Evaluation of Cardiovascular Diseases Risk in the Iranian Population

Background: Cardiovascular diseases (CVDs) are among the leading causes of death and morbidity around the world. Risk score assessment can assist in anticipating a person's CVD risk over the next five years. Objectives: This study aimed to investigate the risk of CVDs in the general Iranian population. Methods: This study was conducted in September 2020, and 5324 participants aged 35 to 74 years were registered from 95 metro stations throughout Tehran. Participants' demographics (ie, age, gender, current smoking and exercise habits, and family history of hypertension, CVDs, and diabetes) were collected by in-person interviews, and their body mass index (BMI) and systolic blood pressure (SBP) were measured. The five-year risk of CVDs was estimated and categorized into low (< 10%), some risk (10 - 20%), moderate (21 - 30%), increased (31 - 40%), and high (> 40%) groups, and its association with the participants’ demographics was evaluated by SPSS version 21. Results: The mean age of 5324 participants was 45.3 ± 14.8 years, and 64% were male. The frequency of CVD risk scores was as follows: low (54%), some risk (17.5%), moderate (15.4%), increased (5.7%), and high (3.5%), which were significantly associated with gender (P < 0.001), smoking status (P = 0.048), exercise (P = 0.014), and family history of diseases (all P < 0.001). Age (β = 0.774, P < 0.001) increased the odds of CVD, while other variables had small or no effects on CVD. Conclusions: This study found a high prevalence of high-risk CVD in the Iranian population, emphasizing the importance of risk score assessment, which should include not only basic non-laboratory risk assessment scores, but also exercise and a positive family history of associated diseases.

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Lipoprotein(A) and BMI: Significant correlation with positive family history of cardiovascular diseases in obese, hypertensive and diabetic children

Atherosclerosis Supplements ◽

10.1016/s1567-5688(02)80227-6 ◽

2002 ◽

Vol 3 (2) ◽

pp. 114

Keyword(s):

Family History ◽

Cardiovascular Diseases ◽

Positive Family History ◽

Lipoprotein A ◽

Diabetic Children ◽

History Of

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Parkinson’s disease determinants, prediction and gene–environment interactions in the UK Biobank

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-323646 ◽

2020 ◽

Vol 91 (10) ◽

pp. 1046-1054 ◽

Cited By ~ 2

Author(s):

Benjamin Meir Jacobs ◽

Daniel Belete ◽

Jonathan Bestwick ◽

Cornelis Blauwendraat ◽

Sara Bandres-Ciga ◽

...

Keyword(s):

Risk Factors ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Family History ◽

Genetic Risk ◽

Positive Family History ◽

Risk Scores ◽

Uk Biobank ◽

Gene Environment ◽

History Of

ObjectiveTo systematically investigate the association of environmental risk factors and prodromal features with incident Parkinson’s disease (PD) diagnosis and the interaction of genetic risk with these factors. To evaluate whether existing risk prediction algorithms are improved by the inclusion of genetic risk scores.MethodsWe identified individuals with an incident diagnosis of PD (n=1276) and controls (n=500 406) in UK Biobank. We determined the association of risk factors with incident PD using adjusted logistic regression models. We constructed polygenic risk scores (PRSs) using external weights and selected the best PRS from a subset of the cohort (30%). The PRS was used in a separate testing set (70%) to examine gene–environment interactions and compare predictive models for PD.ResultsStrong evidence of association (false discovery rate <0.05) was found between PD and a positive family history of PD, a positive family history of dementia, non-smoking, low alcohol consumption, depression, daytime somnolence, epilepsy and earlier menarche. Individuals with the highest 10% of PRSs had increased risk of PD (OR 3.37, 95% CI 2.41 to 4.70) compared with the lowest risk decile. A higher PRS was associated with earlier age at PD diagnosis and inclusion of the PRS in the PREDICT-PD algorithm led to a modest improvement in model performance. We found evidence of an interaction between the PRS and diabetes.InterpretationHere, we used UK Biobank data to reproduce several well-known associations with PD, to demonstrate the validity of a PRS and to demonstrate a novel gene–environment interaction, whereby the effect of diabetes on PD risk appears to depend on background genetic risk for PD.

