scholarly journals Evaluation of cardiovascular risk in adult psychiatric outpatients in Qatar using two risk assessment tools

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Safa Al-Rawi ◽  
Monica Zolezzi ◽  
Yassin Eltorki
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Prediction ◽  
Assessment Tools ◽  
World Health ◽  
Health Clinic ◽  
Risk Calculator ◽  
Cvd Risk ◽  
Risk Estimates

Introduction: Individuals with serious mental illness (SMI) experience premature death, likely due to increased rates of obesity and cardiovascular disease (CVD). This study was conducted to estimate the CVD risk in a cohort of individuals with SMI receiving outpatient psychiatric services in Qatar and to assess contributory CVD risk factors. Methods: This is a retrospective review of the electronic medical records of a cohort of outpatients with SMI attending a mental health clinic in Doha, Qatar. The CVD risk was estimated using two risk prediction tools: the American Heart Association and the American College of Cardiology (AHA/ACC) risk calculator and the World Health Organization/International Society of Hypertension (WHO/ISH) CVD risk prediction charts for the Eastern Mediterranean region. Descriptive and inferential statistics were used to analyze the demographic and clinical data. Data were analyzed using Statistical Package for the Social Sciences. Results: Of the 346 eligible patients, 28% (n = 97) had obtainable data for the estimation of their CVD risk using both tools. Approximately one-third of the cohort (33%) were classified as high risk using the AHA/ACC risk calculator, and 13.3% were classified as intermediate to high risk using the WHO/ISH CVD risk prediction charts. Based on the AHA/ACC risk scores, among those with a high CVD risk, almost two-thirds had CVD modifiable risk factors (i.e., smoking, diabetes, dyslipidemia, and hypertension). No statistically significant difference in the CVD risk estimates was observed among individuals with a body mass index of more or lower than 30 kg/m2 (p = 0.815). Conclusion: Based on the AHA/ACC risk calculator, approximately one-third of the study cohort had high CVD risk estimates. The WHO/ISH CVD risk prediction charts appeared to underestimate CVD risk, particularly for those identified as high risk using the AHA/ACC risk calculator. A closer alliance between psychiatrists and primary healthcare professionals to control modifiable cardiovascular risk factors among patients with SMI is necessary.

scholarly journals A community based cross sectional study to estimate total cardiovascular risk in rural Punjab

2017 ◽  
Vol 4 (4) ◽  
pp. 1295
Author(s):  
Bibhava Vikramaditya ◽  
Mahesh Satija ◽  
Anurag Chaudhary ◽  
Sarit Sharma ◽  
Sangeeta Girdhar ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
High Risk ◽  
Risk Prediction ◽  
Cross Sectional Study ◽  
World Health ◽  
Sectional Study ◽  
Cvd Risk ◽  
Community Based ◽  
Cross Sectional

Background: Cardiovascular diseases (CVD) are leading cause of non communicable deaths in India. CVD risk prediction charts by World Health Organization/International Society of Hypertension (WHO/ISH) are designed for implementing timely preventive measures. The objective of the study was to assess the prevalence of CVD risk parameters and to estimate total CVD risk among adults aged ≥40 years, using the WHO/ISH risk charts alone and also to assess the effect of the inclusion of additional criteria on CVD risk.Methods: A community based cross sectional study was conducted in fifteen villages of Ludhiana district under rural health training centre of Department of Community Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab. Desired information was obtained using WHO STEPS survey (STEP wise approach to surveillance) from 324 adults aged ≥40 years. Anthropometric, clinical and laboratory measurements were also performed. WHO/ISH risk prediction chart for South East Asian region (SEAR-D) was used to assess the cardiovascular risk among the subjects.Results: WHO/ISH risk prediction charts identified 16.0% of the subjects with high risk (≥20%) of developing a cardiovascular event. The study population showed higher prevalence of physical inactivity, obesity, abdominal obesity, hypertension and diabetes. Amongst high risk CVD group, maximum prevalence was of hypertension and high perceived stress level. However, the proportion of high CVD risk (≥20%) increased to 33.6% when subjects with blood pressure ≥160/100 mmHg and /or on hypertension medication were added as high risk.Conclusions: A substantial proportion of this community is at high risk of developing cardiovascular diseases.

scholarly journals Estimation of the cardiovascular risk using world health organization/international society of hypertension risk prediction charts in Central Vietnam

