Cardiovascular Disease Risk Algorithms Research Articles

VEGF-A related SNPs: a cardiovascular context.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Currently, cardiovascular disease risk algorithms play a role in primary prevention. However, this is complicated by a lack of powerfully predictive biomarkers that could be observed in individuals before the onset of overt symptoms. A key potential biomarker for heart disease is the vascular endothelial growth factor (VEGF-A), a molecule that plays a pivotal role in blood vessel formation. This molecule has a complex biological role in the cardiovascular system due to the processes it influences, and its production is impacted by various CVD risk factors. Research in different populations has shown single nucleotide polymorphisms (SNPs) may affect circulating VEGF-A plasma levels, with some variants associated with the development of CVDs, as well as CVD risk factors. This minireview aims to give an overview of the VEGF family, and of the SNPs reported to influence VEGF-A levels, cardiovascular disease, and other risk factors used in CVD risk assessments.

The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk.

Framingham risk score (FRS), systematic coronary risk evaluation (SCORE), the 10-year atherosclerotic cardiovascular disease risk algorithm (ASCVD), and their modified risk scores are the most common cardiovascular risk scores. The aim of this case-control study was to evaluate the performance of cardiovascular risk scores in detecting carotid subclinical atherosclerosis (SCA) in patients with idiopathic inflammatory myopathies (IIMs). A total of 123 IIMs patients (71.5% female, mean age 50 ± 14 years) and 123 age- and gender-matched healthy controls were included in this study. Carotid SCA was more prevalent in IIMs patients compared with controls (77.2 vs 50.4%, P < 0.001). Moreover, patients with carotid SCA+ had older age, and all risk scores were significantly higher in IIMs patients with SCA+ compared to subjects with SCA- (all P < 0.001). According to FRS, SCORE, and ASCVD risk scores, 77.9, 96.8, and 66.7% patients with SCA+ were classified as low risk category, respectively. The modified scores also demonstrated a modest improvement in sensitivity. Notably, by adopting the optimal cutoff values, these risk scores had good discrimination on patients with SCA+, with area under curves of 0.802-0.893. In conclusion, all cardiovascular risk scores had a poor performance in identifying IIMs patients at high cardiovascular risk.

Risky business: a single-centre cross-sectional analysis of calculated cardiovascular risk in patients with primary aldosteronism and essential hypertension

ObjectivesPrimary aldosteronism (PA), the most common endocrine cause of hypertension, is associated with a higher risk of cardiovascular disease (CVD) than blood pressure (BP)-matched essential hypertension (EH). We aimed to...

Cardiovascular risk profile in patients with hepatic steatosis

Background. Fatty liver disease (FLD) is composed of a wide spectrum including metabolic associated fatty liver disease (MAFLD). Cardiovascular disease (CVD) is the leading cause of mortality in this populational group. Many risk estimation systems are in existence for improving the management of population groups, but currently, none of the available risk prediction models are authenticated in patients with hepatic steatosis. Materials and methods. Transversal, observational, prospective, case control study has been included 680 patients with MAFLD and 96 control subjects without MAFLD. Experimental group was divided in tree subgroups: A - overweight or obesity (BMI ≥ 25 kg/m2 ) N= 498; B – lean/normal weight (BMI &lt;25kg/m2 ) N= 58 and C – Type 2 diabetes mellitus N= 156. For each patient, cardiovascular risk was estimated using the Framingham equation (risk ≥ 20% – high), SCORE risk chat (risk ≥ 10% – high) and Atherosclerotic Cardiovascular Disease Risk Algorithm from the American College of Cardiology and the American Heart Association (AHA/ACC) (risk ≥ 20% – high). Results. Model Risk SCORE and Risk ACC/AHA had identified the low proportion of patients with high risk, however, Risk FRS determined the highest proportion of the patients as being ‘at high-risk’ (Risk SCORE -7% vs Risk ACC/AHA - 15% vs Risk FRS - 38%, p &lt;0.001). Statistically significant correlations were found between the scoring systems Risk FRS and Risk ACC/AHA (Pearson’s r = 0.939, p = 0.0001, Spearman`s rho=0.960, p &lt;0.001). The highest proportion of the patients as being ‘at high-risk’ from group C – DMT2 was found by model RiskFRS – 82.7%, with statistically significant difference between group A and B – 28.1 % vs 6.8%, p &lt; 0.001. The same tendency was observed for RiskSCORE and Risk ACC/AHA (RiskSCORE DMT2 – 26.3% vs Risk ACC/AHA DMT2 – 46.8%), bur these scores have identified the low proportion of patients with high risk in this populational group. Conclusions. The study shows that RiskFRS appeared to be most useful CVD risk assessment model in hepatic steatosis, RiskFRS is likely to identify a greater number of patients at ‘high-risk’ as compared to Risk SCORE and Risk ACC/AHA.