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Who Gets Inhibitors? Predicting Inhibitory Antibodies in Children with Severe Hemophilia A.

Blood ◽

10.1182/blood.v110.11.1158.1158 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1158-1158

Author(s):

Petra C. ter Avest ◽

Kathelijn Fischer ◽

Elena Santagostino ◽

Marijke H. van den Berg ◽

Johanna G. van der Bom

Keyword(s):

Family History ◽

High Risk ◽

Risk Score ◽

Hemophilia A ◽

Positive Family History ◽

Treatment Strategies ◽

Intensive Treatment ◽

Severe Hemophilia ◽

Inhibitor Development ◽

History Of

Abstract Background. Replacement therapy in severe hemophilia A patients is complicated by formation of inhibitors in around 25% of children. Identification of patients at the highest risk may help to tailor personalized treatment strategies. Objectives. To develop a scoring system that may be used to identify patients at the highest risk of inhibitor development at first treatment. Methods. We used the data from a retrospective multicentre cohort study (the Canal cohort) of patients with severe hemophilia A (factor VIII (FVIII)less than 0.01 IU/ml), born 1990–2000, followed at least until their 50th exposure day. Presence of inhibitor was defined as twice a positive inhibitor titer and a decreased FVIII recovery. Based on the coefficients of a logistic regression model, a weighted risk-score was developed. Shrinkage of regression coefficients was used to control for overfitting. The discriminative ability of the risk-score was expressed as the area under the curve (AUC) of a receiver operating characteristic curve. Results. Out of the 366 patients from the Canal cohort, 284 children were selected of whom 78 developed an inhibitor (27%). Logistic regression analysis revealed 3 independent risk factors for inhibitor development: positive family history, intensive treatment (at least 5 consecutive days) at the first FVIII exposure, and high risk FVIII gene mutations. Table 1 presents odds ratios of the uni- and multivariate analyses, and the risk score. The AUC for the risk-score was 0,724. Table 2 shows that the model is able to separate high and low risk patients from patients with an intermediate risk of 25%. Conclusions. The risk score includes positive family history of inhibitors, high risk factor VIII gene mutation and intensive treatment at first FVIII exposure. This risk score can recognize patients with a doubled risk for inhibitor development and may be used to guide inhibitor preventive treatment strategies. Table 1. Uni- and Multivariate analysis and risk-score. OR (CI), Univariate OR (CI), Multivariate p-value Risk-Score CI = confidence interval 95% Positive Family History of Inhibitors 4.0 (1.7–9.4) 3.0 (1.2–7.7) ,022 3 High risk FVIII Gene Mutation 3.6 (1.8–7.2) 3.7 (1.8–7.9) ,001 4 Intensive Treatment at 1st FVIII exposure 6.8 (3.6–12.9) 7.2 (3.4–15.1) ,000 6 Table 2. Calibration of the risk-score. Model Total n° patients Predicted n° Inhibitors Observed n° Inhibitors Positive Predictive Value Negative Predictive Value LR= Low Risk, MR= Medium Risk, HR= High risk LR:0 72 7 6 0,34 0,92 MR:3–4 153 39 38 0,25 0,69 HR: >4 59 32 34 0,58 0,80

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Vorsorgeuntersuchungen und Check-ups in der Kardiologie

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0818-8169 ◽

2019 ◽

Vol 144 (17) ◽

pp. 1192-1201

Author(s):

Ulrike Rudolph ◽

Ulrich Laufs

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Cardiovascular Diseases ◽

Smoking Status ◽

Risk Scores ◽

Modifiable Risk Factors ◽

Cvd Risk ◽

Artery Disease

AbstractCardiovascular diseases (CVD), especially coronary artery disease (CAD), are the leading causes of morbidity and mortality worldwide. Elimination of modifiable risk factors has the potential to prevent up to 80 % of CVD. Therefore, disease prevention is based on the assessment of individual total CVD risk by using risk scores such as SCORE-algorithm that include the known main cardiovascular risk factors such as age, sex, smoking status, arterial hypertension und cholesterol.