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242666
Author(s):  
Ho Anh Hien ◽  
Nguyen Minh Tam ◽  
Vo Tam ◽  
Huynh Van Minh ◽  
Nguyen Phuong Hoa ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Ethnic Minorities ◽  
Risk Prediction ◽  
International Society ◽  
World Health ◽  
Moderate Risk ◽  
Cvd Risk ◽  
Central Vietnam ◽  
Health Organization

Introduction Cardiovascular disease (CVD) being the leading cause of the morbidity and mortality in Vietnam, the objective of this study was to estimate the total 10-year CVD risk among adults aged 40–69 years by utilizing World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in Central Vietnam. Materials and methods In this cross-sectional study, multi-staged sampling was used to select 938 participants from a general population aged from 40 to 69. The CVD risk factors were then collected throughout the interviews with a standardized questionnaire, anthropometric measurements and a blood test. The cardiovascular risk was calculated using the WHO/ISH risk prediction charts. Results According to the WHO/ISH charts, the proportion of moderate risk (10–20%) and high risk (>20%) among the surveyed participants were equal (5.1%). When “blood pressure of more than 160/100 mmHg” was applied, the proportion of moderate risk reduced to 2.3% while the high risk increased markedly to 12.8%. Those proportions were higher in men than in women (at 18.3% and 8.5% respectively, p-value <0.001, among the high-risk group), increasing with age. Male gender, smoking, ethnic minorities, hypertension and diabetes were associated with increased CVD risk. Conclusions There was a high burden of CVD risk in Central Vietnam as assessed with the WHO/ISH risk prediction charts, especially in men and among the ethnic minorities. The use of WHO/ISH charts provided a feasible and affordable screening tool in estimating the cardiovascular risk in primary care settings.

scholarly journals Comparative risk assessment for the development of cardiovascular diseases in the Hungarian general and Roma population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peter Piko ◽  
Zsigmond Kosa ◽  
Janos Sandor ◽  
Roza Adany
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Average Risk ◽  
Cvd Risk ◽  
Roma Population

AbstractCardiovascular diseases (CVDs) are the number one cause of death globally, and the early identification of high risk is crucial to prevent the disease and to reduce healthcare costs. Short life expectancy and increased mortality among the Roma are generally accepted (although not indeed proven by mortality analyses) which can be partially explained by the high prevalence of cardiovascular risk factors (CVRF) among them. This study aims to elaborate on the prevalence of the most important CVD risk factors, assess the estimation of a 10-year risk of development of fatal and nonfatal CVDs based on the most used risk assessment scoring models, and to compare the Hungarian general (HG) and Roma (HR) populations. In 2018 a complex health survey was accomplished on the HG (n = 380) and HR (n = 347) populations. The prevalence of CVRS was defined and 10-year cardiovascular risk was estimated for both study populations using the following systems: Framingham Risk Score for hard coronary heart disease (FRSCHD) and for cardiovascular disease (FRSCVD), Systematic COronary Risk Evaluation (SCORE), ACC/AHA Pooled Cohort Equations (PCE) and Revised Pooled Cohort Equations (RPCE). After the risk scores had been calculated, the populations were divided into risk categories and all subjects were classified. For all CVD risk estimation scores, the average of the estimated risk was higher among Roma compared to the HG independently of the gender. The proportion of high-risk group in the Hungarian Roma males population was on average 1.5–3 times higher than in the general one. Among Roma females, the average risk value was higher than in the HG one. The proportion of high-risk group in the Hungarian Roma females population was on average 2–3 times higher compared to the distribution of females in the general population. Our results show that both genders in the Hungarian Roma population have a significantly higher risk for a 10-year development of cardiovascular diseases and dying from them compared to the HG one. Therefore, cardiovascular interventions should be focusing not only on reducing smoking among Roma but on improving health literacy and service provision regarding prevention, early recognition, and treatment of lipid disorders and diabetes among them.

scholarly journals Predicting 10-year cardiovascular risk using WHO/ISH risk prediction chart among urban population in Salem

2018 ◽  
Vol 5 (12) ◽  
pp. 5228
Author(s):  
K. Premanandh ◽  
R. Shankar
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Prediction ◽  
Disease Risk ◽  
Smoking Status ◽  
Cardiovascular Disease Risk ◽  
Total Serum ◽  
Total Serum Cholesterol ◽  
Cvd Risk ◽  
Very High