961Absolute cardiovascular disease risk scores and medication use in rural India

Abstract Background Low-to-middle-income countries (LMICs) have limited resources to tackle the burden of cardiovascular disease (CVD). Most screening guidelines recommend the use of absolute risk scoring to determine treatment, but there is uncertainty among policy makers and clinicians about which risk algorithm to choose. We aimed to compare laboratory-based absolute CVD risk algorithms in a LMIC setting. Methods The study was conducted in the Rishi Valley, Andhra Pradesh, India. Over 8,000 participants were surveyed between 2012-2015. The 10-year absolute risk was computed and compared using the Framingham, WHO, and Australian absolute risk CVD algorithms. Results In participants aged 35-74 years, 151 (3%) had prior CVD. In all algorithms, absolute CVD risk increased with age and was greater in men than women. Using the WHO algorithm 4% were characterized as high-risk while &amp;gt;29% were at high-risk using the Australian risk tool. Agreement of risk classification among men ranged from a high of 84% (Spearman’s rho (rs) =0.92) between Australian and Framingham algorithms to 43% (rs=0.6) between the Australian and WHO risk scores. Among the high-risk population, only 15% were on lipid-lowering or antihypertensive therapy. Conclusions The Framingham and Australian risk scores enable some discrimination between high- and low-risk groups. However, the WHO algorithm underestimates these high-risk groups. Even though one third of the participants were at high-risk, most of them were not receiving recommended treatment. Key messages Lab-based CVD risk assessment tools have the potential in identifying high-risk populations in LMICs but the WHO risk scoring tool should be used with caution.

976-P: Cardiovascular Risk Predicts Severe Respiratory Failure in Patients Hospitalized with COVID-19

Cardiometabolic disease is associated with mortality and requirement for ventilation in COVID-19. Symptomatic atherosclerotic cardiovascular disease (CVD) implies the presence of significant endothelial dysfunction and is a risk factor for severe COVID-19. However, many patients with no history of CVD exhibit severe COVID-19. We hypothesised that CVD risk calculators could serve as a proxy for significant endothelial dysfunction and predict COVID-19 outcomes in those without symptomatic CVD. We reviewed 230 patients aged 35 to 65 years, hospitalized with COVID-19 at our institution. 190 patients with no history of symptomatic CVD were included. 23% developed severe respiratory failure (RF, requiring mechanical or non-invasive ventilation), while 4% (7/164) of those without prior end-stage renal disease required renal replacement therapy (RRT). In univariate analysis, age (β = 0.057 ± 0.02, p= 0.02), BMI (β = 0.05 ± 0.03, p = 0.049) and T2DM (β = 0.81 ± 0.41, p = 0.048) predicted RF. In keeping with a link between insulin resistance and severe COVID-19, an association was observed between triglycerides and RF (β = 0.26 ± 0.14, P = 0.058). CVD risk indices QRISK3 (0.07 ± 0.02, P &amp;lt;0.001), a CVD Risk Algorithm that predicts the risk of a CV event in next 10 years, and CHADS2VASC (0.53 ± 0.20, P=0.01) were both associated with RF. Age and QRISK3 were associated with a requirement for RRT and length of stay. We observed a threshold effect for QRISK3: when 10 year risk of a CV event was &amp;gt; 5% the risk of RF markedly increased (OR: 6.86 (95% CI: 2.30 - 20.5, P&amp;lt;0.001). The risk of RF was similar across all strata of QRISK3 &amp;gt;5%. A similar trend was observed when analysis was limited to those with T2DM (Ventilatory support in T2DM: QRISK&amp;lt;5% - 0/8, QRISK&amp;gt;5%: 11/30). All cases of RRT occurred in those with QRISK &amp;gt;5%. CVD risk calculators predict severe COVID-19, supporting a role for subclinical CVD in severe COVID-19. Patients hospitalized with QRISK3 &amp;gt;5% may be candidates for early intervention and enhanced monitoring. Disclosure S. Lockhart: None. A. Sheikh: None. H. Griffiths: None. J. Calvo latorre: None. A. B. Daly: None. L. Sibal: None. Funding National Institute for Health Research

Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality: Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: The INTERPRESS-IPD Collaboration.

Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02-1.08) and 1.06 (95% CI, 1.02-1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01-1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00-1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01-1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06-1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal. Registration: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227.

Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement.

Cardiovascular disease (CVD) is a leading cause of preventable morbidity and mortality in Aboriginal and Torres Strait Islander peoples. This statement from the Australian Chronic Disease Prevention Alliance, the Royal Australian College of General Practitioners, the National Aboriginal Community Controlled Health Organisation and the Editorial Committee for Remote Primary Health Care Manuals communicates the latest consensus advice of guideline developers, aligning recommendations on the age to commence Aboriginal and Torres Strait Islander CVD risk assessment across three guidelines. MAIN RECOMMENDATIONS: In Aboriginal and Torres Strait Islander peoples without existing CVD: CVD risk factor screening should commence from the age of 18 years at the latest, including for blood glucose level or glycated haemoglobin, estimated glomerular filtration rate, serum lipids, urine albumin to creatinine ratio, and other risk factors such as blood pressure, history of familial hypercholesterolaemia, and smoking status. Individuals aged 18-29 years with the following clinical conditions are automatically conferred high CVD risk: ▶type 2 diabetes and microalbuminuria; ▶moderate to severe chronic kidney disease; ▶systolic blood pressure ≥180mmHg or diastolic blood pressure ≥110mmHg; ▶familial hypercholesterolaemia; or ▶serum total cholesterol >7.5mmol/L. Assessment using the National Vascular Disease Prevention Alliance absolute CVD risk algorithm should commence from the age of 30 years at the latest - consider upward adjustment of calculated CVD risk score, accounting for local guideline use, risk factor and CVD epidemiology, and clinical discretion. Assessment should occur as part of an annual health check or opportunistically. Subsequent review should be conducted according to level of risk. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: From age 18 years (at the latest), Aboriginal and Torres Strait Islander adults should undergo CVD risk factor screening, and from age 30 years (at the latest), they should undergo absolute CVD risk assessment using the NVDPA risk algorithm.

Computed tomography calcium scoring association and reclassification of clinical cardiovascular risk in asymptomatic Mexican patients.