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Can FRAX Tool be Used for Determination of Risk Score for Osteoporosis Fractures in a Financially Constrained Society Like Bangladesh?

BIRDEM Medical Journal ◽

10.3329/birdem.v8i1.35031 ◽

2017 ◽

Vol 8 (1) ◽

pp. 9-15

Author(s):

Nazma Akter ◽

Nazmul Kabir Qureshi ◽

Zafar Ahmed Latif

Keyword(s):

Risk Assessment ◽

Hip Fracture ◽

Fracture Risk ◽

Risk Score ◽

Osteoporotic Fractures ◽

Fracture Risk Assessment ◽

Assessment System ◽

Risk Scores ◽

Assessment Scores ◽

History Of

Background: This study was designed to assess the effectiveness of use of the fracture risk assessment system (FRAX) as risk assessment tool for osteoporosis risk score scale in Bangladeshi subjects and to assess how the results of the tools correlate with each other.Methods: This cross-sectional study was conducted between January 2016 to August 2016. The study population was randomly collected 600 Bangladeshi subjects; who attended outpatient department (OPD) of MARKS Medical College & Hospital, Dhaka, Bangladesh. The age range of the subjects was between 40 to 75 years. The subjects had not done a bone mineral density (BMD) score. None of them were previously diagnosed or got treatment for osteoporosis. A questionnaire was designed to complete the osteoporosis specific risk score sheet. Major osteoporotic and hip fracture incidence to 10-years as a function of the FRAX probability was calculated by using fracture risk assessment system.Results: A total of 600 subjects were included. Among them, 59.2% and 40.8%were male and female respectively. Mean age (Mean ± SD) of the study, subjects were 52.16±7.96 years. Among study subjects, mean BMI was more in females in comparison to males (p<0.05). The FRAX predicted 10-year risk assessment scores of major osteoporotic fractures were significantly more in females than males (p<0.02). Risk assessment scores of both major osteoporotic fractures and hip fractures showed significant association in post-menopausal women when compared with there who were not menopausal (p<0.05). Risk assessment factors for risk scores did differ significantly among male and female subjects and among postmenopausal and non-menopausal women. Among risk assessment factors, subjects having finally history of fracture hip, glucocorticoids, rheumatoid arthritis showed strong association with presence of ≥20% risk scores for major osteoporotic fracture (p<0.05) and ≥ 3% for hip fracture (p<0.05). Subjects having history of previous fracture and secondary osteoporosis showed only significant association with ≥3% risk scores for hip fracture (p<0.05).Conclusion: The public health burden of fractures will fail to compromise unless the subset of patients who are at increased risk for fracture are identified and treated. Ten-year fracture risk assessment with the fracture risk assessment system is increasingly used to guide for treatment decisions. It is an effective tool to predict fracture probability, particularly in developing countries like Bangladesh, where most of the patients cannot afford expensive dual energy x-ray absorptiometry scans.Birdem Med J 2018; 8(1): 9-15

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PRE-DIABETES;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.12.618 ◽

2017 ◽

Vol 24 (12) ◽

pp. 1860-1866

Author(s):

Rizwana Kitchlew ◽

Aijaz Zeeshan Khan Chachar ◽

Miqdad Haider ◽

Abdul Rehman Saleem ◽

Muhammad Shahjehan Mirza ◽

...

