10-year Coronary Heart Disease Risk Research Articles

Association between plant-based diets and the risk of coronary heart disease predicted using the Framingham Risk Score in Korean men: data from the HEXA cohort study.

This study investigated the potential correlation between 4 plant-based diet indices and the predicted risk of coronary heart disease (CHD) in Korean men using the Framingham Risk Score. The study included 12,356 male participants (aged ≥40 years) from the Health Examinees Study. Dietary intake was estimated using a validated food frequency questionnaire. Four plant-based diet indices were measured, including the overall plant-based diet index, the healthy plant-based diet index (hPDI), the unhealthy plant-based diet index (uPDI), and the pro-vegetarian diet index. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the predicted 10-year risk of CHD. The study found that individuals in the highest hPDI quintile had a 19% lower risk score for CHD based on the Framingham Risk Score (model 3, HR=0.801; 95% CI, 0.689-0.930, p for trend=0.0105). In stratified analyses, the highest pro-vegetarian diet index was associated with a lower risk score for CHD in physically active individuals (HR=0.740; 95% CI, 0.588-0.931; p for interaction=0.020). Conversely, the highest uPDI was associated with the highest risk score for CHD in those with a body mass index of ≥25 kg/m² and a waist circumference ≥90 cm. This prospective cohort study highlights the positive role of adhering to a high hPDI diet in the prevention of CHD in Korean men. Further prospective studies are needed to determine the association between various plant-based diet indices and the risk of CHD in Asian populations with different dietary habits.

Residual risk of cardiovascular complications in statin-using patients with type 2 diabetes: the Taiwan Diabetes Registry Study

BackgroundThe residual risks of atherosclerotic cardiovascular disease in statin-treated patients with diabetes remain unclear. This study was conducted to identify factors associated with these residual risks in patients with no prior vascular event.MethodsData on 683 statin-using patients with type 2 diabetes mellitus (T2DM) from the Taiwan Diabetes Registry were used in this study. Patients aged < 25 or > 65 years at the time of diabetes diagnosis and those with diabetes durations ≥ 20 years were excluded. The United Kingdom Prospective Diabetes Study risk engine (version 2.01; https://www.dtu.ox.ac.uk/riskengine/) was used to calculate 10-year residual nonfatal and fatal coronary heart disease (CHD) and stroke risks. Associations of these risks with physical and biochemical variables, including medication use and comorbidity, were examined.ResultsThe 10-year risks of nonfatal CHD in oral anti-diabetic drug (OAD), insulin and OAD plus insulin groups were 11.8%, 16.0%, and 16.8%, respectively. The 10-year risks of nonfatal stroke in OAD, insulin and OAD plus insulin groups were 3.0%, 3.4%, and 4.3%, respectively. In the multivariate model, chronic kidney disease (CKD), neuropathy, insulin use, calcium-channel blocker (CCB) use, higher body mass indices (BMI), low-density lipoprotein (LDL), fasting glucose, log-triglyceride (TG), and log–alanine transaminase (ALT) levels were associated with an increased CHD risk. The residual risk of stroke was associated with CKD, neuropathy, CCB use, and lower LDL cholesterol levels, higher BMI and diastolic blood pressure.ConclusionThis study indicated that insulin was probably a residual risk factor of CHD but not stroke, and that there was a possible presence of obesity paradox in patients with T2DM on statin therapy. In addition to lowering TG and normalizing fasting glucose levels, lower LDL cholesterol level is better for reduction of risk of CHD on statin therapy. On the other hand, lower LDL cholesterol level could potentially be related to higher risk of stroke among populations receiving statin therapy. These findings suggest potential therapeutic targets for residual cardiovascular risk reduction in patients with T2DM on statin therapy.

The predictive accuracy of coronary heart disease risk prediction models in rural Northwestern China

Cardiovascular risk models developed may have limitations when applied to rural Chinese. This study validated and compared the Framingham Risk Score (FRS) and Prediction for Atherosclerotic Cardiovascular Disease Risk in China (PAR) models in predicting 10-year risk of coronary heart disease (CHD) in a rural cohort in Ningxia, China from 2008 to 2019. The FRS and PAR models were validated by estimating predicted events, C index, calibration χ2 and plots. 1381 adults without CHD at baseline were followed up for 9.75 years on average. 168 CHD cases were observed. The FRS and PAR underestimated CHD events by 22 % and 46 % for the total population, while overestimated for males by 152 % and 78 %, respectively. The C index was slightly higher for PAR than FRS. Both models showed weak calibration with chi-square values above 20 (p < 0.001). Bland-Altman plots indicated FRS predicted higher CHD risk than PAR, lacking consistency. Overall, FRS and PAR demonstrated limited performance in predicting 10-year CHD risk in this rural population. PAR had slightly better discrimination than FRS, but require further improvement in calibration and individual risk estimation to suit the rural population in Northwest China.

