10-year Risk Of Cardiovascular Events Research Articles

IJCM_168A: Cardiovascular disorder risk among the police personnel in Ernakulam District, Kerala, India

Background: Appropriate assessment and management of cardiovascular risk is vital in reducing the occurrence of fatal and non fatal cardiovascular events like stroke or myocardial infarction in high risk occupational group such as Police personnel. Several studies have reported high prevalence of risk factors of cardiovascular diseases (CVD) such as hypertension, high blood lipids, physical inactivity, obesity, positive family history etc among police personnel Objective: To estimate the 10-year risk of cardiovascular events (fatal or non-fatal) among police personnel in Ernakulam City, Kerala, India Methodology: A cross sectional study was carried out among police personnel in various police stations of the district. All the police stations in the district were listed and selected randomly using the MS Excel random number generator. After getting prior permission from the concerned authorities in the Police department, Police personnel above the age of 40 years in Ernakulam city were screened for CVD risk using the WHO – non-laboratory-based CVD risk chart. Data was entered into Microsoft Office Excel and analysed using Jamovi version 2.3.28 Results: Out of 246 participants studied, the mean age was 48.4 + 3.97. Less than half of the participants (44.3%) were Civil Police Officers (CPO) or Senior Civil Police Officer (SCPO). About a third of the participants (32.1%) were having CVD risk in yellow category (5-<10%), 3.3% in orange category (10-<20%) and majority (64.6%) in green category (<5%). On multivariate analysis, age>50 years (OR – 3.36[1.73,6.5]) and duration of service>20 years (OR – 4.9[2.35,10.23] were the independent determinants of higher CVD risk (yellow and orange category) Conclusion: About 35% of the participants belonged to higher risk category (yellow and orange) and duration of service>20 years, age>50 years were the independent determinants

Body Mass Index and Waist Circumference as Predictors of Above-Average Increased Cardiovascular Risk Assessed by the SCORE2 and SCORE2-OP Calculators and the Proposition of New Optimal Cut-Off Values: Cross-Sectional Single-Center Study.

Background: Obesity has been perceived as one of the important cardiovascular risk factors, but SCORE2 calculators used in clinical practice do not include the most popular parameters assessed for body composition: body mass index (BMI) and waist circumference (WC). The objective of this research was to determine which of the aforementioned variables is a more reliable predictor of an above-average increased cardiovascular risk for gender and age (ICVR). Methods: Data from 2061 patients were analyzed; the 10-year risk of cardiovascular events was assessed by SCORE2 tables, and the correlations with BMI and WC were analyzed. Results: BMI and WC independently predicted ICVR (OR 1.10-1.27). In males, BMI was a more accurate predictor (AUC = 0.816); however, in females, it was WC (AUC = 0.739). A novel threshold for BMI (27.6 kg/m2) was suggested, which increases the risk of cardiovascular disease by 3.3-5.3 times depending on gender; the same holds true for WC (93 cm in women and 99 cm in men; 3.8-4.8-fold higher risk). Conclusions: Despite their heterogeneity, BMI and WC are effective cardiovascular risk predictors, especially BMI for males and WC for females; therefore, more research is needed to include them in future models for predicting unfavorable cardiometabolic events.

Make your choice: Angiography or periodical health examination?

Periodical health examination is one of the important factors influencing a healthy lifestyle. Patients undergoing routine physical examination in primary care are included in the scope of preventive medical services, which is the most basic principle of primary care. Identifying the risk factors enables individuals to adopt healthier lifestyle practices. In our study, we examined the correlation between patients undergoing coronary angiography for suspected coronary stenosis and the extent of primary care services they had received in their medical history, along with the severity of stenosis observed during the angiography. Patients were interviewed using a pre-structured questionnaire to gather information about their past utilization of primary healthcare services related to coronary matters and their cardiovascular (CV) risk profile as documented in their medical history. The necessary standard tests for angiography procedures were retrieved from patient records. The SYNTAX score, a tool that aids in the objective assessment of the severity of coronary artery disease (CAD), was computed and documented. This score was then compared with the history of primary care utilization. The patients' utilization of services from the Primary Healthcare Center (PHC) was evaluated using a scoring system, with an average score of 29.27 ± 11.27 out of 100 points (minimum: 20; maximum: 60). The average SCORE Türkiye indicating the 10-year risk of CV events for all patients was calculated as 14.31% ± 8.65% (high-very high risk), while the average SYNTAX score was 15.20 ± 9.97. There was a positive and significant correlation found between fasting blood glucose and creatinine values with both SYNTAX score and SCORE Türkiye (respectively; R = 0.238, P = .013; R = 0.289, P = .002). Factors such as smoking and metabolic syndrome were associated with CAD severity. It important to highlight that individual recommended for angiography had a notably lower utilization of healthcare services from the PHC based on their medical histories. This circumstance has resulted in individuals who do not undergo CV event screenings at PHCs having higher SYNTAX scores, indicating more severe CAD that necessitates angiography. Conducting regular periodical health examinations at PHCs can help mitigate these statistics.

