Abstract
BackgroundWe hypothesized that discriminating the early subclinical organ damage would serve as a great opportunity for prevention against atherosclerotic cardiovascular disease (ASCVD). Brachial-ankle pulse wave velocity (baPWV), low retinal vascular fractal dimension, and albuminuria are surrogates of subclinical vascular changes.MethodsThe aim of this study was to use Pooled Cohort Equations (PCE) and ASCVD risk equations derived from “Prediction for ASCVD Risk in China project (CHINA-PAR)” to observe the prevalence of macro- and microcirculation abnormalities. A total of 2166 subjects were involved. Characteristics were investigated using questionnaire and physical examinations. We calculated the urine albumin to creatinine ratio (UACR). The baPWV was measured using a fully automatic arteriosclerosis detector. The retinal vascular fractal dimension was measured by a semiautomated computer-based program. The 10-year ASCVD risk was estimated using the PCE and CHINA-PAR model.ResultsThe cut-off values for the elevated baPWV were 2.82 and 2.92% in the PCE model and CHINA-PAR model, respectively, with nearly 85% sensitivity and an average specificity of 74%. For low retinal fractal dimension, at the cut-off point of 3.8%, we acquired an acceptable sensitivity of 66.27–68.24% and specificity of 62.57–67.45%. All the C-statistics presented a significant improvement from the PCE model to the CHINA-PAR model (P < 0.05). For all categories—net reclassification improvement (NRI) values were significant and clearly varied (0.329, 0.183, and 0.104, respectively) depending on the cut-off set at 3%.ConclusionOur study demonstrated that the CHINA-PAR equations rather than PCE could provide better identification of macro- and microcirculation abnormalities. A lower cut-off point for the subclinical vascular changes may be selected in a population from southeast China.
Highlights
We hypothesized that discriminating the early subclinical organ damage would serve as a great opportunity for prevention against atherosclerotic cardiovascular disease (ASCVD)
We aimed to use the ASCVD risk scores to observe the prevalence of macro- and microcirculation abnormalities in a Chinese population, achieving a more valuable equation by comparing the Pooled Cohort Equations (PCE) and CHINA-PAR models
We explored categorical net reclassification improvement (NRI) to evaluate the stratification of effects from the PCE model to the CHINA-PAR model at the cut-off point derived from the Receiver operating characteristic (ROC)
Summary
We hypothesized that discriminating the early subclinical organ damage would serve as a great opportunity for prevention against atherosclerotic cardiovascular disease (ASCVD). In 2013, the American College of Cardiology and the American Heart Association developed the Pooled Cohort Equations (PCE) to estimate the 10-year risk of developing a first hard atherosclerotic CVD (ASCVD) event (defined as the first occurrence of nonfatal myocardial infarction, coronary heart disease, death, or stroke) [3]. The CHINA-PAR equations are based on traditional major risk factors with several new variables, validated by 4 Chinese cohorts, and aimed to serve as valuable predictor of ASCVD risk in the general Chinese population. Studies have shown controversial results with the CHINA-PAR model. It outperformed PCE in ASCVD risk prediction in a rural northern Chinese population [5] but underestimated the risk in Mongolians [6]. Further validation of ASCVD risk predictions in other Chinese populations needs to be performed
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