Impact of coronary artery calcium score level in prediction of major adverse cardiovascular events

Abstract Background Elevated coronary artery calcium (CAC) is associated with an increased risk of cardiovascular (CV) and total mortality, while the coronary artery calcium score (CACS) significantly increases the sensitivity and specificity of traditional risk factors and risk scores in asymptomatic patients with intermediate risk. Purpose The aim of the study was to determine an association between the CACS and risk of major adverse CV events (MACE), as well as which value of CACS could be added in a prediction model based on traditional cardiovascular risk factors (CVRFs) in patients without established coronary artery disease (CAD) to improve risk stratification. Methods The study was performed as retrospective study, included patients of both sexes, aged over 40 years, with at least one traditional CVRF who underwent MSCT coronarography with follow up of 3 years. All patients were monitored for the presence of CVRFs, use of antihypertensive, statin and antiplatelet therapy, atherosclerotic cardiovascular disease risk score (ASCVD), 10-Year Coronary Heart Disease Risk with Coronary Artery Calcification (MESA score) and CACS. Results Of the 100 included patients, 61 (61%) were male and the mean age was 57.1±10.7 years. Most of patients (47%) had an intermediate ASCVD risk, average CACS value of 65.0 (0.0 - 383.3), mean value of CACS of 327.8±653.2, mean MESA score of 13.4±10.1 and a total of 29% MACE, with hospitalization as a most common (24%). There was an association between MACE and ASCVD score (p = 0.037), as well as CACS (p = 0.022). Logistic regression showed that the occurrence of MACE is influenced by: glucose level ([OR] (95%CI) 1.330 (1.003-1.762), (p = 0.047)), ASCVD score (([OR] (95%CI) 1.881(1.161- 3.048, (p =0.010)), MESA score (([OR] (95%CI) 1.055(1.004-1.109) (p = 0.033) and CACS (([OR] (95%CI) 1.902(1.170-3.092) (p = 0.010), where an increase in CACS by one increases the risk of MACE by almost 2 times. Conclusions The occurrence of cardiovascular outcomes is influenced by CACS, MESA score, ASCVD score, glucose level and age. Additional research is needed, with larger number of patients, to develop a predictive model based on traditional CVRFs and CACS values, in asymptomatic patients, in order to improve risk stratification.

Polygenic Risk, Rare Variants, and Family History: Independent and Additive Effects on Coronary Heart Disease

BackgroundGenetic factors are not included in prediction models for coronary heart disease (CHD). ObjectivesThe authors assessed the predictive utility of a polygenic risk score (PRS) for CHD (defined as myocardial infarction, coronary revascularization, or cardiovascular death) and whether the risks due to monogenic familial hypercholesterolemia (FH) and family history (FamHx) are independent of and additive to the PRS. MethodsIn UK-biobank participants, PRSCHD was calculated using metaGRS, and 10-year risk for incident CHD was estimated using the pooled cohort equations (PCE). The area under the curve (AUC) of the receiver operator curve and net reclassification improvement (NRI) were assessed. FH was defined as the presence of a pathogenic or likely pathogenic variant in LDLR, APOB, or PCSK9. FamHx was defined as a diagnosis of CHD in first-degree relatives. Independent and additive effects of PRSCHD, FH, and FamHx were evaluated in stratified analyses. ResultsIn 323,373 participants with genotype data, the addition of PRSCHD to PCE increased the AUC from 0.759 (95% CI: 0.755-0.763) to 0.773 (95% CI: 0.769-0.777). The AUC and NRIEvent for PRSCHD were higher before the age of 55 years. Of 199,997 participants with exome sequence data, 10,000 had a PRSCHD ≥95th percentile (PRSP95), 673 had FH, and 46,163 had FamHx. The CHD risk associated with PRSP95 was independent of FH and FamHx. The risks associated with combinations of PRSCHD, FH, and FamHx were additive and comprehensive estimates could be obtained by multiplying the risk from each genetic factor. ConclusionsIncorporating PRSCHD into the PCE improves risk prediction for CHD, especially at younger ages. The associations of PRSCHD, FH, and FamHx with CHD were independent and additive.