A comparative study of cardiovascular risk stratification methods in type 1 diabetes mellitus patients

The Steno Diabetes Center Copenhagen developed the Steno T1 Risk Engine (ST1RE) to predict cardiovascular events, encompassing fatal and nonfatal ischemic heart disease, ischemic stroke, heart failure, and peripheral arterial disease in type 1 diabetes mellitus(T1DM).The current study investigated the agreement between ST1RE and the Brazilian Society for Endocrinology and Metabology (SBEM) classification. Participants were included in the study if diagnosed with T1DM and had at least one outpatient visit in 2021. Patients with established cardiovascular disease and chronic kidney disease on dialysis were excluded. Clinical parameters were obtained from medical records, such as age, body mass index (BMI), blood pressure, physical activity, current smoking, microvascular target organ damage, levels of low-density lipoprotein cholesterol, creatinine, glycated hemoglobin (HbA1c), and albuminuria.Overall, 92 patients (38 males and 53 females) with an age median (P25; P75) of 33 years (25.5;42.5), BMI of 24.8 + 4.1 kg/m2, and duration of diabetes (mean ± SD) of 23.4 + 9.5 years were evaluated. There were no differences considering the gender for most analyzed variables, but a higher proportion of women exhibited microvascular complications such as microalbuminuria, macroalbuminuria, and retinopathy. Our results show a weak agreement in the 10-year cardiovascular risk estimation between SBEM and ST1RE classifications. According to SBEM criteria, 72.8% of patients were considered high-risk, while only 15.2% of patients received the same classification using ST1RE. The dissimilarities between these two classifications were also evident when age and gender factors were compared. While 60% of patients under 35 years were classified as high risk according to SBEM criteria, only 1.8% received this stratification risk in the ST1RE classification.The results indicate a low agreement between the 10-year cardiovascular event risk classification by SBEM and the classification by ST1RE for type 1 diabetes patients without established cardiovascular disease.

COMPARATIVE ASSESSMENT OF THE RISKS OF FATAL AND NON-FATAL CARDIOVASCULAR EVENTS USING THE SCORE/SCORE-2 SCORE IN PATIENTS WITH CARDIOVACULAR PATHOLOGY

The main morbidity and mortality in the world is associated with pathologies of non-infectious origin, most of which are accounted for by diseases of the cardiovascular system. For the purpose of screening, a rating scale is currently used - SCORE. In 2021, the forecasting model was improved - the SCORE2 rating scale was released, which allows you to predict the risk of complications at an early stage using additional criteria. The purpose of the study: analysis of the risk assessment of cardiovascular events using the SCORE / SCORE - 2 scales. Materials and methods. A retrospective analysis of 140 patients' medical records was carried out. The inclusion criterion was the age of more than 40 years, the absence of concomitant cardiovascular diseases. Results. There were significant differences in Score (Men=9.5 points, Interwomen=3 points, p0.001) and SCORE2 (Men=22 points, Interwomen=18 points, p=0.049) between men and women aged 50 to 70 years old. When calculating, it turned out that most patients are at moderate risk of cardiovascular complications according to the SCORE scale, at very high risk according to the updated SCORE2 algorithm. Conclusion. In the course of comparing the 10-year risk of cardiovascular events calculated using the new SCORE2 algorithm, significant differences with the SCORE scale in digital values were revealed. All smokers, regardless of age and gender, were at very high risk, which absolutely increases the risk of complications.

ApoB-specific CD4+ T cells circulate in human blood and formation of a memory population is driven by coronary artery disease and an elevated cardiovascular risk profile

