Cardiovascular Risk Assessment Tools Research Articles

Utilidad de la ecografía portátil en el cribado del aneurisma de aorta abdominal y de la ateromatosis de aorta abdominal

Background and objectiveTo determine the prevalence of abdominal aortic aneurysm (AAA) and abdominal aortic atheromatosis (AA-At) using a hand-held ultrasound by a general practitioner in the public Primary Health Care system. Patients and methodPilot study that prospectively studied a cohort of men over 50 years with cardiovascular risk factors: active smokers, former smokers, or hypertensive patients, attended in primary health care center. The general practitioner completed an ultrasonography training in an Ultrasound Unit under supervision of experienced radiologists using an standard ultrasound equipment and hand-held ultrasound (VScan®, General Electric, USA). One hundred and six patients participated in the study and all imaging data recorded were blindly evaluated by a radiologist in order to establish the concordance in the interpretation of images between general practitioner and radiologist. The kappa index was calculated to study the agreement on the presence or absence of AAA and AA-At. ResultsWe observed a prevalence of 5.88% of AAA. Kappa index for concordance in AAA diagnosis was absolute (κ=1.0), with a sensitivity and specificity of 100%. Otherwise, the general practitioner identified 59 patients (58.4%) with AA-At, while radiologist identified 39 (38.6%) in the image review, with moderate concordance (κ=.435), sensitivity 89.74% and specificity 57.14%. Hypercholesterolemia (odds ratio [OR] 2.61; 95% confidence interval [95% CI] 0.92-7.39) and diabetes mellitus (OR 3.35; 95%CI 0.89-12.55) were independent risk factors for AA-At development in logistic regression. ConclusionsAfter an adequate training in ultrasonography, hand-held ultrasound is a useful tool for AAA screening in Primary Care. Its simplicity, security, validity, cost-effectiveness and acceptance by the general population, makes it a feasible tool for cardiovascular risk assessment.

Assessment of cardiovascular risk and target organ damage among adult patients with primary hypertension in Thika Level 5 Hospital, Kenya: a criteria-based clinical audit

Appropriate management of hypertension reduces the risk of death from stroke and cardiac disease and includes routine assessment for target organ damage and estimation of cardiovascular risk. However, implementation of evidence-based hypertension management guidelines is unsatisfactory. We explore the use of audit and feedback as a quality improvement (QI) strategy for reducing the knowledge practice gap in hypertension care in a resource poor setting. The aim of this study is to determine the level of compliance to evidence-based guidelines on assessment of cardiovascular risk and target organ damage among patients with hypertension in Thika Level 5 Hospital in central Kenya and to implement best practice with regard to evidence utilisation among clinicians in the hospital. A retrospective clinical audit done in three phases spread over 5 months. Phase one involved identifying five audit criteria on assessment of cardiovascular risk and target organ damage in patients with hypertension and conducting a baseline audit in which compliance to audit criteria, blood pressure control and drug prescription practices were assessed. Phase two involved identifying barriers to compliance to audit criteria and strategies to overcoming these barriers. The third phase was a follow-up audit. There was no use of a cardiovascular risk assessment tool in both audits (0% vs. 0%; P = 1.00). Testing urine for haematuria and proteinuria reduced from 13% to 8% (P = 0.230) while taking a blood sample for measuring blood glucose, electrolytes and creatinine levels improved from 11% to 17% (P = 0.401). Performance of fundoscopy and electrocardiography remained unchanged at 2% and 8%, respectively (P = 0.886 and P = 0.898). High patient load was identified as the biggest barrier to implementation of best practice. Blood pressure control improved from 33% to 70% (P ≤ 0.001), whereas the proportion of patients on two or more recommended antihypertensive drugs rose from 59% to 72% (P = 0.158). In Thika Level 5 Hospital, audit and feedback has a poor impact on assessment of cardiovascular risk and target organ damage but positive impact on blood pressure control and prescription practices. Time and sample size may have affected observed results. Additional audits and alternative QI strategies are warranted.

Diagnosis and Treatment of Erectile Dysfunction for Reduction of Cardiovascular Risk