Mode of transport, genetic susceptibility, and incidence of coronary heart disease

BackgroundCar use has been associated with higher risk of coronary heart disease (CHD). However, whether the associations of transport modes with CHD vary by genetic susceptibility to CHD are unknown. This study aims to investigate the associations of genetic susceptibility and modes of transport with incidence of CHD.MethodsWe included 339,588 white British participants from UK Biobank with no history of CHD or stroke at baseline or within two years of follow-up (52.3% in work). Genetic susceptibility to CHD was quantified through weighted polygenic risk scores derived from 300 single-nucleotide polymorphisms related to CHD risk. Categories of transport mode included exclusive car use and alternatives to the car (e.g., walking, cycling and public transport), separately for non-commuting (e.g., getting about [n=339,588] excluding commuting for work), commuting (in the sub-set in work [n=177,370] who responded to the commuting question), and overall transport (transport mode for both commuting and non-commuting [n=177,370]). We used Cox regression with age as the underlying timescale to estimate hazard ratios (HR) of CHD (n=13,730; median 13.8-year follow-up) and tested the interaction between genetic susceptibility and travel modes with adjustment for confounders.ResultsCompared to those using alternatives to the car, hazards of CHD were higher for exclusive use of cars for overall transport (HR: 1.16, 95% confidence interval (CI): 1.08-1.25), non-commuting (HR: 1.08, 95% CI: 1.04-1.12) and commuting (HR: 1.16, 95% CI: 1.09-1.23), after adjusting for confounders plus genetic susceptibility. HRs of CHD were 1.45 (95% CI: 1.38-1.52) and 2.04 (95% CI: 1.95-2.12) for the second and third tertile of genetic susceptibility to CHD, respectively, compared to the first. There was, in general, no strong evidence of interactions between genetic susceptibility and categories of overall, non-commuting and commuting transport. Estimated 10-year absolute risk of CHD was lower for the alternatives to the car across strata of genetic susceptibility, compared with exclusive use of cars for overall, non-commuting and commuting transport.ConclusionExclusive use of cars was associated with a relatively higher risk of CHD across all strata of genetic susceptibility. Using alternatives to the car should be encouraged for prevention of CHD for the general population including individuals at high genetic risk.

Coronary Artery Calcium Score and Polygenic Risk Score for the Prediction of Coronary Heart Disease Events

Coronary artery calcium score and polygenic risk score have each separately been proposed as novel markers to identify risk of coronary heart disease (CHD), but no prior studies have directly compared these markers in the same cohorts. To evaluate change in CHD risk prediction when a coronary artery calcium score, a polygenic risk score, or both are added to a traditional risk factor-based model. Two observational population-based studies involving individuals aged 45 years through 79 years of European ancestry and free of clinical CHD at baseline: the Multi-Ethnic Study of Atherosclerosis (MESA) study involved 1991 participants at 6 US centers and the Rotterdam Study (RS) involved 1217 in Rotterdam, the Netherlands. Traditional risk factors were used to calculate CHD risk (eg, pooled cohort equations [PCEs]), computed tomography for the coronary artery calcium score, and genotyped samples for a validated polygenic risk score. Model discrimination, calibration, and net reclassification improvement (at the recommended risk threshold of 7.5%) for prediction of incident CHD events were assessed. The median age was 61 years in MESA and 67 years in RS. Both log (coronary artery calcium+1) and polygenic risk score were significantly associated with 10-year risk of incident CHD (hazards ratio per SD, 2.60; 95% CI, 2.08-3.26 and 1.43; 95% CI, 1.20-1.71, respectively), in MESA. The C statistic for the coronary artery calcium score was 0.76 (95% CI, 0.71-0.79) and for the polygenic risk score, 0.69 (95% CI, 0.63-0.71). The change in the C statistic when each was added to the PCEs was 0.09 (95% CI, 0.06-0.13) for the coronary artery calcium score, 0.02 (95% CI, 0.00-0.04) for the polygenic risk score, and 0.10 (95% CI, 0.07-0.14) for both. Overall categorical net reclassification improvement was significant when the coronary artery calcium score (0.19; 95% CI, 0.06-0.28) but was not significant when the polygenic risk score (0.04; 95% CI, -0.05 to 0.10) was added to the PCEs. Calibration of the PCEs and models with coronary artery calcium and/or polygenic risk scores was adequate (all χ2<20). Subgroup analysis stratified by the median age demonstrated similar findings. Similar findings were observed for 10-year risk in RS and in longer-term follow-up in MESA (median, 16.0 years). In 2 cohorts of middle-aged to older adults from the US and the Netherlands, the coronary artery calcium score had better discrimination than the polygenic risk score for risk prediction of CHD. In addition, the coronary artery calcium score but not the polygenic risk score significantly improved risk discrimination and risk reclassification for CHD when added to traditional risk factors.