Objectives:To establish tailored preventive treatment, we studied the ability of coronary artery calcium scoring to reclassify patients with intermediate cardiovascular risk and its association with additional risk factors in our Mexican preventive care center.Materials and methods:In this retrospective cohort study, we analyzed 520 asymptomatic patients from a Mexican primary prevention population between 2014 and 2018. Coronary artery calcium scoring, laboratory results, and anthropometric measurements (abdominal circumference and body mass index) were assessed. The Framingham risk score and American Heart Association/American College of Cardiology (AHA/ACC) atherosclerotic cardiovascular disease risk algorithm were calculated. Correlations between coronary artery calcium scoring, anthropometric measurements, and clinical cardiovascular risk scores were assessed. We assessed the ability of coronary artery calcium scoring to reclassify patients recommended for statin therapy compared with the cardiovascular risk scores.Results:Patients had a mean age of 67.5 years (SD ± 9.8) and 294 subjects (56.5%) were male. Coronary artery calcium scoring has a positive correlation with age, AHA/ACC atherosclerotic cardiovascular disease risk algorithm, and Framingham risk score (p < 0.001 for all). Coronary artery calcium scoring was prevalent, occurring in 63.2% of patients with a median Agatston score of 22 with and interquartile range of 178. Male gender, older age, smoking habit, diabetes, and abdominal circumference were independent predictors of coronary artery calcium scoring (p < 0.001). Coronary artery calcium scoring downwardly reclassified 44.9% of patients in intermediate cardiovascular risk categories by the AHA/ACC atherosclerotic cardiovascular disease risk algorithm and 43.9% by the Framingham risk score. Coronary artery calcium scoring upwardly reclassified 46.8% of patients in intermediate risk categories by the AHA/ACC atherosclerotic cardiovascular disease risk algorithm and 56% by the Framingham risk score.Conclusion:Coronary artery calcium scoring is prevalent in this Mexican primary prevention cohort and has the ability to reclassify a significant percentage of intermediate cardiovascular risk patients.

Real Men Don't Cry: Skill Expressing Discrete Emotions Differentially Predicts Cardiovascular Disease Risk in Men and Women.

Expressing emotions effectively is central to social functioning and has links to health and cardiovascular disease (CVD) risk. Previous work has linked the ability to smile to lower CVD risk in men but has not studied other expressions or considered the context of these skills. To test whether the ability to express fear, anger, sadness, happiness, and disgust cross-sectionally predict CVD risk in both genders and whether links are moderated by the ability to decode others' emotional signals. A community sample of 125 men and women (30-75 years) provided trait emotion data before a laboratory visit where blood was drawn and performance-based assessments of the ability to signal and decode emotions were administered. Expressive accuracy was scored using FaceReader software. Projected CVD risk was calculated using Framingham, a New Zealand (NZ) specific, and Atherosclerosis CVD (ASCVD) risk algorithms. Accuracy expressing happiness predicted lower projected risk, whereas greater accuracy expressing fear and sadness predicted higher risk. Gender frequently moderated these links; greater accuracy expressing happiness predicted lower risk in men but not women. Conversely, greater accuracy expressing fear predicted higher risk in men, whereas greater accuracy expressing sadness predicted lower risk in women but, again, higher risk in men. The ability to accurately decode others' emotions moderated some links. The ability to signal emotion has complex links to health parameters. The ability to flexibly regulate expressions in accordance with gender norms may be one useful way of thinking about adaptive expressive regulation.

Vascular Risk and β-Amyloid Are Synergistically Associated with Cortical Tau.

Neuropathological studies have demonstrated that cerebrovascular disease and Alzheimer disease (AD) pathology frequently co-occur in older adults. The extent to which cerebrovascular disease influences the progression of AD pathology remains unclear. Leveraging newly available positron emission tomography (PET) imaging, we examined whether a well-validated measure of systemic vascular risk and β-amyloid (Aβ) burden have an interactive association with regional tau burden. Vascular risk was quantified at baseline in 152 clinically normal older adults (mean age = 73.5 ± 6.1 years) with the office-based Framingham Heart Study cardiovascular disease risk algorithm (FHS-CVD). We acquired Aβ (11 C-Pittsburgh compound B) and tau (18 F-flortaucipir) PET imaging on the same participants. Aβ PET was performed at baseline; tau PET was acquired on average 2.98 ± 1.1 years later. Tau was measured in the entorhinal cortex (EC), an early site of tau deposition, and in the inferior temporal cortex (ITC), an early site of neocortical tau accumulation associated with AD. Linear regression models examined FHS-CVD and Aβ as interactive predictors of tau deposition, adjusting for age, sex, APOE ε4 status, and the time interval between baseline and the tau PET scan. We observed a significant interaction between FHS-CVD and Aβ burden on subsequently measured ITC tau (p < 0.001), whereby combined higher FHS-CVD and elevated Aβ burden was associated with increased tau. The interaction was not significant for EC tau (p = 0.16). Elevated vascular risk may influence tau burden when coupled with high Aβ burden. These results suggest a potential link between vascular risk and tau pathology in preclinical AD. Ann Neurol 2019; 1-8 ANN NEUROL 2019;85:272-279.

Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.

AimsThere is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after ‘recalibration’, a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.Methods and resultsUsing individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at ‘high’ 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29–39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22–24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44–51 such individuals using original algorithms, in contrast to 37–39 individuals with recalibrated algorithms.ConclusionBefore recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need.

Ethnic disparities in estimated cardiovascular disease risk in Amsterdam, the Netherlands : The HELIUS study.

BackgroundEthnic differences have been reported in cardiovascular disease (CVD) risk factors. It is still unclear which ethnic groups are most at risk for CVD when all traditional CVD risk factors are considered together as overall risk.ObjectivesTo examine ethnic differences in overall estimated CVD risk and the risk factors that contribute to these differences.DesignUsing data of the multi-ethnic HELIUS study (HEalthy LIfe in an Urban Setting) from Amsterdam, we examined whether estimated CVD risk and risk factors among those eligible for CVD risk estimation differed between participants of Dutch, South Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin. Using the Systematic COronary Risk Evaluation (SCORE) algorithm, we estimated risk of fatal CVD and risk of fatal plus non-fatal CVD. These risks were compared between ethnic groups via age-adjusted linear regression analyses.ResultsThe SCORE algorithm was applicable to 9,128 participants. Relative to the fatal CVD risk of participants of Dutch origin, South Asian Surinamese participants showed a higher fatal CVD risk, Ghanaian males a lower fatal CVD risk, and participants of other ethnic origins a similar fatal CVD risk. For fatal plus non-fatal CVD risk, African Surinamese and Turkish men also showed a higher risk. When diabetes was incorporated in the CVD risk algorithm, all but Ghanaian men showed a higher CVD risk relative to the participants of Dutch origin (betas ranging from 0.98–3.10%). The CVD risk factors that contribute the most to these ethnic differences varied between ethnic groups.ConclusionEthnic minority groups are at a greater estimated risk of fatal plus non-fatal CVD relative to the group of native Dutch. Further research is necessary to determine whether this will translate to ethnic differences in CVD incidence and, if so, whether ethnic-specific CVD prevention strategies are warranted.Electronic supplementary materialThe online version of this article (10.1007/s12471-018-1107-3) contains supplementary material, which is available to authorized users.

Underestimation of Risk of Carotid Subclinical Atherosclerosis by Cardiovascular Risk Scores in Patients with Psoriatic Arthritis.