Abstract Aim Atherosclerosis is a chronic inflammatory disease involving an autoimmune response against Apolioprotein B (ApoB), the core protein of low-density lipoprotein (LDL) cholesterol. Using a translational bench-to-bedside approach, we linked the presence and immuno-phenotype of ApoB-specific CD4+ T cells to clinical risk profiles for cardiovascular disease in humans. Methods Peripheral blood mononuclear cells (PBMCs) from 230 patients that underwent coronary angiography were co-incubated in vitro with a pool of immunodominant peptides from human ApoB for 6h. Reactive ApoB-specific T cells (ApoB+) were defined in flow cytometry by expression of the activation marker CD40L. Partition of ApoBpos into naïve and memory T cells was achieved by extracellular fluorochrome-based staining of CD45RO, CCR7 and CD45RA. Cytokine expression of ApoBpos was determined by intracellular staining. Results We found that a median of 0.69±0.1% of circulating CD4+ T cells were reactive to Apolipoprotein B. We found detectable concentrations of auto reactive ApoB+ T cells in 86,44% of all healthy individuals. However, overall frequencies of ApoB reactive T cells did not correlate with diagnosed coronary artery disease (CAD). Compared to ApoBneg. T cells, we detected a higher fraction of memory T cells in ApoBpos (p<0,0001), suggesting a previously occurred ApoB directed immune response. Accordingly, elevated serum levels of ApoB specific IgG Antibodies associated with high proportions of ApoB specific memory cells. Patients diagnosed with coronary artery disease presented higher percentages of central memory T cells among ApoBpos compared to healthy individuals. Correspondingly, these observations applied to patients with an elevated 10-year risk for cardiovascular events estimated by the ESC-SCORE2. These effects largely grounded on strong associations with the clinical diagnosis of arterial hypertension, elevated levels of Lp(a) and obesity. Interestingly, systolic blood pressure and LDL-serum levels correlated with elevated proportions of memory-status ApoBpos T cells in patients without statin intake, although this was not the case for patients with LDL-lowering medication. Analysis of cytokine expression in ApoBpos CD4+ T cells showed significantly increased expression of anti-inflammatory Il-2 and IL-10 in addition to pro-inflammatory IFNγ. Cytokine secretion was mainly driven by memory-status ApoBpos when compared to naïve ApoBpos T cells. Interestingly, a significant number of patients showed a mixed TH1/Treg phenotype among ApoBpos with simultaneous expression of IL-10 and IFN-γ. Conclusions Our data show for the first time that ApoB-reactive T cells exist even in healthy individuals. Cardiovascular risk factors and clinically relevant atherosclerotic disease drive memory formation and activation of ApoB+ T cells. ApoB+ Memory T cells are prone to secrete pro- and anti-inflammatory cytokines and may modulate systemic inflammation in atherosclerosis.

Community-based type 2 diabetes care by lay village health workers in rural Lesotho: protocol for a cluster-randomized trial within the ComBaCaL cohort study (ComBaCaL T2D TwiC)

BackgroundType 2 diabetes (T2D) poses a growing public health burden, especially in low- and middle-income countries (LMICs). Task-shifting to lay village health workers (VHWs) and the use of digital clinical decision support systems (CDSS) are promising approaches to tackle the current T2D care gap in LMICs. However, evidence on the effectiveness of lay worker-led T2D care models, in which VHWs initiate and monitor drug treatment in addition to community-based screening and referral services, is lacking.MethodsWe are conducting a cluster-randomized trial nested within the Community-Based Chronic Disease Care Lesotho (ComBaCaL) cohort study (NCT05596773) using the trial within cohort (TwiC) design to assess the effectiveness of a VHW-led, CDSS-assisted T2D care model in rural Lesotho. Participants are non-pregnant members of the ComBaCaL cohort study with T2D. The ComBaCaL cohort study is conducted in approximately 100 villages in two rural districts in Lesotho and is managed by trained and supervised VHWs. In intervention villages, VHWs offer a community-based T2D care package including lifestyle counselling, first-line oral antidiabetic, lipid-lowering, and antiplatelet treatment guided by a tablet-based CDSS to participants who are clinically eligible, as well as treatment support to participants who prefer or clinically require facility-based T2D care. In control clusters, all participants will be referred to a health facility for T2D management. The primary endpoint is the mean glycosylated haemoglobin (HbA1c) 12 months after enrolment. Secondary endpoints include the 10-year risk for cardiovascular events estimated using the World Health Organization risk prediction tool.DiscussionThe trial was launched on May 13, 2023, and has enrolled 226 participants at the date of submission (October 6, 2023). To our knowledge, the trial is the first to assess task-shifting of T2D care to VHWs at the community level, including the prescription of first-line antidiabetic, lipid-lowering, and antiplatelet medication in sub-Saharan Africa, and will thus provide the missing evidence on the effectiveness of such a T2D care model in this setting. The study is operating within the established Lesotho VHW programme. Similar community health worker programmes which exist across sub-Saharan Africa may benefit from the findings.Trial registrationClinicalTrials.gov NCT05743387. Registered on February 24 2023.

