, a high prevalence of CVD risk factors exists among HIV+ population in our local environment. These risk factors can be identified early by baseline/periodic cardiovascular work-up which should include use of CVD risk tools. Early diagnosis and treatment will significantly reduce morbidity and mortality in these patients.

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Platelet volume is associated with the Framingham risk score for cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2015-0686 ◽

2016 ◽

Vol 54 (5) ◽

Cited By ~ 7

Author(s):

Chams B. Maluf ◽

Sandhi M. Barreto ◽

Rodrigo C.P. dos Reis ◽

Pedro G. Vidigal

Keyword(s):

Risk Factors ◽

Longitudinal Study ◽

Risk Score ◽

Framingham Risk Score ◽

Linear Regression Analysis ◽

Adult Health ◽

Platelet Volume ◽

Cvd Risk ◽

Distribution Width ◽

Framingham Risk

AbstractBackground:Platelet volume indices (PVI), an easy and inexpensive surrogate measure of platelet function, have been associated with cardiovascular diseases (CVD) and their risk factors. However, results are conflicting because of the lack of standardized procedures. The purpose of this study is to investigate the relationship of PVI with the Framingham risk score (FRS).Methods:Baseline data (2008–2010) of 3115 participants enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were used. PVI measurements were strictly controlled. The cohort was distributed according to risk factors and the general FRS was estimated. Multiple linear regression analysis was used to estimate the association between PVI and FRS.Results:Mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (P-LCR) independently correlated (p≤0.01) with FRS after adjustment for confounding variables. One unit increase in MPV, PDW, or P-LCR increased the FRS by 0.59%, 0.40%, and 0.08%, respectively. Diabetics had higher (p≤0.004) MPV, PDW, and P-LCR, and hypertensive individuals had higher (p≤0.045) PDW and P-LCR.Conclusions:Increased PVI was independently correlated with higher CVD risk based on the FRS, diabetes, and systolic hypertension. Prospective follow up of this cohort is warranted to confirm that PVI is associated with the development of CVD.

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A comparative study of cardiovascular disease risk among bus drivers and bus conductors of a state transport corporation in North Goa

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20212009 ◽

2021 ◽

Vol 8 (6) ◽

pp. 3023

Author(s):

Shefalee Pai Vernekar ◽

Hemangini Kishore Shah

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Risk Score ◽

Framingham Risk Score ◽

Bus Drivers ◽

Cvd Risk ◽

Cross Sectional ◽

Framingham Risk ◽

The Difference ◽

Bus Conductors

Background: Bus drivers and bus conductors are predisposed to increased cardiovascular disease (CVD) risks.Driving for long duration involves prolonged sitting, which enforces sedentary behavior among drivers in comparison to conductors who have the freedom to move aboutBackground: Bus drivers and bus conductors are predisposed to increased cardiovascular disease (CVD) risks.Driving for long duration involves prolonged sitting, which enforces sedentary behavior among drivers in comparison to conductors who have the freedom to move about in the bus. The aim and objectives of the study were to identify selected risk factors for CVDs among bus drivers and bus conductors; to estimate the CVDs risk among them using Framingham risk score and to study the difference of risk factors and CVDs risk between bus drivers and conductors.Methods: The present study was a comparative cross-sectional study among 105 bus drivers and 105 bus conductors at the Panaji bus depot of Goa. A pre-designed semi-structured questionnaire was used to collect data along with anthropometric, clinical examination and blood investigations. The Framingham risk score with BMI and lipids was used to compare the CVD risk.Results: Higher percentage of bus drivers had diabetes, hypertension, obesity and dyslipidemia. When the CVD risk was compared using the Framingham risk score, 63.8% bus drivers had intermediate-high CVD risk using FRS-BMI compared to 46.7% bus conductors and the difference is found to be significant. Using FRS- lipids, 65.7% bus drivers had intermediate-high risk compared to 53.3% bus conductors.Conclusions: The behavioral risk factors for CVD were higher among bus drivers compared to bus conductors. in the bus. Aims and objectives: 1) To identify selected risk factors for CVDs among bus drivers and bus conductors 2) To estimate the CVDs risk among them using Framingham risk score 3)To study the difference of risk factors and CVDs risk between bus drivers and conductors.Methods: The present study is a comparative cross sectional study among 105 bus drivers and 105 bus conductors at the Panaji bus depot of Goa. A predesigned semi structured questionnaire was used to collect data along with anthropometric, clinical examination and blood investigations. The Framingham risk score with BMI and Lipids was used to compare the CVD riskResults:Higher percentage of bus drivers had diabetes, hypertension, obesity and dyslipidemia. When the CVD risk was compared using the Framingham risk score, 63.8 % bus drivers had intermediate-high CVD risk using FRS-BMI compared to 46.7 % bus conductors and the difference is found to be significant. Using FRS-Lipids, 65.7 % bus drivers had intermediate-high risk compared to 53.3 % bus conductors.Conclusion: The behavioural risk factors for CVD were higher among bus drivers compared to bus conductors.