To test the performances of established cardiovascular (CV) risk scores in discriminating subclinical atherosclerosis (SCA) in patients with psoriatic arthritis. These scores were calculated: Framingham risk score (FRS), QRISK2, Systematic COronary Risk Evaluation (SCORE), 10-year atherosclerotic cardiovascular disease risk algorithm (ASCVD) from the American College of Cardiology and the American Heart Association, and the European League Against Rheumatism (EULAR)-recommended modified versions (by 1.5 multiplication factor, m-). Carotid intima-media thickness > 0.9 mm and/or the presence of plaque determined by ultrasound were classified as SCA+. We recruited 146 patients [49.4 ± 10.2 yrs, male: 90 (61.6%)], of whom 142/137/128/118 patients were eligible to calculate FRS/QRISK2/SCORE/ASCVD. Further, 62 (42.5%) patients were SCA+ and were significantly older, with higher systolic blood pressure and higher low-density lipoprotein cholesterol (all p < 0.05). All CV risk scores were significantly higher in patients with SCA+ [FRS: 7.8 (3.9-16.5) vs 2.7 (1.1-7.8), p < 0.001; QRISK2: 5.5 (3.1-10.2) vs 2.9 (1.2-6.3), p < 0.001; SCORE: 1 (0-2) vs 0 (0-1), p < 0.001; ASCVD: 5.6 (2.6-12.4) vs 3.4 (1.4-6.1), p = 0.001]. The Hosmer-Lemeshow test revealed moderate goodness of fit for the 4 CV scores (p ranged from 0.087 to 0.686). However, of the patients with SCA+, those identified as high risk were only 44.1% (by FRS > 10%), 1.8% (QRISK2 > 20%), 10.9% (SCORE > 5%), and 43.6% (ASCVD > 7.5%). By applying the EULAR multiplication factor, 50.8%/14.3%/14.5%/54.5% of the patients with SCA+ were identified as high risk by m-FRS/m-QRISK2/m-SCORE/m-ASCVD, respectively. EULAR modification increased the sensitivity of FRS and ASCVD in discriminating SCA+ from 44% to 51%, and 44% to 55%, respectively. All CV risk scores underestimated the SCA+ risk. EULAR-recommended modification improved the sensitivity of FRS and ASCVD only to a moderate level.

Predictive Value of Arterial Stiffness and Subclinical Carotid Atherosclerosis for Cardiovascular Disease in Patients with Rheumatoid Arthritis

We evaluated the predictive value of these vascular biomarkers for cardiovascular disease (CVD) events in patients with rheumatoid arthritis (RA): aortic pulse wave velocity (aPWV), augmentation index (AIx), carotid intima-media thickness (cIMT), and carotid plaques (CP). They are often used as risk markers for CVD. In 2007, 138 patients with RA underwent clinical examination, laboratory tests, blood pressure testing, and vascular biomarker measurements. Occurrence of CVD events was recorded in 2013. Predictive values were assessed in Kaplan-Meier plots, log-rank, and crude and adjusted Cox proportional hazard (PH) regression analyses. Baseline median age and disease duration was 59.0 years and 17.0 years, respectively, and 76.1% were women. CVD events occurred in 10 patients (7.2%) during a mean followup of 5.4 years. Compared with patients with low aPWV, AIx, cIMT, and without CP, patients with high aPWV (p < 0.001), high AIx (p = 0.04), high cIMT (p = 0.01), and CP (p < 0.005) at baseline experienced more CVD events. In crude Cox PH regression analyses, aPWV (p < 0.001), cIMT (p < 0.001), age (p = 0.01), statin (p = 0.01), and corticosteroid use (p = 0.01) were predictive of CVD events, while AIx was nonsignificant (p = 0.19). The Cox PH regression estimates for vascular biomarkers were not significantly altered when adjusting individually for demographic variables, traditional CVD risk factors, RA disease-related variables, or medication. All patients who developed CVD had CP at baseline. CP, aPWV, and cIMT were predictive of CVD events in this cohort of patients with RA. Future studies are warranted to examine the additive value of arterial stiffness and carotid atherosclerosis markers in CVD risk algorithms. Regional Ethical Committee approval numbers 2009/1582 and 2009/1583.

Abstract 613: Cardiovascular Disease Prevalence and Risk Factors in Japanese and American Populations