Uric acid as a predictor of the development of non-alcoholic fatty liver disease in patients with arterial hypertension

Introduction. Currently, increased uric acid (UA) levels are considered an independent risk factor for the development of non-alcoholic fatty liver disease. Oxidative stress, chronic systemic inflammation, and insulin resistance characteristic of non-alcoholic fatty liver disease (NAFLD) may represent possible mechanisms for the association between the development of hyperuricemia and NAFLD.Aim. To clarify the meaning and nature of the relationship between an increase in the level of UA concentration and the development of NAFLD, as well as to evaluate the relationship between uric acid and the risk of cardiovascular complications in patients with hypertension and NAFLD.Materials and methods. A cross-sectional comparative study was conducted, which involved 120 patients aged from 45 to 65 with hypertension of 1–2 degrees, 1–2 stages (with and without NAFLD (FLI > 60). During the examination, a clinical examination was carried out: analysis of anamnesis data, anthropometry. Lipids and uric acid in blood plasma were also analyzed.Results. In the group of comorbid patients, there were significantly more patients with excess of the reference values of UA levels in the blood plasma (OR = 2.25: 95% CI 1.08–4.71). ROC analysis showed that with an uric acid level of 369.5 µmol/l, a high risk of developing NAFLD is predicted. The UA/Cr index in patients with hypertension and NAFLD was statistically significantly higher than in patients in the control group. Increase in the MK/Kr index by 1 USD increases the chances of developing NAFLD by 1.54 times (95% CI: 1.11–2.13). Also, an increase in the concentration of sUA level by 1 µmol/l increases the chances of an increase in the 10-year risk of cardiovascular events to 5.0% or more by 0.6%.Conclusions. With an uric acid level of 369.5 µmol/l, a high risk of developing NAFLD in the study group is predicted. Increase in UA/creatinine index by 1 USD increases the chances of developing NAFLD by 1.54 times. In addition, an increase in the concentration of sUA in the blood plasma by 1 µmol/l increases the chances of an increase in the 10-year risk of cardiovascular events to 5.0% or more by 0.6% in patients with hypertension and NAFLD.

Trimethylamine-N-oxide (TMAO) and predicted risk of cardiovascular events after partial nephrectomy

Emerging evidence suggests that uremic toxins, in particular trimethylamine-N-oxide(TMAO), indoxyl-sulfate(IS), and p-cresyl-sulfate(PCS), may associate with increased risk of cardiovascular events(CVe). However, whether uremic toxins increase after partial nephrectomy(PN) and their correlation with risk for CVe remains unknown. 100 patients managed with PN were retrospectively reviewed. TMAO/IS/PCS levels were examined by liquid chromatography-mass-spectrometry. Renal-parenchymal-volume-preservation(RPVP) was estimated from CT scans. Predicted risks for CVe were obtained using the Framingham score. Linear regression assessed association between uremic toxins, GFR and risk of CVe. Logistic regression evaluated factors associated with post-PN TMAO. TMAO, IS and PCS increased from 1.7, 3.7 and 3.5μmol/L before PN to 3.6, 5.4 and 7.4μmol/L at latest follow-up, respectively, while GFR declined from 102 to 93ml/min/1.73m2 (all p<0.001). TMAO, IS and PCS levels all negatively correlated with GFR(all p<0.001). Predicted 10-year risk of CVe increased from 1.1% pre-PN to 1.7% post-PN(p<0.001), primarily due to increased age(p<0.001), blood pressure(p=0.002) and total cholesterol(p=0.003). TMAO(β=0.038) and GFR (β=-0.02) were independent predictors for predicted 10-year CVe risk on multivariable-analysis. Increased TMAO was an early and sustained finding maintained through 5 years, unlike IS, PCS and eGFR. On multivariable analysis, increased pre-PN TMAO(OR=2.79) and decreased RPVP(OR=3.23) were identified as independent risk factors for higher post-PN TMAO, while ischemia type/duration failed to correlate. Uremic toxin levels increased after PN correlating with reduced GFR. Higher TMAO independently associated with greater predicted 10-year CVe risk. Parenchymal mass preserved rather than ischemia time or type associated with increased TMAO.

