10-year Risk Of Fatal Cardiovascular Disease Research Articles

Metabolic syndrome and the 10-year cardiovascular disease risk in urban public transport drivers in the context of occupational risks and workloads

The specific risks and workloads of urban public transport drivers create a net for the development of several health issues. It is worth mentioning the impact of the work regime on this type of workers’ metabolic and cardiovascular health. This paper represents a sequence from an ample study that has followed the effects of this professional activity on worker’s health and work capacity and has established prevention / reduction of identified risk factors measures. The health state analysis was realized through a prevalence study on three cohorts (bus, tram, trolleybus drivers). The prevalence of metabolic syndrome was the highest in the group of the bus drivers, 16.7%. The 10-year fatal cardiovascular disease risk in both the increased risk category and very increased risk category was the highest in the trolleybus drivers’ cohort, 29%, respectively 6%. Major contributing pathology, such as hypertension and type II diabetes, starts in the 36-45 years of age group regardless of gender in all three cohorts signalizing an early wear and is already important in the 46-55 years of age group.

Estimates of 10-year risk of cardiovascular death and adherence to cardiovascular risk factor management in Danish patients investigated for obstructive sleep apnea

ObjectiveObstructive sleep apnea (OSA) increases the risk of cardiovascular disease (CVD) in both morbidity and mortality. We used the risk chart of Systemic Coronary Risk Evaluation (SCORE) from European Society of Cardiology (ESC) to determine the 10-year risk of cardiovascular death, and adherence to cardiovascular risk factor management in Danish patients investigated for obstructive sleep apnea. Research design and methodsIn a prospective cohort study, 303 patients with mild, moderate and severe OSA were investigated for cardiovascular risk factors before initiating CPAP therapy. Primary outcome was estimates of 10-year risk of cardiovascular death assessed from the ESC risk chart SCORE based on sex, age, smoking status, systolic blood pressure and s-total cholesterol. Furthermore we analyzed treatment indication with statins in patients with mild (apnea-hypopnea index, AHI <15), moderate (AHI 15–29.9) and severe OSA (AHI ≥30). ResultsPatients with mild OSA predominately had low or moderate 10-year risk of CVD (low risk 55.4%, moderate risk 30.8%) while patients with moderate and severe OSA were more likely to have high or very high risk of 10-year CVD (p = 0.001). The large majority of included OSA patients had dyslipidemia, 235 (77.6%) and of those, only 27.4% were treated with cholesterol lowering drugs while additional 27.7% were eligible for oral statin supplement as risk-estimated by the ESC SCORE. In multiple regression analysis among statin naive patients, AHI was positively associated with statin eligibility when adjusted for age and sex. ConclusionPatients with moderate and severe OSA had an elevated 10-year risk of fatal CVD and were undertreated with CVD risk lowering agents such as statins.

Effectiveness of letters to patients with or without Cochrane blogshots on 10-year cardiovascular risk change among women in menopausal transition: 6-month three-arm randomized controlled trial

BackgroundHealth information and patient education on lifestyle changes may have a positive effect on the prevention of many chronic conditions, especially cardiovascular diseases (CVDs). We performed a parallel, three-arm randomized controlled trial (RCT) of 6-month educational intervention in a form of letters containing a reminder of the participant’s CVD risk with or without Cochrane blogshots to reduce CVD risk among women aged 45–65 with one or more known CVD risk factors.MethodsThe control group received a letter about their CVD risk at the beginning of the trial. The intervention groups received the initial letter about their CVD risk and remainder letters about their CVD risk every 2 months, with or without Cochrane blogshots: (1) effect of calcium in the prevention of high blood pressure, (2) effect of reducing saturated fat acids in eating habits, and (3) effects of green and black tea in CVD prevention. The primary outcome was CVD risk reduction calculated as the difference between the baseline and 6-month score for a 10-year risk of fatal CVD according to the ACC/AHA guidelines.ResultsAfter both interventions, CVD risk reduction was significantly higher compared to the control group (P < 0.001, Kruskal-Wallis H test). The number of participants who decreased their CV risk was 29% (20/70) in the control group, 69% (48/70) in the group receiving the reminder letters, and 70% (49/70) in the group receiving the reminder letters and blogshots. The number needed to treat to achieve risk reduction was 2.41 (95% CI = 1.77 to 3.78) for letters with a CVD risk reminder and 2.50 (1.81 to 4.03) for letters with a reminder and a blogshot. The group receiving reminder letters with Cochrane blogshots had a significant change in the category of CVD risk, mainly from high to moderate and from moderate to low CVD risk category.ConclusionsA simple and inexpensive intervention method in a form of letters reminding women about their CVD risk with or without providing additional health information in the form of Cochrane blogshots about interventions for important CVD risk factors may be effective in CVD management and could be considered by primary care providers.Trial registrationClinicalTrials.gov, NCT04601558. Retrospectively registered on October 19, 2020