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Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women

Circulation ◽

10.1161/cir.0000000000000961 ◽

2021 ◽

Author(s):

Nisha I. Parikh ◽

Juan M. Gonzalez ◽

Cheryl A.M. Anderson ◽

Suzanne E. Judd ◽

Kathryn M. Rexrode ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Health Care ◽

Pregnancy Outcomes ◽

White Women ◽

Adverse Pregnancy Outcomes ◽

Transitions Of Care ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Adverse Pregnancy

This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption, and pregnancy loss increase a woman’s risk of developing cardiovascular disease (CVD) risk factors and of developing subsequent CVD (including fatal and nonfatal coronary heart disease, stroke, peripheral vascular disease, and heart failure). This statement highlights the importance of recognizing APOs when CVD risk is evaluated in women, although their value in reclassifying risk may not be established. A history of APOs is a prompt for more vigorous primordial prevention of CVD risk factors and primary prevention of CVD. Adopting a heart-healthy diet and increasing physical activity among women with APOs, starting in the postpartum setting and continuing across the life span, are important lifestyle interventions to decrease CVD risk. Lactation and breastfeeding may lower a woman’s later cardiometabolic risk. Black and Asian women experience a higher proportion APOs, with more severe clinical presentation and worse outcomes, than White women. More studies on APOs and CVD in non-White women are needed to better understand and address these health disparities. Future studies of aspirin, statins, and metformin may better inform our recommendations for pharmacotherapy in primary CVD prevention among women who have had an APO. Several opportunities exist for health care systems to improve transitions of care for women with APOs and to implement strategies to reduce their long-term CVD risk. One proposed strategy includes incorporation of the concept of a fourth trimester into clinical recommendations and health care policy.

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Association between neighbourhood deprivation, fetal growth, small-for-gestational age and preterm birth: a population-based prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-049075 ◽

2021 ◽

Vol 11 (11) ◽

pp. e049075

Author(s):

Dionne V Gootjes ◽

Anke G Posthumus ◽

Vincent W V Jaddoe ◽

Eric A P Steegers

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Preterm Birth ◽

Fetal Growth ◽

Gestational Age ◽

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Neighbourhood Deprivation ◽

Adverse Pregnancy

ObjectiveTo study the associations between neighbourhood deprivation and fetal growth, including growth in the first trimester, and adverse pregnancy outcomes.DesignProspective cohort study.SettingThe Netherlands, Rotterdam.Participants8617 live singleton births from the Generation R cohort study.ExpositionLiving in a deprived neighbourhood.Main outcome measuresFetal growth trajectories of head circumference, weight and length.Secondary outcomes measuresSmall-for-gestational age (SGA) and preterm birth (PTB).ResultsNeighbourhood deprivation was not associated with first trimester growth. However, a higher neighbourhood status score (less deprivation) was associated with increased fetal growth in the second and third trimesters (eg, estimated fetal weight; adjusted regression coefficient 0.04, 95% CI 0.02 to 0.06). Less deprivation was also associated with decreased odds of SGA (adjusted OR 0.91, 95% CI 0.86 to 0.97, p=0.01) and PTB (adjusted OR 0.89, 95% CI 0.82 to 0.96, p=0.01).ConclusionsWe found an association between neighbourhood deprivation and fetal growth in the second and third trimester pregnancy, but not with first trimester growth. Less neighbourhood deprivation is associated with lower odds of adverse pregnancy outcomes. The associations remained after adjustment for individual-level risk factors. This supports the hypothesis that living in a deprived neighbourhood acts as an independent risk factor for fetal growth and adverse pregnancy outcomes, above and beyond individual risk factors.