Keyword(s):

Family History ◽

Strong Association ◽

Positive Family History ◽

Test Material ◽

P Value ◽

Cvd Risk ◽

Family History Of Diabetes ◽

Global Epidemic ◽

History Of ◽

Associated Risk Factors

Introduction: Early intervention among patients with prediabetes can prevent ordelay diabetes. Moreover, regression from prediabetes to normal glucose regulation has beenassociated with reduction in cardiovascular disease (CVD) risk. Estimate of prevalence of thiscondition is vital as diabetes is now a global epidemic requiring steps towards its prevention.Study Design: Descriptive study. Setting: Fatima Memorial Hospital & Medical & Dental CollegeLahore. Period: 1st February 2016 till 1st February 2017. Objective: To determine the prevalenceof pre-diabetes and associated risk factors and demographic features in our local populationusing HbA1c as a screening test. Material and Methods: The study population includes adults18 years and above who reported in hospital outdoor as well as employees, faculty membersand students. Subjects were included in the study after taking written consent. The statisticalanalysis was performed on SPSS version 23. Results: The number of subjects included was400. 138(34%) had HbA1c value in prediabetic range (5.7-6.4%) and 56 (14%) in diabetic range(>6.4%). Mean age of prediabetics was 41± 13, 34% were males and 66% were females, 27%were in age group less than 30 years. Their mean HbA1c was 5.9%. Above normal body massindex (BMI) was reported in 128 (93%) and positive family history of diabetes mellitus (DM) in135 (98 %) subjects (P value: 0.00). All females with history of Polycystic Ovarian Syndromeand Gestational Diabetes showed prediabetes. Conclusion: The prevalence of prediabetes issignificant in our studied population. It has strong association with family history of diabetes andabove normal BMI values. There are also a significant number of undiagnosed asymptomaticdiabetics in our population.

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General Practitioners’ adherence to prescribing guidelines for statins in the United Kingdoms

10.1101/625236 ◽

2019 ◽

Author(s):

Federico Ricciardi ◽

Irwin Nazareth ◽

Irene Petersen

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Statin Therapy ◽

Risk Score ◽

Smoking Status ◽

Risk Scores ◽

List Type ◽

Cvd Risk ◽

Nice Guideline ◽

Clinical Records

ABSTRACTObjectiveIn this retrospective cohort study we aimed to assess, in 202,247 people who started a statin therapy between 2007-2014, the factors that led to the initiation of the drug. To do this we explored CVD risk factors singularly and in combinations as recorded in electronic health records in the year before they receive their first prescription and we compared the risk scores with that suggested by the NICE guideline at that time.MethodsWe summarised demographic characteristics and proportions of people with a risk score below the threshold. Regression-based analyses are performed to evaluate the association between the missingness of the risk score and relevant risk score components.Results45,364 individuals (22.4%) were prescribed statins without a record of a risk score being available in the year prior to the prescription date. When the risk score was available, 68,174 out of 156,883 patients were prescribed statins even with a score below the 20% threshold. Smoking status was the most frequently recorded variable (74.9% of the instances), followed by systolic blood pressure (71.6%) and total cholesterol (70%), while HDL cholesterol was the least recorded (34.1%). Cholesterol levels are positively associated with the missingness of the risk score, while systolic blood pressure shows a negative association.ConclusionsGPs often start statins on people with no risk score recorded in their clinical records or in those with risk scores below the recommended threshold. Higher cholesterol values may result in a GP starting statin therapy without recording the other relevant components required to calculate a risk score.STRENGTHS AND LIMITATIONS OF THIS STUDYOur cohort contains a large number of individuals: the study provide a representative picture of initiation of statins in UK primary care.We specifically focus on which variables and factors GPs record in electronic databases in the year prior statin treatment initiation: this is the first study to directly tackle the issue of statins prescribing in the absence of all the information required by the NICE guidelineWe are not able to verify if GPs actually used the records of the individual health indicators, when these were available, to calculate the risk score.