The Ten-Year Risk Prediction for Cardiovascular Disease for Malaysian Adults Using the Laboratory-Based and Office-Based (Globorisk) Prediction Model.

Background and Objectives: Globorisk is a well-validated risk prediction model that predicts cardiovascular disease (CVD) in the national population of all countries. We aim to apply the Globorisk calculator and provide the overall, sex-specific, ethnic-specific, region-specific, and state-specific 10-year risk for CVD among Malaysian adults. Materials and Methods: Using Malaysia’s risk factor levels and CVD event rates, we calculated the laboratory-based and office-based risk scores to predict the 10-year risk for fatal CVD and fatal plus non-fatal CVD for the Malaysian adult population. We analysed data from 8253 participants from the 2015 nationwide Malaysian National Health and Morbidity Survey (NHMS 2015). The average risk for the 10-year fatal and fatal plus non-fatal CVD was calculated, and participants were further grouped into four categories: low risk (<10% risk for CVD), high risk A (≥10%), high risk B (≥20%), and high risk C (≥30%). Results: Results were reported for all participants and were then stratified by sex, ethnicity, region, and state. The average risks for laboratory-based fatal CVD, laboratory-based fatal plus non-fatal CVD, and office-based fatal plus non-fatal CVD were 0.07 (SD = 0.10), 0.14 (SD = 0.12), and 0.11 (SD = 0.09), respectively. Conclusions: There were substantial differences in terms of the sex-, ethnicity- and state-specific Globorisk risk scores obtained.

Salusin-β in patients with subclinical hypothyroidism and low to moderate cardiovascular disease risk

Abstract :BACKGROUND AND OBJECTIVES: Because Subclinical hypothyroidism may be a risk factor for cardiovascular disease, we aimed to measure the level of salusin-β which is a new biomarker for predicting atherosclerotic cardiovascular diseases (CVD) in those patients.PATIENTS AND METHODS: 57 subclinical hypothyroid patients were compared with a control group of 60 euthyroid subjects whose age and sex were matched to the patient group. Both groups have low to moderate 10-year risk of fatal CVD. We studied the serum level of salusin-β in the selected group of SC hypothyroid patients to find out if it can be used as an indicator of the cardiovascular adverse effects in them. We also studied the association between salusin-β levels and TSH level, thyroid Ab, and individual’s risk of CVD.RESULTS: Salusin-β was higher in the SC hypothyroidism group with a significant difference (p = 0.001). TSH, FT4, diastolic BP and triglycerides showed a significant difference between the two groups. Systolic BP, total cholesterol, smoking, and SCORE showed no significant difference between the two groups. There was a highly +ve correlation with TSH level in the SC hypothyroid group.Conclusion:The elevated salusin-𝛽 level supports the opinion that SC hypothyroidism has a cardiovascular risk and can support treatment of these cases whose TSH < 10 mIU/l.KEYWORDS: salusin-β, Subclinical hypothyroidism, cardiovascular disease risk.

Correlation of vascular risk age with pulse wave velocity in young patients with low absolute cardiovascular risk.