The association between meat intake and the risk of coronary heart disease in Korean men using the Framingham risk score: A prospective cohort study

Background and aimsResearch suggests that meat intake may increase the risk of coronary heart disease (CHD), but most studies take place in Western countries, where the types and amount of meat products consumed differ from those in Asian countries. We aimed to identify the association between meat intake and CHD risk in Korean male adults, using the Framingham risk score. Methods and resultsWe used data from the Korean Genome and Epidemiology Study (KoGES) Health Examinees (HEXA) study, including 13,293 Korean male adults. We estimated the association of meat intake with ≥20% 10-year CHD risk using Cox proportional hazards regression models to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Subjects with the highest total meat intake had a 53% (model 4: HR 1.53, 95% CI 1.05–2.21) increased 10-year CHD risk compared to those with the lowest intake. Those with the highest red meat intake had a 55% (model 3: HR 1.55, 95% CI 1.16–2.06) increased 10-year CHD risk compared to those with the lowest intake. No association was observed between poultry or processed meat intake and 10-year CHD risk. ConclusionsConsumption of total meat and red meat was associated with a higher risk of CHD in Korean male adults. Further studies are needed to provide criteria for the appropriate meat intake by meat type to reduce CHD risk.

Associations of Chronic Diabetes Complications and Cardiovascular Risk with the Risk of Obstructive Sleep Apnea in Patients with Type 2 Diabetes.

Background: Type 2 diabetes mellitus (T2DM) is associated with increased mortality and morbidity, including cardiovascular diseases and obstructive sleep apnea (OSA). The aim of this study was to assess the associations between cardiovascular risk, chronic diabetes complications and the risk of OSA in adult patients with T2DM. Methods: The study included 529 patients with T2DM in whom moderate-to-severe OSA risk was assessed using the STOP-Bang questionnaire, dividing the subjects into two groups: group 1: STOP-Bang score <5, and group 2: STOP-Bang score ≥5, respectively. In all the subjects, cardiovascular risk was assessed using the UKPDS risk engine. Statistical analysis was performed using SPSS 26.0, the results being statistically significant if p value was <0.05. Results: 59% of the subjects scored ≥5 on the STOP-Bang questionnaire. We recorded statistically significant differences between the two groups regarding diabetes duration, HbA1c, HOMA-IR, albuminuria, as well as cardiovascular risk at 10 years for both coronary heart disease (CHD) and stroke (p < 0.05). Furthermore, through logistic regression, adjusting for confounding factors, we demonstrated that the STOP-Bang score ≥ 5 is a risk factor for 10-year fatal and nonfatal CHD risk. Conclusions: It is extremely important to screen and diagnose OSA in patients with T2DM, in order to improve the primary and secondary prevention of cardiovascular events in these patients.

Evaluation of Persistent Efficacy of Diabetes Remission and Decline of Cardiovascular Risk After Laparoscopic Sleeve Gastrectomy: a Preliminary 1-Year Study.