External validation of the ACC/AHA ASCVD risk score in a Colombian population cohort

No cardiovascular risk score has included Latin American patients in its development. The ACC/AHA ASCVD risk score has not been validated in Latin America; consequently, its predictive capacity in the population of the region is unknown. The aim of this study is to evaluate the discrimination capacity and calibration of the ACC/AHA ASCVD score to predict the 10-year risk of a cardiovascular event in a primary prevention cohort followed in a Colombian hospital. A retrospective cohort study was conducted in primary prevention patients belonging to an intermediate/high-risk and low-risk cohort without established atherosclerotic disease. Cardiovascular risk was calculated at inclusion. The calibration was analyzed by comparing observed and expected events in the different risk categories. A discrimination analysis was made using the area under the ROC curve and C statistic. A total of 918 patients were included—202 from the intermediate/high-risk and 716 from the low-risk cohort. The median cardiovascular risk was 3.6% (IQR 1.7–8.5%). At the 10-year follow-up, 40 events (4,4%) occurred. The area under the ROC curve was 0.782 (95% CI 0.71–0.85). The Hosmer–Lemeshow test did not show differences between expected and observed events. The ACC/AHA ASCVD score is calibrated and has good discrimination capacity in predicting 10-year risk of cardiovascular events in a Colombian population.

Daily profile of arterial and central aortic pressure in patients with arterial hypertension and non-alcoholic fatty liver disease

Оbjective : to evaluate the features of daily monitoring of arterial and central aortic pressure in patients with arterial hypertension and non-alcoholic fatty liver disease. Materials and methods: a comparative cross-sectional study was conducted, which involved 120 patients (continuous sample, unorganized population), aged 45 to 65 years (mean age 56.2±8.8 years), including men (34 (28.3%) with AH stage I–II, 1–2 degree. The main group included 60 patients with hypertension and NAFLD, the control group included 60 patients with isolated hypertension. When examining patients, a clinical examination was carried out: taking an anamnesis, measuring "office" blood pressure, anthropometric parameters, calculating body mass index (BMI), WC. 24-hour monitoring of arterial (ABPM) and central aortic pressure (CAP) was assessed using the BPLab complex and Vasotens 24 software (LLC Petr Telegin, Russia). The SCORE scale was used to calculate total cardiovascular risk and 10-year fatal risk. Results : all patients of the study groups underwent ABPM. It was proved that in the patients of the main group, the IV SBP and IV DBP during the day and night significantly exceeded the similar parameters of patients in the comparison group (IV SBP: p=0.0019, p=0.007; IV DBP: p=0.009, p=0.009, respectively). One of the important criteria for assessing blood pressure was the determination of the degree of nighttime decrease in SBP and DBP — the daily index (SI), characterizing the balance in the work of the sympathetic and parasympathetic parts of the autonomic nervous system. In the main group, compared with the control group, there were more patients with SI DBP in the range from 0.0% to 10.0% (non-dipper) (p=0.034), with an increase in SBP at night (night-picker) (p=0.031). When assessing the parameters of CAP, in patients with AH and NAFLD, statistically significantly higher values of mean daily systolic (SADAo) and diastolic (DADo) aortic pressure were observed (p=0.016, p=0.039, respectively), SBP in the daytime (p=0.027), SADao and DADAO at night (p=0.002, p=0.003, respectively), compared with patients with isolated hypertension. Calculation of the risk of cardiovascular complications, in patients with hypertension and NAFLD, a significant increase in the 10-year risk of cardiovascular events was determined, compared with patients with isolated hypertension (3.7 (1.6; 6.0) vs 2.0 (0.6 ;4.3) %, p=0.013). Conclusion : according to the results of 24-hour BP monitoring, in patients with AH and NAFLD, compared with patients with isolated AH, a more significant increase in mean SBP and DBP, an increase in the rate of morning rise and BP variability, and the hypertension time index were revealed. In the main group, patients with a nocturnal increase in SBP were detected significantly more often, which indicates a greater risk of cardiovascular complications in patients with hypertension and NAFLD. In addition, compared with patients with isolated AH, patients with AH and NAFLD showed more significant increases in average daily and nighttime SBPao and DADAO.

Recalibration of the Framingham risk score for predicting 10-year risk of cardiovascular events: A non-concurrent rural cohort study from Tamil Nadu

ObjectiveTo recalibrate the Framingham Risk Score-cardiovascular diseases (FRS-CVD) using 10-year mortality data and baseline risk factor data for a rural cohort and assess the effect of recalibration on proportion categorised as high risk. MethodsParticipants of a cardiovascular risk factor survey aged 30–64 years in 2011–12, from 9 villages of a rural block in Vellore, Tamil Nadu, were followed up for mortality till 2021, as part of an established demographic surveillance system. We calculated both lipid-based and Body Mass Index-based FRS-CVD risk scores, as well as recalibrated scores using risk factor data from the baseline survey and CVD mortality observed over 10 years. ResultsBased on original lipid-based FRS-CVD scores, 8.48% (109) of 1285 males had a 10-year CVD risk ≥30%, compared to 11.60% (149) with recalibrated scores. Among 1737 females, 1.50% (26) had a 10-year CVD risk of ≥30%, using original FRS-CVD scores, and 3.22% (56) using recalibrated scores. Similarly, for BMI based FRS-CVD scores, overall, 3.63% (110/3028) had a 10-year risk of ≥30%, compared to 6.64% (201) using recalibrated scores.The median 10-year FRS-CVD original score in males was 7.57 (IQR: 3.67–15.83), and 2.53 (IQR: 1.28–5.32) in females, compared to 8.95 (IQR: 4.35–18.52) and 3.79 (IQR: 1.92–7.93) respectively, for the recalibrated FRS-CVD risk scores. ConclusionThe recalibrated Framingham models showed a greater proportion of the population at risk of CVDs compared to the original FRS scores, with males having 2–3 times greater CVD risk scores compared to females.