The systematic coronary risk evaluation (SCORE) estimates the 10-year risk of fatal cardiovascular disease (CVD), and its application is recommended. The absolute risk of CVD, independent of risk factors, is relatively low in young individuals. Expressing the risk as their "risk age" may aid in understanding the risk. This study aimed to demonstrate a possible correlation between vascular risk age, SCORE risk value, and the level of subclinical atherosclerosis evaluated using a pulse wave velocity (PWV) device. This work was designed to be a cross-sectional study. The SCORE 10-year fatal CVD risk and vascular risk age were calculated for patients below the age of 50 years and without any previous diagnosis of atherosclerotic disease or equivalents. The PWV of each patient was measured non-invasively using a PWV device. The study population included a total of 300 patients with a mean age of 35.1±9.5 years. The mean PWV and mean vascular age of the entire study population were 6.3±1.3 m/s and 44.3±5.5 years, respectively, and the median 10-year risk of fatal CVD score was 0.4 (0.04-2.74). There was a positive correlation between PWV and the 10-year risk of fatal CVD (r=0.613; P<0.001) and vascular risk age (r=0.684; P<0.001). Despite their young age and low to moderate 10-year risk of fatal CVD (<1%-5%) according to the SCORE chart, patients with a high vascular risk age were found to have high PWV values. These results show that calculations of vascular risk age might be used to assess the risk of fatal CVD in young patients and correlate with subclinical atherosclerosis.

Global brain glucose uptake on 18F-FDG-PET/CT is influenced by chronic cardiovascular risk.

The goal of this study was to assess global cerebral glucose uptake in subjects with known cardiovascular risk factors by employing a quantitative 18F-fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT) technique. We hypothesized that at-risk subjects would demonstrate decreased global brain glucose uptake compared to healthy controls. We compared 35 healthy male controls and 14 male subjects at increased risk for cardiovascular disease (CVD) as assessed by the systematic coronary risk evaluation (SCORE) tool. All subjects were grouped into two age-matched cohorts: younger (<50 years) and older (≥50 years). The global standardized uptake value mean (Avg SUVmean) was measured by mapping regions of interest of the entire brain across the supratentorial structures and cerebellum. Wilcoxon's rank-sum test was used to assess the differences in Avg SUVmean between controls and at-risk subjects. Younger subjects demonstrated higher brain Avg SUVmean than older subjects. In addition, in both age strata, the 10-year risk for fatal CVD according to the SCORE tool was significantly greater in the at-risk groups than in healthy controls (younger: P = 0.0304; older: P = 0.0436). In the younger cohort, at-risk subjects demonstrated significantly lower brain Avg SUVmean than healthy controls (P = 0.0355). In the older cohort, at-risk subjects similarly had lower Avg SUVmean than controls (P = 0.0343). Global brain glucose uptake appears to be influenced by chronic cardiovascular risk factors. Therefore, FDG-PET/CT may play a role in determining the importance of CVD on brain function and has potential for monitoring the efficacy of various therapeutic interventions.

Proportion of High-Risk/Very High-Risk Patients in Europe with Low-Density Lipoprotein Cholesterol at Target According to European Guidelines: A Systematic Review.

