Abstract
Introduction: Framingham risk score (FRS) has been widely used, despite its sub-optimal contribution for early CVD risk stratification, mainly in women. The ACC/AHA atherosclerotic cardiovascular disease (ASCVD) score has been recently introduced as an improvement to FRS for CV risk assessment. Hypothesis: The aim of this work was to assess if blood pressure rise post mild exercise (BPrisePME) and abnormal pro-BNP is an appropriate tool for early detection of structural and functional CV abnormalities in asymptomatic subjects. Methods: We screened 2406 asymptomatic subjects, age 20-79, for CVD risk using the Early Cardiovascular Disease Risk Scoring System (ECVDRS), which consists of 10 tests: large (C1) and small (C2) artery stiffness, blood pressure (BP) at rest and post mild exercise (PME), Carotid Intima Media Thickness (CIMT), abdominal aorta and left ventricle ultrasound (LVUS), retinal photography, microalbuminuria, ECG, and pro-BNP. Abnormal blood pressure rise post mild exercise (BPrisePME) was defined as systolic BP rise >30mmHg post 3-min-walk at 7% elevation, 2.5mph. Normotension (NT), pre-hypertension (pre-HTN), and hypertension (HTN) were defined according to JCN7 criteria. Results: Among the 2406 subjects, 1482 were in the age range 40-79, not taking any CV medication. These subjects, 841 female and 641 male, were stratified according to ASCVD, FRS and ECVDRS risk scores, respectively and assigned to low (L), intermediate (I) or high (H) risk. Prevalence of abnormal structural and functional abnormalities is in Table. Conclusions: Based on our data, 1. Abnormal rise in blood pressure prevalence correlates with the risks (L, I and H) in female and male, exhibiting structural and functional abnormalities. 2. ProBNP and BPrisePME are not statistically different in the ASCVD. and FRS underestimates the risk for female. 3. Abnormal rise and elevated ProBNP can help in the identification of early CVD and risk stratification in asymptomatic subjects.
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