Association of thyroid function, within the euthyroid range, with cardiovascular risk: The EPIPorto study.

Thyroid hormones are important modulators of cardiovascular function. Both hypothyroidism and hyperthyroidism are known to contribute to an increased cardiovascular risk. It remains uncertain whether thyroid hormones level within the euthyroid range are associated with cardiometabolic risk. We aimed to evaluate the association between thyroid function levels within the euthyroid range and cardiovascular risk in a population-based cohort. Eight hundred thirty-five subjects aged ≥45 years from the EPIPorto population-based cohort were included. We excluded participants with TSH, free T4 (FT4), or free T3 (FT3) outside of the reference range, or with previous cardiovascular or thyroid disease. The associations between thyroid function, cardiovascular risk factors and the 10-year estimated risk of cardiovascular events (using SCORE2 and SCORE2-OP) were evaluated in linear and logistic regression models, crudely and adjusting for age, sex, BMI, diabetes, and smoking. The mean age of the participants was 61.5 (SD 10.5) years and 38.9% were men. Eleven percent of the participants had diabetes, 47.8% had dyslipidemia, and 54.8% had hypertension. The mean body mass index (BMI) was 27.4 (SD 4.6) kg/m2, and the median (percentile25-75) 10-year risk of cardiovascular events was 5.46% (2.92, 10.11). Participants with higher BMI, larger waist circumference and higher hs-CRP had higher levels of FT3 and FT3/FT4 ratio. Lower FT3/FT4 ratio and higher FT4 levels were associated with higher prevalence of diabetes and more adverse lipid profile. Higher TSH, lower FT3 and lower FT3/FT4 ratio were associated with lower eGFR. Lower FT3, lower FT3/FT4 ratio and higher FT4 were associated with an increased 10-year risk of cardiovascular events. In a population-based study, variations of thyroid function within the euthyroid range were associated with cardiovascular risk factors. On one hand, individuals with higher BMI, larger waist circumference and higher hs-CRP had higher levels of FT3 and FT3/FT4 ratio. On the other hand, a decreased conversion of T4 to T3 (lower FT3, lower FT3/FT4 ratio and/or higher FT4) was associated with a higher prevalence of diabetes, a more adverse lipid profile, a lower eGFR and an increased 10-year risk of cardiovascular events.

Low-grade albuminuria and its relationship with cardiovascular disease risk in hypertensive and diabetic patients in primary health care

ObjectiveTo evaluate the presence of LGA and the relationship with the 10-year risk of a cardiovascular event in hypertensive and diabetic patients in Primary Health Care.Study designThe study design used is cross-sectional.MethodsThis study was based on the application of questionnaires, anthropometric measurements, and laboratory tests carried out from August 2017 to April 2018. Logistic regression was used to evaluate the odds ratio of the explanatory variables in relation to the highest tercile of LGA. The Framingham risk score was used to assess the 10-year risk of cardiovascular event. The comparison of this score with the LGA terciles was analyzed using ANOVA.ResultsAn increase in the 10-year risk of cardiovascular event score was observed with an increasing LGA tercile, and this pattern prevailed after adjusting for confounding variables.ConclusionAn association between LGA and the 10-year risk of cardiovascular event was observed in a representative sample of hypertensive and diabetic patients.

The Multi-Ethnic Study of Atherosclerosis-Calcium Score Improves Statin Treatment Allocation in Asymptomatic Adults.