ObjectiveAssess achievement of low-density lipoprotein cholesterol (LDL-C) targets in European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines.DesignSystematic literature review.Data SourcesMedline, EMBASE, Cumulated Index to Nursing and Allied Health Literature.Eligibility CriteriaObservational studies reporting LDL-C levels/target attainment, measured between 1 August 2006 to 31 August 2017, in European adults with established cardiovascular disease (CVD), diabetes with target organ damage, familial hypercholesterolaemia (FH) or 10-year risk of fatal CVD ≥ 5% (assessed by Systematic Coronary Risk Evaluation [SCORE]).Data Extraction and SynthesisTwo reviewers independently extracted relevant studies and assessed study quality using the Risk of Bias for Non-Randomised Studies–Interventions (ROBINS-I) tool. Primary outcome was the proportion of patients achieving LDL-C targets in the 2011/2016 ESC/EAS guidelines. Where available, patient characteristics were presented as means weighted by sample size. The proportions of patients achieving LDL-C targets in the 5 years before and after publication of the 2011 guidelines were compared using a chi-square test.ResultsAcross 81 eligible studies (303,534 patients), achievement of LDL-C < 1.8 mmol/L was poor among patients with established CVD (16%; range 9–56%) and at very high risk of CVD (SCORE ≥ 10% [18%; 14–25%]). In individuals with FH, SCORE 5–10%, or diabetes and target organ damage, LDL-C < 2.5 mmol/L was achieved by 15% (9–22%), 46% (21–55%) and 13% (6–34%), respectively. Comparing the 5 years before/after publication of the 2011 guidelines, target achievement increased significantly over time but remained suboptimal (LDL-C < 1.8, 22% versus 15%; LDL-C < 2.5, 68% versus 61%; both p < 0.001; established CVD group only).ConclusionsThese data show suboptimal LDL-C control among European patients at high risk of CVD. Those at greatest overall risk (clinically established CVD or at least a 10% 10-year risk of fatal CVD) had the lowest achievement of 2011/2016 EAS/ESC LDL-C targets. With lower LDL-C targets advocated in 2019 ESC/EAS guidelines, this unmet need will increase.Protocol RegistrationPROSPERO registration number; CRD77844Electronic supplementary materialThe online version of this article (10.1007/s12325-020-01285-2) contains supplementary material, which is available to authorized users.

Time course of changes in lipid profile measures in patients with early psoriatic arthritis during adalimumab therapy

Patients with psoriatic arthritis (PsA) have a higher risk of cardiovascular disease (CVD) compared with the general population. Inflammation and traditional CVD risk factors (RFs), including dyslipidemia, make a significant contribution to the development of CVD and their complications in patients with PsA. Objective: to assess the time course of changes in lipid profile measures in patients with early PsA (ePsA) during adalimumab (ADA) treatment for 3-months. Subjects and methods. The investigation enrolled 16 patients (11 women, 5 men; median (Me) age, 45.5 years) with early PsA (ePsA) (disease duration, 7.7 months). ADA was administered subcutaneously at doses of 40 mg once every 2 weeks for 3 months. Before and 3 months after the start of ADA therapy, DAS, C-reactive protein levels, and traditional CVD RFs, including lipid profile measures (total cholesterol, TC, low-density lipoprotein cholesterol, LDL-C, triglycerides, TG, high-density lipoprotein cholesterol, HDL-C, and atherogenic coefficient, AC) were estimated. Ten-year risk for fatal CVD was assessed using the SCORE scale. Results and discussion. Lipid profile disorders mainly associated with elevated LDL-C levels were revealed in 11 (69%) patients; according to the SCORE scale, the total 10-year risk for fatal CVD was low and moderate in 10 (62.5%) and 6 (37.5%) patients, respectively. A correlation was found between the baseline DAS and TG (r=0.53; p 0.05). Conclusion. Lipid profile changes were found in 69% of patients with ePSA and correlated with disease activity. The lower inflammatory activity during ADA therapy was accompanied by elevated TC and TG levels.

Wiek naczyń — u kogo i jak go oceniać? Czy możemy „odmłodzić” naczynia naszych pacjentów?

Total cardiovascular risk assessment plays a key role in the prevention of cardiovascular disease (CVD). It facilitates identification of patients with increased CVD risk and allows to plan appropriate actions to reduce or eliminate risk factors. The SCORE chart is a practical tool for estimation of individual 10-year risk of fatal CVD. However, in young patients with risk factors, the absolute risk calculated with the SCORE chart may be low despite significantly elevated relative risk. In this group of patients, assessment of cardiovascular risk age (heart age, vascular age) may be useful for identification of individuals in whom intensive preventive measures should be implemented. These measures should focus on reducing existing risk factors, which in some patients might require the use of pharmacotherapy. Statins were proven to be effective in CVD risk reduction, including primary prevention. Statins significantly lower concentrations of low-density lipoproteins, which are crucial for the development of atherosclerosis. Moreover, beyond their cholesterol- -lowering properties, statins exert pleiotropic effects, leading to inhibition or even partial reversal of unfavorable changes within the vessel wall, and to a reduction of cardiovascular risk age.