Background: Coronary vascular disease (CVD) risk estimation tools are a simple means of identifying those at high risk in a community and hence a potentially cost-effective strategy for CVD prevention in resource-poor countries. The WHO /ISH risk prediction charts provide approximate estimates of cardiovascular disease risk in people who do not have established coronary heart disease, stroke or other atherosclerotic disease.Methods: A total of 280 subjects between 40 to 70 years of age were included in this cross sectional study. Eligible households was selected randomly (every 5th household) for the interview using systematic random sampling. Age, gender, smoking status, systolic blood pressure, presence or absence of diabetes and total serum cholesterol were used to compute the total CVD risk using WHO/ISH CVD risk prediction chart. The chart stratify an individual into low (<10%), moderate (10% to <20%), high (20% to <30%), and very high (>30%) risk groups.Results: Moderate and high CVD risk were 12.14% and 7.5% respectively. Of total study participants, 2.5% had very high risk (>40%). High risk (binge drinking) alcohol drinkers (p=0.04) and abdominal obesity (p=0.0001) were significantly associated with higher CVD risk. Higher prevalence of behavioral risk factors was also reported in our study population.Conclusions: A large proportion of the population is at moderate and high cardiovascular risk. Risk stratification and identification of individuals with a high risk for CHD who could potentially benefit from intensive primary prevention efforts are critically important in reducing the burden of CVD in India.

scholarly journals Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 134
Author(s):  
Gediminas Urbonas ◽  
Lina Vencevičienė ◽  
Leonas Valius ◽  
Ieva Krivickienė ◽  
Linas Petrauskas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
High Risk ◽  
Lipid Lowering ◽  
Blood Pressure Target ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Risk Patients ◽  
Very High

Background and Objectives: Cardiovascular disease (CVD) prevention guidelines define targets for lifestyle and risk factors for patients at high risk of developing CVD. We assessed the control of these factors, as well as CVD risk perception in patients enrolled into the primary care arm of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE V) survey in Lithuania. Materials and Methods: Data were collected as the part of the EUROASPIRE V survey, a multicenter, prospective, cross-sectional observational study. Adults without a documented CVD who had been prescribed antihypertensive medicines and/or lipid-lowering medicines and/or treatment for diabetes (diet and/oral antidiabetic medicines and/or insulin) were eligible for the survey. Data were collected through the review of medical records, patients’ interview, physical examination and laboratory tests. Results: A total of 201 patients were enrolled. Very few patients reached targets for low-density lipoprotein cholesterol (LDL-C) (4.5%), waist circumference (17.4%) and body mass index (15.4%). Only 31% of very high CVD risk patients and 52% of high-risk patients used statins. Blood pressure target was achieved by 115 (57.2%) patients. Only 21.7% of patients at very high actual CVD risk and 27% patients at high risk correctly estimated their risk. Of patients at moderate actual CVD risk, 37.5% patients accurately self-assessed the risk. About 60%–80% of patients reported efforts to reduce the intake of sugar, salt or alcohol; more than 70% of patients were current nonsmokers. Only a third of patients reported weight reduction efforts (33.3%) or regular physical activity (27.4%). Conclusions: The control of cardiovascular risk factors in a selected group of primary prevention patients was unsatisfactory, especially in terms of LDL-C level and body weight parameters. Many patients did not accurately perceive their own risk of developing CVD.

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.

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.

Performance of cardiovascular risk prediction equations in Indigenous Australians

Heart ◽  
2020 ◽  
Vol 106 (16) ◽  
pp. 1252-1260
Author(s):  
Elizabeth Laurel Mary Barr ◽  
Federica Barzi ◽  
Athira Rohit ◽  
Joan Cunningham ◽  
Shaun Tatipata ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Prediction ◽  
Meta Analysis ◽  
Age Groups ◽  
Future Research ◽  
Indigenous Australians ◽  
Cvd Risk ◽  
Clinical Criteria ◽  
Percentage Difference

ObjectiveTo assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians.MethodsWe conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30–74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk individuals.ResultsWhen applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: −55% to −14%), with underestimation greater in women (−63% to −13%) than men (−47% to −18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk; corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell.ConclusionThe CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.

scholarly journals Cardiovascular Disease Risk Prediction Models in Haiti: Implications for Primary Prevention in Low-Middle Income Countries