BackgroundThe current categorization of cardiovascular (CV) risk broadens the indications for statin therapy. Coronary artery calcium (CAC) identifies those who are most likely to benefit from primary prevention with statin therapy. The multi-ethnic study of atherosclerosis-calcium (MESA-C) includes CAC for CV risk stratification.ObjectiveWe aimed to establish whether the MESA-C score improves allocation to statin treatment in a cohort of asymptomatic adults. We also analyzed patient survival according to their risk score calculation.DesignA retrospective analysis of asymptomatic adults.ParticipantsA total of 632 consecutive subjects free of coronary artery disease (CAD) and/or stroke, mean age 56 ± 7 years, 84% male, underwent clinical evaluations and CAC measurements.Main MeasuresPCE and MESA-C risk scores were calculated for each subject. According to the 10-year risk for CV events, subjects were classified into moderate and high CV risk (≥7.5%) for whom a statin is clearly indicated, or borderline and low CV risk (<7.5%).Key ResultsDuring mean follow-up of 6.5 ± 3.3 years, 52 subjects experienced their first CV event. Those with a MESA-C risk score < 7.5% had favorable outcomes even when the PCE indicated a risk of ≥ 7.5%. The MESA-C score improved the discrimination of CV risk with the ROC curves C-statistics increasing from 0.653 for the PCE to 0.770 for the MESA-C. Of those, 84% (99/118) with borderline CV risk (5–7.5%) according to the PCE score, were reallocated by the MESA-C score into a higher (≥7.5%) or lower (<5%) CV risk category. Furthermore, subjects with low MESA-C scores had the highest survival rate regardless of the PCE risk, while those with high MESA-C risks had the lowest survival rate regardless of the PCE risk.ConclusionIn asymptomatic subjects, the MESA-C score improves allocation to statin treatment and CV risk discrimination, while both scores are essential for more precise survival estimations.

C-reactive protein and 10-year cardiovascular risk in rheumatoid arthritis

ObjectivesTo evaluate the association between C-reactive protein (CRP) and 10-year risk of cardiovascular (CV) events using the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA), based on conventional and RA-specific risk factors but not CRP, in RA patients without previous cardiovascular events. MethodsERS-RA was calculated in 1,251 “Cardiovascular Obesity and Rheumatic Disease Study (CORDIS)” database patients [(age 60.4(9.3) years; 78% female; disease duration, 11.6(8) years; CDAI, 9(9); CRP, 6.8(12) mg/L]. ResultsThe mean (SD) 10-year risk of CV events was 12.9% (10). After adjusting for the use of DMARDs and biologics, CRP concentrations were significantly associated with 10-year risk of CV events (coefficient=0.005 for each 10 mg/L CRP increment; 95%CI 0.000–0.111; p = 0.047). In mediation analysis, the association between CRP and ERS-RA was not explained by disease activity. ConclusionIn a large cohort of RA patients without previous cardiovascular events, a 20 mg/L increase in CRP concentrations was associated with a 1% increase in 10-year risk of CV events. This suggests that actively targeting residual inflammatory risk beyond conventional and RA-specific risk factors might further reduce CV event rates in RA patients.

Cardiovascular risk assessment based on SCORE and SCORE2

Introduction: The 2021 European Society of Cardiology (ESC) guidelines on cardiovascular disease prevention introduced significant changes compared to the previous 2016 edition. Particular attention should be paid to the stepwise approach to treating patients with cardiovascular risk factors, based on individual risk stratification. The SCORE scale previously recommended for risk assessment and its Polish adaptation Pol-SCORE have been replaced by SCORE2 and SCORE2-OP in the latest guidelines. The aim of the study: The aim of this study is a parallel cardiovascular risk assessment with Pol-SCORE and SCORE2 in the same patient population. Material and methods: The study included 159 patients aged 40 to 70 years without prior cardiovascular events that were diagnosed with hypertension or hypercholesterolemia between 6 and 24 months before the start of the study. Patients with diabetes mellitus, chronic kidney disease, and familial hypercholesterolemia were excluded from the study. Results: The 10-year risk of cardiovascular event (SCORE2) was twice as high as the risk of cardiovascular death (Pol-SCORE). In the Pol-SCORE scale, most patients were at moderate risk (65.41%), while based in the SCORE2 scale the dominant group was in the low-to-moderate risk category (49.06%). Among the patients with moderate risk of cardiovascular death (Pol-SCORE), low-to-moderate, high, and very high CVD risk groups (SCORE2) were reported. In other cases, the risk assessments of cardiovascular death and cardiovascular event appear to be consistent. This observation is confirmed by the strong positive correlation (R = 0.7493; p &lt; 0.0001) between the Pol-SCORE and SCORE2 scales. Conclusions: Cardiovascular risk assessments based on the SCORE and SCORE2 scales are broadly consistent, but in individual cases, the results fall into radically different risk categories.