Evaluation of cardiovascular risk in patients with rheumatoid arthritis

Introduction: Rheumatoid Arthritis (RA) and fibromyalgia (FM) are among the most prevalent rheumatic diseases in women causing significant functional and occupational disability [1]. FM main feature is diffuse and widespread musculoskeletal pain while RA is characterized by chronic inflammation, preferably of peripheral joints, which may lead to the appearance of deformities. In Portugal, RA affects between 0.8 to 1.5% of the population [1], mainly postmenopausal women, and cardiovascular diseases (CVD) have been identified as the main cause of death, in which the role of atherosclerosis is recognized as determinant. In clinical practice, according to the European League Against Rheumatism recommendations, the Systemic Coronary Risk Evaluation (SCORE) index is the best tool to quantify that risk in RA patients, having no specific guidelines for it [2]. SCORE index estimates the risk of an individual having the first fatal cardiovascular event within 10 years, whether would be a heart attack, stroke or other occlusive artery disease, including cardiac death. This work aimed to assess the 10-year CVD risk in patients with RA using the SCORE predictive index and its comparison with fibromyalgia patients. Material and methods: The sample was selected by convenience, including all female patients with RA and FM with recent data on blood lipid levels, assisted in outpatient or inpatient settings. Patients with clinical analysis performed for more than one year and/or patients with fibromyalgia and other associated rheumatic diseases of inflammatory nature were excluded. Several factors as age, rheumatic and other conditions, smoking habits, and type and frequency of physical activity were recorded. Blood pressure, anthropometric and body composition, analyzed with InBody 720, were used to calculate the high risk SCORE index. Data was studied using the rheumatic pathology as the dependent variable. Results: A total of 40 women, 24 with RA and 16 with FM, aged 33 to 89 were included. The mean age was 64 ± 11 years for RA patients and 60 ± 8 years for FM patients and the prevalence of comorbidities was similar in both groups (p > 0.05). The mean SCORE index value for RA patients was 2.5 ± 1.4 higher than the 1.7 ± 0.8 found for FM patients. By using the SCORE index, the subjects were divided into 3 risk categories and although the majority (80 %) was classified as of moderate risk, two patients (5%) were identified as at high risk of fatal cardiovascular event in 10 years. Discussion and conclusion: The application of the SCORE index showed a higher 10-year risk of fatal CVD for RA patients compared to FM patients although not significant.

Predicting 10-Year Risk of Fatal Cardiovascular Disease in Germany: An Update Based on the SCORE-Deutschland Risk Charts.

Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008–11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40–65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29% and the estimated proportion of high risk people (10-year risk > = 5%) by 50% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk.

A six question screen to facilitate primary cardiovascular disease prevention.

BackgroundEuropean guidelines on primary prevention of cardiovascular disease (CVD) recommend the SCORE risk charts for determining CVD risk, which include blood pressure and serum cholesterol as risk parameters. To facilitate cost-effective large-scale screening, we aimed to construct a risk score with ‘non-invasive’ parameters as a first screening step to identify persons at increased CVD risk requiring further risk assessment.MethodsWe used data of Dutch employees from 25 organisations participating in a health risk assessment between August 2007 and January 2013. Backward multivariate logistic regression analysis was employed to select non-invasive, independent predictors of high CVD risk, defined as the 10-year risk of fatal CVD of ≥5 % based on the SCORE formula. The total CVD risk score was calculated as the summed coefficients of the retained variables.ResultsData of 6189 male participants was used for the development and validation of the risk score. Age, tobacco use, history of hypertension, alcohol consumption, BMI, and waist circumference were independent predictors of high CVD risk. Ten-fold cross-validation resulted in an area under the curve of 0.95 (SE 0.01, 95 % confidence interval 0.94–0.96). A cut-off score ≥45 on the CVD risk score yielded a sensitivity of 0.93, and a specificity of 0.85.ConclusionsWe developed a simple, non-invasive risk score that accurately identifies persons at increased CVD risk according to the SCORE formula in a population of working men. The risk score enables a stepwise approach in large screening programmes, strongly reducing the number of persons that require full risk estimation including blood pressure and cholesterol measures.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-015-0131-0) contains supplementary material, which is available to authorized users.