2021 ◽  
Author(s):  
Lily D Yan ◽  
Jean Lookens Pierre ◽  
Vanessa Rouzier ◽  
Michel Theard ◽  
Alexandra Apollon ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Prediction ◽  
Prediction Models ◽  
Risk Groups ◽  
Cvd Risk ◽  
Middle Income ◽  
Risk Prediction Models ◽  
Middle Income Countries ◽  
Low Middle Income Countries

Background Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries (LMICs). Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention and risk factor treatment among high-risk groups. Available CVD risk prediction models are built on predominantly Caucasian, high-income country populations, and have not been evaluated in LMIC populations. Objective To compare the predicted 10-year risk of CVD and identify high-risk groups for targeted prevention and treatment in Haiti. Methods We used cross-sectional data within the Haiti CVD Cohort Study, including 653 adults ≥ 40 years without known history of CVD and with complete data. Six CVD risk prediction models were compared: pooled cohort equations (PCE), adjusted PCE with updated cohorts, Framingham CVD Lipids, Framingham CVD Body Mass Index (BMI), WHO Lipids, and WHO BMI. Risk factors were measured during clinical exams. Primary outcome was continuous and categorical predicted 10-year CVD risk. Secondary outcome was statin eligibility. Results Seventy percent were female, 65.5% lived on a daily income of ≤1 USD, 57.0% had hypertension, 14.5% had hypercholesterolemia, 9.3% had diabetes mellitus, 5.5% were current smokers, and 2.0% had HIV. Predicted 10-year CVD risk ranged from 3.9% in adjusted PCE (IQR 1.7-8.4) to 9.8% in Framingham-BMI (IQR 5.0-17.8), and Spearman rank correlation coefficients ranged from 0.87 to 0.98. The percent of the cohort categorized as high risk using the uniform threshold of 10-year CVD risk ≥ 7.5% ranged from 28.8% in the adjusted PCE model to 62.0% in the Framingham-BMI model (χ2 = 331, p value < 0.001). Statin eligibility also varied widely. Conclusions In the Haiti CVD Cohort, there was substantial variation in the proportion identified as high-risk and statin eligible using existing models, leading to very different treatment recommendations and public health implications depending on which prediction model is chosen. There is a need to design and validate CVD risk prediction tools for low-middle income countries that include locally relevant risk factors.

scholarly journals Development and validation of an International Prognostic Score of thrombosis in World Health Organization–essential thrombocythemia (IPSET-thrombosis)

Blood ◽  
2012 ◽  
Vol 120 (26) ◽  
pp. 5128-5133 ◽  
Author(s):  
Tiziano Barbui ◽  
Guido Finazzi ◽  
Alessandra Carobbio ◽  
Juergen Thiele ◽  
Francesco Passamonti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Stratification ◽  
Prognostic Model ◽  
Low Risk ◽  
World Health ◽  
Intermediate Risk ◽  
Validation Set ◽  
Health Organization

Abstract Accurate prediction of thrombosis in essential thrombocythemia (ET) provides the platform for prospective studies exploring preventive measures. Current risk stratification for thrombosis in ET is 2-tiered and considers low- and high-risk categories based on the respective absence or presence of either age > 60 years or history of thrombosis. In an international study of 891 patients with World Health Organization (WHO)–defined ET, we identified additional independent risk factors including cardiovascular risk factors and JAK2V617F. Accordingly, we assigned risk scores based on multivariable analysis–derived hazard ratios (HRs) to age > 60 years (HR = 1.5; 1 point), thrombosis history (HR = 1.9; 2 points), cardiovascular risk factors (HR = 1.6; 1 point), and JAK2V617F (HR = 2.0; 2 points) and subsequently devised a 3-tiered prognostic model (low-risk = < 2 points; intermediate-risk = 2 points; and high-risk = > 2 points) using a training set of 535 patients and validated the results in the remaining cohort (n = 356; internal validation set) and in an external validation set (n = 329). Considering all 3 cohorts (n = 1220), the 3-tiered new prognostic model (low-risk n = 474 vs intermediate-risk n = 471 vs high-risk n = 275), with a respective thrombosis risk of 1.03% of patients/y versus 2.35% of patients/y versus 3.56% of patients/y, outperformed the 2-tiered (low-risk 0.95% of patients/y vs high-risk 2.86% of patients/y) conventional risk stratification in predicting future vascular events.

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