Laparoscopic sleeve gastrectomy (LSG) is a relative safe procedure in bariatric surgery. However, relatively few studies had been assessed its comprehensive efficacies. In the current study, the efficacies of LSG were comprehensively explored on glycemic control and cardiovascular disease (CVD) risk reduction. A total of 95 obese patients, who owned body mass index (BMI) of more than 35, were recruited. All of them primarily underwent LSG from 2014 to 2016. Type 2 diabetes mellitus (T2DM) remission was defined as levels of glycated hemoglobin (A1C) and fasting blood glucose (FBG) of less than 6.4% and 125mg/dL, respectively. The further efficacies of LSG on CVD and coronary heart disease (CHD) risks were explored by using original- and recalibrated Framingham 10-year CHD risk scores and the other 3 well-established CVD risk prediction models. Systolic blood pressure (SBP), serum FBG, A1C, triglyceride (TG), BMI, and body weight showed significantly declined and high-density lipoprotein-cholesterol (HDL) displayed twice higher than beginning level after LSG. The 71 of 95 patients with obesity were T2DM; 62 of them exhibited persistent DM remission until 1year after LSG. Cardiovascular age, general cardiovascular risk (GCVR), and atherosclerotic cardiovascular disease risk (ASCVD) also showed significant decrements after LSG. We also observed significant reductions in estimated CVD and CHD risks. LSG resulted in a persistent T2DM remission and corrected metabolic abnormalities. Subsequently, LSG also benefits declined risks of CVD and 10-year CHD developments. LSG may be helpful for primary CVD care in obese patients with BMI of more than 35.

Evaluating the relationship of sleep quality and sleep duration with Framingham coronary heart disease risk score

ABSTRACT Sleep is an important modulator of cardiovascular function and is recognized to play an important role in the pathogenesis and progression of cardiovascular disease. However, results of the studies investigating the relationship between sleep complaints and cardiovascular outcomes are still controversial. This study aimed to investigate the associations of sleep duration and sleep quality with Framingham 10-year hard coronary heart disease (CHD) risk score in Turkish adults. We included a total of 362 participants (mean age: 48.5 ± 9.0 years, 50.6% males) and measured sleep quality and sleep duration using Pittsburgh Sleep Quality Index (PSQI). Framingham risk scoring system was utilized to calculate the 10-year hard CHD risk of participants. Binary logistic regression analysis was performed to determine the association between sleep quality, sleep duration, and CHD risk. Both short sleep duration (<6 hours) (OR = 3.858, 95% CI: 1.245–11.956) and long sleep duration (≥8 hours) (OR = 2.944, 95% CI: 1.087–7.967) were identified as the predictors of 10-year hard CHD risk. However, sleep quality was not associated with 10-year CHD risk even as a categorical or continuous variable (OR = 0.864, 95% CI: 0.418–1.787 and OR = 0.985, 95% CI: 0.868–1.117, respectively). Our findings highlighted previous studies demonstrating the U-shaped relationship, with both short and long sleep durations to be associated with a higher CHD risk. Evaluation of habitual sleeping patterns may provide additional information in clinical cardiovascular risk assessment. Future research should investigate whether interventions to optimize sleep duration may help to prevent coronary events in large population-based cohorts.

Does Cardiovascular Disease Risk Decrease after Smoking Cessation in Occupational Risk Groups?

Smoking cessation is very important for workers due to the possibility of exposure to additional environmental risks in the workplace environment. This study was performed to determine the changes in the Framingham Risk Score (FRS) and 10-year risk of cardiovascular disease (CVD) of employees before smoking cessation and after 6 months. Five hundred and sixty-two employees who want to quit smoking were included in the study. In this prospective study, the baseline and 6-month FRS, and 10-year risk of CVD of workers were calculated. Furthermore, the Hospital Anxiety and Depression Scale was used for assessments of employees' anxiety and depression symptoms. After 6 months, 37% of the participants quit smoking. It was determined that 11.9% of employees have a high CVD risk and 10.6% moderate CVD risk. After 6 months, there was a statistically significant reduction in FRS who quit smoking (P < 0.001). In addition, within the 6 months after smoking cessation, 10-year coronary heart disease risk reduction was higher in quitters than those who cannot quit smoking (47.6% decrease in quitters and 14.9% in nonquitters, P < 0.001). Significant decreases in fasting blood glucose levels were determined after smoking cessation (P = 0.003). The FRS and CVD risk of smoker employees were decreased 6 months after smoking cessation. In 6 months, CVD risk is reduced in almost half of those who quit smoking. Even in the short term, it is possible to reduce the CVD risk of a worker who quits smoking.