The clinical performance of an office-based risk scoring system for fatal cardiovascular diseases in North-East of Iran.

BackgroundCardiovascular diseases (CVD) are becoming major causes of death in developing countries. Risk scoring systems for CVD are needed to prioritize allocation of limited resources. Most of these risk score algorithms have been based on a long array of risk factors including blood markers of lipids. However, risk scoring systems that solely use office-based data, not including laboratory markers, may be advantageous. In the current analysis, we validated the office-based Framingham risk scoring system in Iran.MethodsThe study used data from the Golestan Cohort in North-East of Iran. The following risk factors were used in the development of the risk scoring method: sex, age, body mass index, systolic blood pressure, hypertension treatment, current smoking, and diabetes. Cardiovascular risk functions for prediction of 10-year risk of fatal CVDs were developed.ResultsA total of 46,674 participants free of CVD at baseline were included. Predictive value of estimated risks was examined. The resulting Area Under the ROC Curve (AUC) was 0.774 (95% CI: 0.762-0.787) in all participants, 0.772 (95% CI: 0.753-0.791) in women, and 0.763 (95% CI: 0.747-0.779) in men. AUC was higher in urban areas (0.790, 95% CI: 0.766-0.815). The predicted and observed risks of fatal CVD were similar in women. However, in men, predicted probabilities were higher than observed.ConclusionThe AUC in the current study is comparable to results of previous studies while lipid profile was replaced by body mass index to develop an office-based scoring system. This scoring algorithm is capable of discriminating individuals at high risk versus low risk of fatal CVD.

Trends in Cardiovascular Disease Risk Factor Prevalence and Estimated 10-Year Cardiovascular Risk Scores in a Large Untreated French Urban Population: The CARVAR 92 Study.

BackgroundSurveys measuring effectiveness of public awareness campaigns in reducing cardiovascular disease (CVD) incidence have yielded equivocal findings. The aim of this study was to describe cardiovascular risk factors (CVRFs) changes over the years in an untreated population-based study.MethodsBetween 2007 and 2012, we conducted a screening campaign for CVRFs in men aged 40 to 65 yrs and women aged 50 to 70 yrs in the western suburbs of Paris. Data were complete for 20,324 participants of which 14,709 were untreated.ResultsThe prevalence trend over six years was statistically significant for hypertension in men from 25.9% in 2007 to 21.1% in 2012 (p=0.002) and from 23% in 2007 to 12.7% in 2012 in women (p<0.0001). The prevalence trend of tobacco smoking decreased from 38.6% to 27.7% in men (p=0.0001) and from 22.6% to 16.8% in women (p=0.113). The Framingham 10-year risk for CVD decreased from 13.3 ± 8.2 % in 2007 to 11.7 ± 9.0 % in 2012 in men and from 8.0 ± 4.1 % to 5.9 ± 3.4 % in women. The 10-year risk of fatal CVD based on the European Systematic COronary Risk Evaluation (SCORE) decreased in men and in women (p <0.0001).ConclusionsOver a 6-year period, several CVRFs have decreased in our screening campaign, leading to decrease in the 10-year risk for CVD and the 10-year risk of fatal CVD. Cardiologists should recognize the importance of community prevention programs and communication policies, particularly tobacco control and healthier diets to decrease the CVRFs in the general population.