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Abstract P332: Framingham Risk Score to Predict Subsequent Coronary Artery Calcification in a Young Adult Population

Circulation ◽

10.1161/circ.129.suppl_1.p332 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Jia Pu ◽

Dave Vanness ◽

Heather Johnson ◽

David Kreling ◽

Henry Young ◽

...

Keyword(s):

Risk Factors ◽

African American ◽

Coronary Artery ◽

Risk Score ◽

African American Males ◽

Framingham Risk Score ◽

Adult Population ◽

Framingham Risk ◽

Young Adult Population ◽

Subclinical Cvd

Introduction: Coronary artery calcification (CAC) has been identified as an independent predictor of coronary events, suggesting the potential use of CAC for risk assessment in asymptomatic individuals. However, ionizing radiation exposure associated with CAC CT scans remains a concern. If elevated risk for developing subclinical cardiovascular disease (CVD) could be identified based on less invasive risk assessment, such as the Framingham risk score, intensified prevention and screening services could be provided to this targeted population. Hypothesis: This study aims to assess the association between the Framingham risk score in early adulthood and subsequent subclinical CVD measured by CAC. Additional risk factors including demographics, socioeconomic status and health behaviors were tested in terms of their capabilities to enhance prediction of subclinical CVD beyond the Framingham risk score. Methods: This study used the Coronary Artery Risk Development in Young Adults (CARDIA) data, with a total of 5,115 Caucasian and African American males and females. Information collected at examination year 10 was used to calculate the Framingham risk score. CAC was measured ten years later (examination year 20). Participants’ demographics, health behaviors (alcohol consumption, BMI, and exercise), socioeconomic status and medical needs at year 10 were identified as potential risk factors associated with the subsequent presence of CAC beyond the Framingham risk score. Multiple logistic regression was used to examine the adjusted association between CAC, Framingham risk score and proposed risk factors. Model comparison was estimated using the area under the receiver operating characteristic curve (AUC) and Akaike information criterion (AIC). Results: By year 20, CAC was present in 19% of the CARDIA population. The Framingham risk score in young adulthood was strongly associated with the subsequent presence of CAC ten years later, regardless of race and gender. Overall, 42% of the CARDIA participants with elevated Framingham risk scores at year 10 had CAC at year 20, compared to 16% of participants with normal scores. The Framingham risk score may underestimate the risk of CAC for males compared to females (Negative Predictive Value: 75% vs. 91%). Beyond the Framingham risk score, the subsequent presence of CAC was associated with being overweight or obese in all populations, at-risk alcohol consumption in African American males, and having high school level or lower education and financial hardship in African American females. Conclusions: Our findings support the potential use of the Framingham risk score as a screening tool for subsequent subclinical atherosclerosis in a young adult population. However, other gender-specific risk factors beyond the Framingham risk score such as obesity also may be important to better predict subclinical CVD risk, especially in male populations.