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Evolving patterns in the presentation of coeliac disease over the last 25 years

Frontline Gastroenterology ◽

10.1136/flgastro-2018-101170 ◽

2019 ◽

Vol 11 (2) ◽

pp. 98-103

Author(s):

Callan Stroud ◽

Orouba Almilaji ◽

David Nicholas ◽

Silvia Kirkham ◽

Susan L Surgenor ◽

...

Keyword(s):

Family History ◽

Coeliac Disease ◽

Smoking Status ◽

Positive Family History ◽

Age At Diagnosis ◽

Cigarette Smokers ◽

Female Predominance ◽

High Prevalence ◽

Autoimmune Conditions ◽

History Of

ObjectiveTo document changes in the clinical features of coeliac disease (CD) at presentation over the last 25 years.DesignObservational study.Patients802 subjects diagnosed between 1993 and 2017 at a single general hospital.Outcome measuresDate of diagnosis, age, sex, postcode, symptoms, haematinic deficiency, smoking status, serology, family history and autoimmune phenomena.ResultsThe incidence of diagnosed CD rose threefold during the course of the study, with a rising prevalence of positive coeliac serology and positive family history of CD, and a falling prevalence of symptoms and haematinic deficiencies. There was little change in the female predominance, age at diagnosis or high prevalence of other autoimmune conditions over the 25 years, and a paucity throughout of cigarette smokers, particularly heavy smokers. A cohort of patients with seronegative CD was identified who shared many of the characteristics of seropositive CD, but with a significantly older age at diagnosis and a higher prevalence of cigarette smokers.ConclusionThere have been major changes in the epidemiology of CD over the last 25 years, of relevance to both our understanding of the aetiopathogenesis of CD and the requirement for service provision. The implications are discussed.

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Endogenous Steroid Hormone Concentrations and Risk of Breast Cancer: Does the Association Vary by a Woman's Predicted Breast Cancer Risk?

Journal of Clinical Oncology ◽

10.1200/jco.2005.03.7432 ◽

2006 ◽

Vol 24 (12) ◽

pp. 1823-1830 ◽

Cited By ~ 58

Author(s):

A. Heather Eliassen ◽

Stacey A. Missmer ◽

Shelley S. Tworoger ◽

Susan E. Hankinson

Keyword(s):

Breast Cancer ◽

Family History ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Risk Score ◽

Low Risk ◽

Risk Scores ◽

Total N ◽

History Of ◽

Predicted Risk

PurposeTo examine whether the associations of endogenous estrogens and testosterone with breast cancer risk differ between high- and low-risk women, as determined by the Gail model and the Rosner and Colditz model, and by family history of breast cancer.MethodsWe conducted a prospective nested case-control study within the Nurses' Health Study. From 1989 or 1990 until June 2000, blood samples were collected, 418 breast cancer patient cases were identified, and two controls (total n = 817) were matched to each case. We classified women as high or low risk based on their family history of breast cancer, their 5-year Gail risk score, and their 5-year Rosner and Colditz risk score. Multivariate relative risks (RR) and 95% CI were calculated by unconditional logistic regression, adjusting for matching and breast cancer risk factors.ResultsEstrone sulfate was statistically significantly associated with breast cancer risk among women with low (< 1.66%) and high (≥ 2.52%; 75th percentile) Gail predicted risk (fourth v first quartile RR = 3.6; 95% CI, 1.9 to 7.0; RR = 2.5; 95% CI, 1.2 to 5.1, respectively). Testosterone results were similar across strata of predicted risk, with two times the risk in the fourth (v first) quartile. Estradiol appeared more strongly associated with breast cancer in women with higher predicted risk (RR = 4.5; 95% CI, 2.1 to 9.5) compared with women with lower risk (RR = 2.1; 95% CI, 1.2 to 3.6), but differences were not statistically significant. Results were similar across predicted Rosner and Colditz risk scores.ConclusionThese data suggest that higher levels of endogenous estrogens and testosterone are associated with increased breast cancer risk, regardless of predicted risk or family history of breast cancer.

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