Cardiovascular disease risk in adults with spastic bilateral cerebral palsy

To explore: (i) cardiovascular disease risk factors and the 10-year clustered risk of a fatal cardiovascular event in adults with spastic bilateral cerebral palsy; and (ii) relationships between the 10-year risk and body fat, aerobic fitness and physical activity. Cross-sectional study. Forty-three adults with spastic bilateral cerebral palsy without severe cognitive impairment (mean age 36.6 years (standard deviation 6); 27 men). Biological and lifestyle-related risk factors and the 10-year risk according to the Systematic Coronary Risk Evaluation (SCORE) were assessed. Relationships were studied using multivariable linear regression analysis. The following single risk factors were present: hypertension (n = 12), elevated total cholesterol (n = 3), low high-density lipoprotein cholesterol (n = 5; all men), high-risk waist circumference (n = 11), obesity (body mass index; n = 5; all men), reduced aerobic fitness (on average 80% of reference values), reduced level of everyday physical activity (on average 78% of reference values) and smoking (n=9). All participants had a 10-year risk <1%. Corrected for gender, participants with higher waist circumference (β = 0.28; p = 0.06) or body mass index (β=0.25; p = 0.08) tended to have a higher 10-year risk. In this relatively young adult sample of people with spastic bilateral cerebral palsy several single cardiovascular disease risk factors were present. The 10-year fatal cardiovascular disease risk was low, and higher body fat tended to be related to higher 10-year risk.

Belgian global implementation of cardiovascular and stroke risk assessment study: methods and baseline data of the BELGICA-STROKE STUDY

BELGICA-STROKE is a longitudinal study to enhance the use of online cardiovascular risk prediction scores based on the SCORE 10-year risk estimates for fatal cardiovascular disease (adapted for Belgium) and the Framingham 10-year stroke risk and to evaluate their impact on the cardiovascular risk profile of hypertensive patients. Methods and baseline characteristics are described here. Prospective, multicenter study in primary care. General practitioners (N = 810) recruited consecutive hypertensive patients aged >40 years who were not at blood pressure goal and assessed them every 4 months. The estimated 10-year risks for fatal cardiovascular disease and stroke were available on a secured, specially designed study website. The calculated risk profile of a patient was modifiable by adding treatment goals in order to increase awareness and motivation of both physician and patient. An automated feedback on goal-level attainment and both cardiovascular risk scores was provided. Mean age of the 15,744 patients was 66.3 years: 51.9% were men, 77.8% had excess weight, 19.4% were smokers, and 25.9% had diabetes. Left ventricle hypertrophy was present in 20.0%, atrial fibrillation in 5.8%. Mean blood pressure was 153.8/88.2 mmHg, mean cholesterol 211.5 mg/dl. Most patients (89.2%) received antihypertensive medication, of which 36.9% was monotherapy. Mean estimated 10-year stroke risk was 19.1%, and mean estimated 10-year fatal cardiovascular disease risk 5.9%. The 10-year estimated stroke and fatal cardiovascular disease risks were moderate to high in hypertensive patients not at goal blood pressure, emphasizing the importance of global cardiovascular risk factor assessment.

Obesity markers and estimated 10-year fatal cardiovascular risk in Switzerland

Background and aim There is an ongoing debate on which obesity marker better predicts cardiovascular disease (CVD). In this study, the relationships between obesity markers and high (>5%) 10-year risk of fatal CVD were assessed. Methods and results A cross-sectional study was conducted including 3047 women and 2689 men aged 35–75 years. Body fat percentage was assessed by tetrapolar bioimpedance. CVD risk was assessed using the SCORE risk function and gender- and age-specific cut points for body fat were derived. The diagnostic accuracy of each obesity marker was evaluated through receiver operating characteristics (ROC) analysis. In men, body fat presented a higher correlation ( r = 0.31) with 10-year CVD risk than waist/hip ratio (WHR, r = 0.22), waist ( r = 0.22) or BMI ( r = 0.19); the corresponding values in women were 0.18, 0.15, 0.11 and 0.05, respectively (all p < 0.05). In both genders, body fat showed the highest area under the ROC curve (AUC): in men, the AUC (95% confidence interval) were 76.0 (73.8–78.2), 67.3 (64.6–69.9), 65.8 (63.1–68.5) and 60.6 (57.9–63.5) for body fat, WHR, waist and BMI, respectively. In women, the corresponding values were 72.3 (69.2–75.3), 66.6 (63.1–70.2), 64.1 (60.6–67.6) and 58.8 (55.2–62.4). The use of the body fat percentage criterion enabled the capture of three times more subjects with high CVD risk than the BMI criterion, and almost twice as much as the WHR criterion. Conclusion Obesity defined by body fat percentage is more related with 10-year risk of fatal CVD than obesity markers based on WHR, waist or BMI.