Cardiovascular disease (CVD) prevalence is known to be lower in Japan than in the United States. In this international cohort-comparative study, we compared CVD prevalence rates and risk factors in Fukuoka, Japan and in Framingham, United States. Using plasma samples obtained after an overnight fast from men and women in Fukuoka (n=1108) and age (median, 53 years), gender and menopausal status matched subjects in Framingham (n=1101), we measured plasma glucose, insulin, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C), and triglycerides. Blood pressure, body mass index (BMI), use of medications, and history of CVD were also assessed. CVD prevalence rates were 2.1% and 1.0%, respectively, in Fukuoka men and women, and were more than 6 folder higher (both P&lt;0.001) at 13.2% and 8.6%, respectively, in Framingham men and women. Median BMI, LDL-C, insulin levels and insulin resistance in men and women in Fukuoka were all significantly (P&lt;0.01) lower than those in their Framingham counterparts. However the diabetes prevalence in Fukuoka men was significantly (P&lt;0.01) higher than that observed in Framingham men, while female rates were similar, as were levels of systolic blood pressure. Smoking rates were lower in Fukuoka women, but were higher in Fukuoka men as compared to their Framingham counterparts. HDL-C and surprisingly sdLDL-C levels were significantly (P&lt;0.001) higher in Fukuoka subjects than in Framingham subjects. Based on the results, the estimated 10 year risk of atherosclerotic cardiovascular disease, using the new American College of Cardiology/American Heart Association risk calculator, were 6.9% and 2.3%, respectively, for Framingham men and women, while these values for Fukuoka men and women were 7.4% and 1.7%, respectively. Only the risk estimates in women were significantly different (P&lt;0.001). Our data are consistent with prior studies indicating that CVD prevalence rates in Japan are lower than those in the United States, and that CVD risk algorithms for the United States markedly overestimate CVD risk in Japan. The markedly lower levels of insulin and insulin resistance in Japanese subjects may account for some of the population differences in CVD prevalence and risk.

Development and Validation of Risk Prediction Models for Cardiovascular Events in Black Adults: The Jackson Heart Study Cohort.

Cardiovascular risk assessment is a fundamental component of prevention of cardiovascular disease (CVD). However, commonly used prediction models have been formulated in primarily or exclusively white populations. Whether risk assessment in black adults is dissimilar to that in white adults is uncertain. To develop and validate risk prediction models for CVD incidence in black adults, incorporating standard risk factors, biomarkers, and subclinical disease. The Jackson Heart Study (JHS), a longitudinal community-based study of 5301 black adults in Jackson, Mississippi. Inclusive study dates were the date of a participant's first visit (September 2000 to March 2004) to December 31, 2011. The median (75th percentile) follow-up was 9.1 (9.7) years. The dates of the analysis were August 2013 to May 2015. Measurements included standard risk factors, including age, sex, body mass index, systolic and diastolic blood pressure, ratio of fasting total cholesterol to high-density lipoprotein cholesterol, estimated glomerular filtration rate, antihypertensive therapy, diabetes mellitus, and smoking; blood biomarkers; and subclinical disease measures, including ankle-brachial index, carotid intimal-medial thickness, and echocardiographic left ventricular hypertrophy and systolic dysfunction. Incident CVD event was defined as the first occurrence of myocardial infarction, coronary heart disease death, congestive heart failure, stroke, incident angina, or intermittent claudication. Model performance was compared with the American College of Cardiology/American Heart Association (ACC/AHA) CVD risk algorithm and the Framingham Risk Score (FHS) refitted to the JHS data and evaluated in the Atherosclerosis Risk in Communities (ARIC) and Multi-Ethnic Study of Atherosclerosis cohorts. The study cohort comprised 3689 participants with mean (SD) age at baseline was 53 (11) years, and 64.8% (n = 2390) were female. Over a median of 9.1 years, 270 participants (166 women) experienced a first CVD event. A simple combination of standard CVD risk factors, B-type natriuretic peptide, and ankle-brachial index (model 6) yielded modest improvement over a model without B-type natriuretic peptide and ankle-brachial index (C statistic, 0.79; 95% CI, 0.75-0.83 [relative integrated discrimination improvement, 0.22; 95% CI, 0.15-0.30]). However, the reclassification improvement was not substantially different between model 6 and the ACC/AHA CVD Pooled Cohort risk equations or between model 6 and the FHS. The models discriminated reasonably well in the ARIC and Multi-Ethnic Study of Atherosclerosis data (C statistic range, 0.70-0.77). Our findings using the JHS data in the present study are valuable because they confirm that current FHS and ACC/AHA risk algorithms work well in black individuals and are not easily improved on. A unique risk calculator for black adults may not be necessary.