Comparative Performance Analysis of Random Forests against AutoPrognosis for predicting Coronary Heart Disease Risk and Metabolic Syndrome: A Retrospective Cohort Study

Cardiovascular Disease (CVD) is the leading cause of mortality worldwide. Amongst them, Coronary Heart Disease (CHD) is the most common type of CVD. The consequences of the presence of CVD risk factors often manifest as Metabolic Syndrome (MetS). In this study, data from the Framingham Heart Study (FHS), consisting of 4240 records and 17 variables, was used to build two types of 10-year CHD risk prediction models based on Random Forests (RF) and AutoPrognosis. The Framingham Risk Score model (AUC-ROC: 0.633) was used as a baseline model for performance evaluation. Results showed that the RF model with optimized hyperparameters had the best performance (AUC-ROC: 0.728). Furthermore, a dataset of 7821 records and 77 variables from the National Health and Nutrition Examination Survey (NHANES) was used to assess the predictive performance of RF against AutoPrognosis for determining the presence of MetS. The RF model with optimized hyperparameters had the best performance (AUC-ROC: 0.851). The performance of RF against AutoPrognosis on different sample sizes of data, ranging from 100 to 4900, was tested. The RF model with optimized hyperparameters had the best overall performance, followed by AutoPrognosis with an ensemble pipeline, then AutoPrognosis with a single pipeline and finally the RF model with default hyperparameter values.

Use of Artificial Intelligence in Coronary Artery Calcium Scoring.

Coronary artery calcium (CAC) scoring improves traditional risk factor-based coronary heart disease (CHD) risk stratification. Here, the contribution of CAC scoring to a traditional 10-year CHD risk prediction scores and new artificial intelligence methods used to automate CAC scoring were reviewed. Research shows that traditional risk factors tend to overestimate or underestimate the actual risk of CHD, meaning that including CAC score in the risk stratification has potential to reduce over- and undertreatment. The automated CAC scoring methods are shown to be accurate and significantly more time-effective than the commonly used semi-automated method.

Clinical Significance of Intermediate-Density Lipoprotein Cholesterol Determination as a Predictor for Coronary Heart Disease Risk in Middle-Aged Men.

Background: Not only low-density lipoprotein (LDL) cholesterol but also non-high-density lipoprotein cholesterol (non-HDL-C), very low-density lipoprotein (VLDL) cholesterol (VLDL-C), and intermediate-density lipoprotein (IDL) cholesterol (IDL-C) are reported to be significant risk markers for coronary heart disease (CHD). We reported the relevance of IDL-C to Framingham risk score (F-score), but the present study addressed the relevance of IDL-C to Suita score (S-score), a risk score for coronary heart disease (CHD) developed for the Japanese individuals in addition to F-score.Methods: The cholesterol levels of lipoproteins, including triglyceride (TG)-rich lipoproteins (IDL and VLDL), were measured by an anion exchange high-performance liquid chromatography (AEX-HPLC). This study enrolled 476 men, aged mean 51 years and free of CHD and stroke.Results: Non-HDL-C, IDL-C, and VLDL-C significantly correlated with F-score and S-score. In the multiple stepwise regression analysis, IDL-C as well as body mass index (BMI) significantly correlated with both F-score and S-score in both the total subjects and the subjects without drug therapy. The multivariate logistic analysis with the model composed of BMI and IDL-C as the predictor variables demonstrated that 1 SD increase in IDL-C was an independent predictor for 10-year CHD risk >10% of F-score (OR 1.534, 95% CI 1.266–1.859, p < 0001) and that of S-score (OR 1.372, 95% CI 1.130–1.667, p = 0.0014) in the total subjects. Even in the subjects without the drug therapy, the increased IDL-C, as well as BMI, were significant predictors for 10-year CHD risk >10% of S-score as well as F-score.Conclusion: These results suggest the significant relevance of the increased IDL-C for CHD risk scores in middle-aged men free of CHD and stroke. Further investigations are needed in women and elderly subjects.

Cardiovascular risk score associations with frailty in men and women with or at risk for HIV.

