Abstract P047: The Effect of Serum C-reactive Protein (CRP) or Handgrip Strength Inclusion on the Framingham Risk Score Model of CVD Risk in a Cohort of Middle-aged to Elderly Australian Men

Abstract

Introduction: Cardiovascular disease (CVD) risk prediction models are used extensively in clinical practice. Recent reviews have suggested that such models would benefit from the identification of novel predictors to improve specificity and sensitivity. Both serum CRP and lower handgrip strength have been demonstrated to predict incident CVD suggesting its utility as a prognostic CVD marker. Objectives: To determine whether handgrip strength improves global CVD risk prediction models based on the Framingham Risk Score (FRS) (using NCEP-ATP-III criteria), and to validate CRP as a marker adding predictive value. Method: Participants were drawn from a randomly-selected, community-dwelling cohort of men residing in Adelaide, Australia. Of these, n=2162 men without CVD at baseline (2002-5) and covariate data (age, fasting total & HDL cholesterol, smoking status, mean systolic blood pressure, and anti-hypertensive usage) were followed for a median period of 8.3 years. Incident CVD events (n=248) were identified through a state-wide registry of in-hospital events (emergency department visit or hospital separation) and cardiac-specific mortality. Mean handgrip strength (by dynamometry) and serum high-sensitivity CRP were obtained at baseline visit. The added prognostic value of handgrip strength and CRP was assessed using splines and log-likelihood ratio tests of nested Cox proportional models, BIC and AIC. Model discrimination was assessed using Harrell’s c-index. Results: Within the FRS 10-year risk groups 0-<5%, 5-<10%, 10-<20%, and 20+% the estimated 10-year CVD event rates were 3% (95%CI: 2-5%), 7% (5-10%), 15% (13-18%) and 22% (17-27%), respectively. Hand grip strength did not add predictive value above standard Framingham risk factors ( p =0.25). CRP made a contribution to estimating global CVD risk ( p =0.002). Both the BIC and AIC were reduced (4.9 and 7.9 units, respectively) and the c-index increased from 0.727 to 0.732 (SE=0.024). Conclusions: A global risk prediction model that includes serum CRP improves CV risk classification in men.