Evaluation of a recalibrated Systematic Coronary Risk Evaluation cardiovascular risk chart: results from Systematic Coronary Risk Evaluation Germany

A recalibrated cardiovascular disease (CVD) risk chart for the German population, Systematic Coronary Risk Evaluation (SCORE) Germany, was developed in 2005. We evaluated the risk prediction by SCORE Germany in two large population-based surveys. STUDY POPULATIONS AND METHODS: We applied the SCORE Germany risk function to men and women, aged 40-65 years, who participated in surveys of the Study of Health in Pomerania (SHIP), north-east Germany or the Cooperative Health Research in the Augsburg Region (KORA) study (southern Germany). The prevalence of single risk factor combinations and of the SCORE Germany risk prediction categories was assessed. The 10-year risk of fatal CVD predicted by SCORE Germany (P) was evaluated against the risk observed in the general population using official mortality data (O). Less than one in 25 women in the two studies had a high-predicted 10-year risk of fatal CVD (> or =5%), whereas one in three men in SHIP and about one in four men in KORA belonged to this risk group. The age-specific predicted risk of fatal CVD was consistently higher for men and women from SHIP than from KORA. On comparison, the P/O ratio of 10-year CVD risks was close to unity and tended to decline with higher age in the both studies. Overestimations of risks with the original SCORE model are reduced mostly with SCORE Germany. Differences in risk factors and CVD risk between populations within Germany are reflected properly by risk predictions with SCORE Germany. The recalibrated risk chart seems to be suited for use in German clinical practice.

Assessment of global cardiovascular risk and risk factors in Portugal according to the SCORE® model

Cardiovascular diseases (CVD) are the leading cause of mortality in European countries. This study aimed at estimating the 10-year risk of fatal CVD in Portuguese adults and to assess the prevalence of major cardiovascular risk factors, according to the SCORE® risk prediction system. A cross-sectional survey was carried out in 60 community pharmacies (CP) from October 2005 to January 2006 in a sample of CP users (≥40 and ≤65 years). Data were collected by patient interviews using a structured questionnaire applied by a trained pharmacist. A total of 1,043 individuals were enrolled in the study (participation rate: 91%). The mean age was 53.7 years (SD: 7.1) with a ratio men/women of 0.68. The average risk in the sample was 1.94 (minimum 0, maximum 28, SD =2.69). About 20% of the studied adults were at high risk, of which 39.4% were asymptomatic. CV risk was significantly higher in the oldest age group and in men (p < 0.05). The prevalence of main CV risk factors was: hypertension-54.8%; hypercholesterolemia-63.1%, diabetes-13.4%; smoking-10.4% and obesity–29.0%. About 1/3 of those asked had family history of premature CVD. Mean values of biochemical and clinical parameters were: systolic blood pressure (mmHg): 134.8 ± 19.7; diastolic blood pressure (mmHg): 81.0 ± 11.4; total cholesterol (mg/dl): 193.8 ± 34.6; body mass index (kg/m2): 28.0 ± 4.5. According to SCORE®, about one-fifth of the individuals was classified as high risk, and 7.7% was asymptomatic. CV risk was significantly higher in the oldest age group (55–65 years old) and in men (p < 0.05). These results show a high prevalence of some risk factors, particularly hypertension and hypercholesterolemia.