Cardiovascular disease risk assessment in a rural population (&gt;40 years)

Context: Cardiovascular diseases (CVDs) are the most common cause of death worldwide, although low- and middle-income countries are affected disproportionately. By 2020, it is estimated that there will be around 25 million deaths from Cardiovascular diseases globally,and out of that 19 million would be from middle- and low-income countries. Aims: The aim of this study was to estimate the 10-year risk of cardiovascular events among adults aged ≥40 years in a rural population of Meerut district using the World Health Organization (WHO)/International Society of Hypertension (ISH) risk prediction charts for SEAR-D region. Community based cross-sectional study, which was conducted from january 2021 to december 2021, in the rural areas of Meerut district. Methods and Material: Study was conducted on 397 subjects who were aged ≥40 years. Two sets of the WHO/ISH risk prediction charts, with and without cholesterol, for WHO SEAR-D region were used in this study. Statistical analysis used: SPSS, version 23 was used for data analysis. Results: By using the risk assessment tools, with and without cholesterol, 78.5 and 76.8%, of the population being studied were in the 10-year cardiovascular risk category with &lt;10% risk, whereas 11.2 and 10.4%, were in the cardiovascular risk category of ≥20% risk.

Estimated cardiovascular benefits of bempedoic acid in patients with established cardiovascular disease

Background and aimsCardiovascular outcomes trials have demonstrated that lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk for future cardiovascular events. We assessed the potential cardiovascular benefits of bempedoic acid through a simulation study in patients with atherosclerotic cardiovascular disease (ASCVD) and elevated LDL-C. MethodsThe validated SMART prediction model was used to estimate the baseline 10-year risk of three-point major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke) in patients with ASCVD who were enrolled in four Phase 3, randomized, placebo-controlled bempedoic acid studies. The predicted change in 10-year cardiovascular risk associated with bempedoic acid was estimated for each patient based on the Cholesterol Treatment Trialists’ model. Data were analyzed in two cohorts: Cohort 1 included mostly patients treated with moderate-high intensity statins, and Cohort 2 included patients who were intolerant of more than low-intensity statin. ResultsA total of 2884 patients were included in Cohort 1 and 226 in Cohort 2. Weighted average baseline 10-year cardiovascular event risk was 26.1% and 31.6% for Cohorts 1 and 2, respectively. The least squares mean percent difference (95% confidence interval (CI) of the predicted absolute change in 10-year cardiovascular event risk with bempedoic acid was −3.3% (−3.7% to −2.9%) for patients in Cohort 1 and -6.0% (−7.7% to −4.3%) for patients in Cohort 2 compared with placebo (p < 0.0001 for both). ConclusionsAmong patients with ASCVD who could potentially benefit from additional LDL-C lowering, our simulation predicted a lower absolute cardiovascular event risk after initiating bempedoic acid as compared with placebo.

Insomnia disorders are associated with increased cardiometabolic disturbances and death risks from cardiovascular diseases in psychiatric patients treated with weight-gain-inducing psychotropic drugs: results from a Swiss cohort

Study objectivesInsomnia disorders as well as cardiometabolic disorders are highly prevalent in the psychiatric population compared to the general population. We aimed to investigate their association and evolution over time in a Swiss psychiatric cohort.MethodsData for 2861 patients (8954 observations) were obtained from two prospective cohorts (PsyMetab and PsyClin) with metabolic parameters monitored routinely during psychotropic treatment. Insomnia disorders were based on the presence of ICD-10 “F51.0" diagnosis (non-organic insomnia), the prescription of sedatives before bedtime or the discharge letter. Metabolic syndrome was defined using the International Diabetes Federation definition, while the 10-year risk of cardiovascular event or death was assessed using the Framingham Risk Score and the Systematic Coronary Risk Estimation, respectively.ResultsInsomnia disorders were observed in 30% of the cohort, who were older, predominantly female, used more psychotropic drugs carrying risk of high weight gain (olanzapine, clozapine, valproate) and were more prone to suffer from schizoaffective or bipolar disorders. Multivariate analyses showed that patients with high body mass index (OR = 2.02, 95%CI [1.51–2.72] for each ten-kg/m2 increase), central obesity (OR = 2.20, [1.63–2.96]), hypertension (OR = 1.86, [1.23–2.81]), hyperglycemia (OR = 3.70, [2.16–6.33]), high density lipoprotein hypocholesterolemia in women (OR = 1.51, [1.17–1.95]), metabolic syndrome (OR = 1.84, [1.16–2.92]) and higher 10-year risk of death from cardiovascular diseases (OR = 1.34, [1.17–1.53]) were more likely to have insomnia disorders. Time and insomnia disorders were associated with a deterioration of cardiometabolic parameters.ConclusionsInsomnia disorders are significantly associated with metabolic worsening and risk of death from cardiovascular diseases in psychiatric patients.