Using primary care data to evaluate the 10-year cost-effectiveness of cardiovascular disease risk algorithms in patients with serious mental illness: a patient level simulation

Methods Patient data was extracted from The Health Improvement Network (THIN), a primary care database, to populate the patient level simulation. Patients had SMI, were aged 30 to 74 years and free of CVD. A CVD risk algorithm was applied and patients scoring above 10% prescribed statins. We tested four CVD risk algorithms against no algorithm; lipid and body mass index (BMI) versions of SMI specific and general population algorithms. Time dependent transition probabilities for fatal and non-fatal CVD events were calculated using survival analysis. Utility scores to calculate quality adjusted life years (QALYs) were obtained from the literature.

Association of Chest Pain and Risk of Cardiovascular Disease with Coronary Atherosclerosis in Patients with Inflammatory Joint Diseases.

The relation between chest pain and coronary atherosclerosis (CA) in patients with inflammatory joint diseases (IJD) has not been explored previously. Our aim was to evaluate the associations of the presence of chest pain and the predicted 10-year risk of cardiovascular disease (CVD) by use of several CVD risk algorithms, with CA verified by multidetector computed tomography (MDCT) coronary angiography. Detailed information concerning chest pain and CVD risk factors was obtained in 335 patients with rheumatoid arthritis and ankylosing spondylitis. In addition, 119 of these patients underwent MDCT coronary angiography. Thirty-one percent of the patients (104/335) reported chest pain. Only six patients (1.8%) had atypical angina pectoris (pricking pain at rest). In 69 patients without chest pain, two thirds had CA, while in those who reported chest pain (n = 50), CA was present in 48.0%. In a logistic regression analysis, chest pain was not associated with CA (dependent variable) (p = 0.43). About 30% (Nagelkerke R (2)) of CA was explained by any of the CVD risk calculators: Systematic Coronary Risk Evaluation, Framingham Risk Score, or Reynolds Risk Score. The presence of chest pain was surprisingly infrequently reported in patients with IJD who were referred for a CVD risk evaluation. However, when present, chest pain was weakly associated with CA, in contrast to the predicted CVD risk by several risk calculators which was highly associated with the presence of CA. These findings suggest that clinicians treating patients with IJD should be alert of coronary atherosclerotic disease also in the absence of chest pain symptoms.

Identification by Ultrasound Evaluation of the Carotid and Femoral Arteries of High-Risk Subjects Missed by Three Validated Cardiovascular Disease Risk Algorithms

Atherosclerotic cardiovascular disease (ASCVD) events are the leading cause of death in the United States and globally. Traditional global risk algorithms may miss 50% of patients who experience ASCVD events. Noninvasive ultrasound evaluation of the carotid and femoral arteries can identify subjects at high risk for ASCVD events. We examined the ability of different global risk algorithms to identify subjects with femoral and/or carotid plaques found by ultrasound. The study population consisted of 1,464 asymptomatic adults (39.8% women) aged 23 to 87 years without previous evidence of ASCVD who had ultrasound evaluation of the carotid and femoral arteries. Three ASCVD risk algorithms (10-year Framingham Risk Score [FRS], 30-year FRS, and lifetime risk) were compared for the 939 subjects who met the algorithm age criteria. The frequency of femoral plaque as the only plaque was 18.3% in the total group and 14.8% in the risk algorithm groups (n = 939) without a significant difference between genders in frequency of femoral plaque as the only plaque. Those identified as high risk by the lifetime risk algorithm included the most men and women who had plaques either femoral or carotid (59% and 55%) but had lower specificity because the proportion of subjects who actually had plaques in the high-risk group was lower (50% and 35%) than in those at high risk defined by the FRS algorithms. In conclusion, ultrasound evaluation of the carotid and femoral arteries can identify subjects at risk of ASCVD events missed by traditional risk-predicting algorithms. The large proportion of subjects with femoral plaque only supports the use of including both femoral and carotid arteries in ultrasound evaluation.