To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011-2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4+ cell count/μl, antiretroviral therapy, and HIV viral load. There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) = 2.12, 95% confidence interval (CI):1.22-3.69] and MWH (aHR = 2.19, 95% CI: 1.33-3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR = 1.88, 95% CI: 1.48-2.39) and MWH (aHR = 1.59, 95% CI: 1.26-2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) = 1.43, 95% CI: 1.02-2.00] and WWH (aOR = 1.36, 95% CI: 1.08-1.71); however, high-risk FRS was not (seronegative: aOR = 1.03, 95% CI: 0.30-3.49; WWH: aOR = 0.86, 95% CI: 0.23-3.20). Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.

Prediction of Coronary Calcification and Stenosis: Role of Radiomics From Low-Dose CT

We aimed to assess relationship between single-click, whole heart radiomics from low-dose computed tomography (LDCT) for lung cancer screening with coronary artery calcification and stenosis. The institutional review board-approved, retrospective study included all 106 patients (68 men, 38 women, mean age 64 ± 7 years) who underwent both LDCT for lung cancer screening and had calcium scoring and coronary computed tomography angiography in our institution. We recorded the clinical variables including patients' demographics, smoking history, family history, and lipid profiles. Coronary calcium scores and grading of coronary stenosis were recorded from the radiology information system. We calculated the multiethnic scores for atherosclerosis risk scores to obtain 10-year coronary heart disease (MESA 10-Y CHD) risk of cardiovascular disease for all patients. Deidentified LDCT exams were exported to a Radiomics prototype for automatic heart segmentation, and derivation of radiomics. Data were analyzed using multiple logistic regression and kernel Fisher discriminant analyses. Whole heart radiomics were better than the clinical variables for differentiating subjects with different Agatston scores (≤400 and >400) (area under the curve [AUC] 0.92 vs 0.69). Prediction of coronary stenosis and MESA 10-Y CHD risk was better on whole heart radiomics (AUC:0.86-0.87) than with clinical variables (AUC:0.69-0.79). Addition of clinical variables or visual assessment of coronary calcification from LDCT to whole heart radiomics resulted in a modest change in the AUC. Single-click, whole heart radiomics obtained from LDCT for lung cancer screening can differentiate patients with different Agatston and MESA risk scores for cardiovascular diseases.

Electronic Medical Record Risk Modeling of Cardiovascular Outcomes Among Patients with Type 2 Diabetes.

IntroductionIncreased utilization of electronic health records (EHR) has enriched databases for creating risk models. We used machine learning techniques to develop an EHR-based risk model locally fitted to patients with type 2 diabetes mellitus (T2DM) for predicting cardiovascular disease.MethodsThis retrospective observational study was conducted within Ochsner Health, Louisiana, USA, between 2013–2017. Data analysis included 6245 patients who had two outpatient diagnoses of T2DM recorded on separate days or a diagnosis recorded during an inpatient encounter. Baseline clinical data were limited to 180 days before the index diagnosis. Cardiovascular outcomes were coronary heart disease (CHD), heart failure and stroke. Machine learning approaches were used to select predictor variables into Cox proportional hazards models for each outcome. Locally fit equations were compared to “generalized” risk equations (RECODe, AS-CVD, QRISK3) using model discrimination and calibration.ResultsAmong factors identified in the Ochsner (n = 11), RECODe (n = 14), AS-CVD (n = 15) and QRISK3 (n = 23), only age was common to all four risk equations. The Ochsner model had high internal discrimination for CHD (C-statistics 0.85) and better discrimination than RECODe (C-statistics 0.45), the QRISK3 (C-statistics 0.72) and AS-CVD (C-statistics 0.54).ConclusionsThe Ochsner model overestimated 5-year CHD risk, but had relatively higher calibration than the other models in CHD. Risk equations fitted for local populations improved cardiovascular risk stratification for patients with T2DM. Application of machine learning simplified the models compared to “generalized” risk equations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01096-w.

Abstract P029: Non-high Density Lipoprotein Is A Residual Risk For The Progression Of Endothelial Dysfunction In Patients With Well Controlled Low-density Lipoprotein Cholesterol: Multicenter Prospective Study FMDJ Study