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Cardiovascular Disease Risk Predicts Health Perception in Prison Inmates

Clinical Nursing Research ◽

10.1177/1054773817740534 ◽

2017 ◽

Vol 28 (2) ◽

pp. 235-251 ◽

Cited By ~ 4

Author(s):

Zyad T. Saleh ◽

Alison Connell ◽

Terry A. Lennie ◽

Alison L. Bailey ◽

Rami A. Elshatarat ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Risk Score ◽

Framingham Risk Score ◽

Short Form ◽

Health Perception ◽

Health Perceptions ◽

Prison Inmates ◽

Framingham Risk ◽

Starting Point

We hypothesized that risk factors for cardiovascular disease (CVD) would be associated with worse health perceptions in prison inmates. This study included 362 inmates recruited from four medium security prisons in Kentucky. Framingham Risk Score was used to estimate the risk of developing CVD within the next 10 years. A single item on self-rated health from the Medical Outcomes Survey–Short Form 36 was used to measure health perception. Multinomial logistic regression showed that for every 1-unit increase in Framingham Risk Score, inmates were 23% more likely to have rated their health as fair/poor and 11% more likely to rate their health as good rather than very good/excellent. These findings demonstrate that worse health perceptions may serve as a starting point for discussing cardiovascular risk factors and prevention with inmates.

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P4450Atherosclerosis in women with systemic lupus erythematosus with and without nephritis

European Heart Journal ◽

10.1093/eurheartj/ehz745.0850 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Panafidina ◽

T V Popkova ◽

D S Novikova

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Blood Pressure ◽

Disease Activity ◽

Risk Score ◽

Lupus Erythematosus ◽

Framingham Risk Score ◽

Systemic Lupus ◽

Framingham Risk ◽

Coronary Events

Abstract Background Nephritis in systemic lupus erythematosus (SLE) is a factor contributing to early development of atherosclerosis (AS). Objectives The aim of the study is to determine differences in cardiovascular risk factors and AS in SLE pts with and without lupus nephritis (LN). Methods The study included 162 females, age 35 [26–43] years (median [interquartile range 25–75%])) with SLE (ACR,1997). We divided SLE pts on two groups, comparable in age: the 1st group is the pts with LN (n=84, 52%), the 2nd - without LN (n=78, 48%). We considered traditional factors of cardiovascular disease (CVD): (smoking, family history of CVD, blood pressure, cholesterol (total, HDL, LDL) and triglyceride (TG) levels, body mass index, diabetes mellitus) and SLE-related factors (age at onset, duration, clinical features, SLE Disease Activity Index (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics damage index (SLICC/DI), treatment with steroids); intima-media thickness (IMT) and the 10-year risk for coronary events. Carotid intima-media wall thickness of common carotid arteries was measured by high resolution B-mode ultrasound. The 10-year risk for coronary events was estimated by the Framingham risk equation. Results Median SLE duration was 8,0 [2,3–17,0] years, SLEDAI 2K – 8 [3–16], SLICC/DI score – 2 [0–3], duration of prednisone treatment – 72 [26–141] months. SLE pts from the 1st group had higher prevalence of hypertension (61% vs 36%, p<0,01), systolic blood pressure (130 [110–150] vs 120 [110–130]mm Hg, p<0,01), diastolic blood pressure (80 [70–95] vs 70 [70–80] mm Hg, p<0,05), TG concentration (136 [98–184] vs 100 [61–162] mg/dl, p<0,01), Framingham Risk Score (5 [1–30] vs 1 [1–27]%, p<0,05), SLEDAI-2K (12 [5–19] vs 4 [2–10], p<0,ehz745.08501), SLICC/DI score (2 [0–4] vs 0 [0–2], p<0,01), prednisone therapy duration (95 [26–192] vs 44 [14–98] months, p<0,05), prednisone cumulative dose (34,4 [13,6–82,5] vs 15,7 [6,2–35,2] g, p<0,001), mean IMT (0,73 [0,65–0,83] vs 0,67 [0,61–0,75] mm, p<0,01), than the pts from the 2nd group. There is no difference in CVD frequency in these groups (17% vs 8%, p=0,084). Conclusions SLE patients with and without LN had no difference in frequency of clinical manifestations of AS (CVD), but had a greater value of mean IMT, Framingham Risk Score and a higher incidence of both traditional (hypertension, TG concentration) and SLE-related (disease activity, prednisone therapy) risk factors for AS.

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