Introduction: Recently, several guidelines suggest the usefulness of non-high density lipoprotein cholesterol (non-HDLC) as a secondary treatment target for CVD prevention, next to low-density lipoprotein cholesterol (LDLC). However, its effect on endothelial dysfunction have not been fully clarified. The objective of this multicenter-prospective-observational study, FMD-J Study, is to evaluate whether non-HDLC is a residual risk for the progression of endothelial dysfunction in patients with hypertension. Hypothesis: Non-HDLC is a residual risk for the progression of endothelial dysfunction in patients with hypertension. Methods: 633 treated hypertensive patients (mean age 62±9 years) in the FMD-J study were followed for 3 years. Endothelial function was evaluated by the change of flow mediated vasodilation (FMD). Multivariate regression analysis adjusted for established coronary heart disease (CHD) risk factors (sex, age, BMI, systolic blood pressure, heart rate, fasting blood glucose, high density lipoprotein cholesterol, baseline FMD, current smoking, treatment of diabetes, and treatment of dyslipidemia) was performed to evaluate whether LDLC and non-HDLC were associated with the change of FMD. We also performed secondary analysis to evaluate whether non-HDLC is associated with progression of endothelial dysfunction in patients with well controlled LDLC level according to their CHD risk. CHD risk was evaluated by Suita score, which is established risk score to assess the 10-year risk of CHD for the Japanese population. (High-risk: 56≦Suita score, Mid-risk: 41≦Suita score≦55, Low-risk: Suita score≦40) Target controlled LDLC levels according to CHD risk were defined as follows; High-risk: LDLC&lt;70 mg/dl, Mid-risk: LDLC&lt;100 mg/dl, Low-risk: LDLC&lt;70 mg/dl. Results: Mean change of FMD after 3 years was 0.07±2.97% and mean Suita score was 46.4±8.9. Overall, both higher LDLC and non-HDLC was significantly associated with impairment of FMD. (Adjusted 1SD increase of LDLC; β: -0.26±0.11, P=0.02, Adjusted 1SD increase of non-HDLC; β: -0.25±0.11, P=0.03 ). In secondary analysis, 97 patients’ LDLC reached target LDLC level according to CHD risk. Among LDLC controlled group, higher non-HDLC was significantly associated with impairment of FMD. (Adjusted 1SD increase of non-HDLC; β: -0.75±0.13, P=0.02). However, among 536 patients whose LDLC did not reach target LDLC value, non-HDLC was not associated with the change pf FMD. (Adjusted 1SD increase of non-HDLC; β: -0.15±0.12, P=0.20). Conclusions: Non-HDLC may be a residual risk for the progression of endothelial dysfunction in patients with hypertension, especially in hypertensive patients with well controlled LDLC.

Transient ischemic dilatation with adenosine 99mTc-sestamibi stress: prognostic significance in patients with normal myocardial perfusion.

To determine the significance of transient ischemic dilatation (TID) in patients with normal perfusion on adenosine stress/rest. We analyzed 430 consecutive patients with normal perfusion on 2-day adenosine stress/rest 99mTc-sestamibi. A group of 70 patients with Framingham 10-year coronary heart disease risk < 10% was used to derive abnormal TID thresholds (derivation group). The significance of TID at these thresholds was validated in the remaining 360 patients (validation group) followed for cardiac events for 31.2 ± 9.7 (mean ± SD) months. Transient ischemic dilatation in the derivation group was 1.05 ± 0.13. Three definitions of an abnormal TID were used: > mean + 2SD (TID ≥ 1.32), > mean + 1SD (TID ≥ 1.19) and a TID in the group's highest quartile (TID ≥ 1.15). Of the 360 validation group patients, 12 (3.3%), 48 (13.3%) and 70 (19.4%) had TID ≥ 1.32, 1.19 and 1.15, respectively. Age, gender, family history of coronary artery disease (CAD), known CAD, smoking, hypertension, diabetes, dyslipidemia, rest LVEF, post-stress LVEF, ΔLVEF, ≥ 5% or 10% decrease in LVEF did not predict TID ≥ 1.32. However, TID ≥ 1.19 was predicted by rest LVEF and ≥ 5% decrease in LVEF (P = 0.04 and 0.02, respectively) and TID ≥ 1.15 was predicted by ≥ 5% decrease in LVEF (P = 0.02). Cardiac event-free survivals were similar in patients with a TID ≥ and < 1.32 (P = 0.68), ≥ and < 1.19 (P = 0.40) and ≥ and < 1.15 (P = 0.79). Transient ischemic dilatation does not confer adverse prognosis in patients with normal perfusion on adenosine stress/rest 99mTc-sestamibi irrespective of the threshold used for its definition.