We established erectile dysfunction as an often neglected but valuable marker of cardiovascular risk, particularly in younger men and men with diabetes. We also reviewed evidence that lifestyle change, combined with informed prescribing of pharmacotherapies used to mitigate cardiovascular risk, can improve overall vascular health and sexual functioning in men with erectile dysfunction. We performed a PubMed® search for articles and guidelines pertinent to relationships between erectile dysfunction and cardiovascular disease, cardiovascular and all cause mortality, and pharmacotherapies for dyslipidemia and hypertension. The clinical guidance presented incorporates the current literature and the expertise of the multispecialty investigator group. Numerous cardiovascular risk assessment tools exist but risk stratification remains challenging, particularly in patients at low or intermediate short-term risk. Erectile dysfunction has a predictive value for cardiovascular events that is comparable to or better than that of traditional risk factors. Interventional studies support lifestyle changes as a means of improving overall vascular health as well as sexual functioning. Statins, diuretics, β-blockers and renin-angiotensin system modifiers may positively or negatively affect erectile function. Furthermore, the phosphodiesterase type 5 inhibitors used to treat erectile dysfunction may have systemic vascular benefits. Erectile dysfunction treatment should be considered secondary to decreasing cardiovascular risk. However, informed prescribing may prevent worsening sexual function in men receiving pharmacotherapy for dyslipidemia and hypertension. As the first point of medical contact for men with erectile dysfunction symptoms, the primary care physician or urologist has a unique opportunity to identify those who require early intervention to prevent cardiovascular disease.

Coronary Calcium: New Insights, Recent Data, and Clinical Role

Calcium artery calcium (CAC) scoring has become an integral part in the era of preventive cardiology, it has been extensively studied and been validated as a powerful tool for cardiovascular risk assessment in conjunction with other traditional well established scoring systems such as Framingham risk score. In addition, CAC testing has found its way into emergency department algorithms assessing low to intermediate risk patients presenting with chest pain, this strategy was recently adopted by the UK NICE guidelines, confidently ruling out cardiac origin of chest pain. Several studies have demonstrated that risk assessment using CAC was motivational to patients leading to better adherence to their preventive practices as well as to medications. Accordingly, this test has several recommendations for use by national and international guidelines.

The Application of Brachial-Ankle Pulse Wave Velocity as a Clinical Tool for Cardiovascular Risk Assessment

I read with interest the article of Vlachopoulos et al1, which evaluated the usefulness of brachial-ankle elasticity index (also known as brachial-ankle pulse wave velocity [baPWV], which is the term more commonly used in Japan) for predicting future cardiovascular (CV) events by meta-analysis.⇓ I would like to describe here the applicability of baPWV as a clinical tool for CV risk assessment. The concept that increased large arterial stiffness is one of the novel players in the initiation and/or progression …

Response to The Application of Brachial-Ankle Pulse Wave Velocity as a Clinical Tool for Cardiovascular Risk Assessment

We thank Tomiyama and Yamashina1 for their interest in our study.2 Ease of use for a promising biomarker, such as the brachial-ankle elasticity index, is an important advantage, but together with the predictive ability of brachial-ankle elasticity index it should be weighed against shortcomings that exist at present and should be tackled in future studies, such as …

The Increasing Burden of Mortality From Viral Hepatitis in the United States

The Increasing Burden of Mortality From Viral Hepatitis in the United States

On the Estimation of Total Arterial Compliance from Aortic Pulse Wave Velocity

Total arterial compliance (C(T)) is a main determinant of cardiac afterload, left ventricular function and arterio-ventricular coupling. C(T) is physiologically more relevant than regional aortic stiffness. However, direct, in vivo, non-invasive, measurement of C(T) is not feasible. Several methods for indirect C(T) estimation require simultaneous recording of aortic flow and pressure waves, limiting C(T) assessment in clinical practice. In contrast, aortic pulse wave velocity (aPWV) measurement, which is considered as the "gold standard" method to assess arterial stiffness, is noninvasive and relatively easy. Our aim was to establish the relation between aPWV and C(T). In total, 1000 different hemodynamic cases were simulated, by altering heart rate, compliance, resistance and geometry using an accurate, distributed, nonlinear, one-dimensional model of the arterial tree. Based on Bramwell-Hill theory, the formula C(T) = k • aPWV(-2) was found to accurately estimate C(T) from aPWV. Coefficient k was determined both analytically and by fitting C(T) vs. aPWV data. C(T) estimation may provide an additional tool for cardiovascular risk (CV) assessment and better management of CV diseases. C(T) could have greater impact in assessing elderly population or subjects with elevated arterial stiffness, where aPWV seem to have limited prognostic value. Further clinical studies should be performed to validate the formula in vivo.

Femoral Plaque Echogenicity and Cardiovascular Risk in Claudicants

The present study was designed to verify whether the evaluation of femoral plaque echogenicity might be a useful tool for cardiovascular risk assessment in patients affected by lower extremity peripheral arterial disease. Lower extremity peripheral arterial disease is a common manifestation of atherosclerosis and is associated with a high risk of developing major cardiovascular events. Vulnerable atherosclerotic plaque plays a central role in the occurrence of acute ischemic events in different vascular territories. Furthermore, atherosclerosis is a systemic disease, and the presence of an unstable atherosclerotic plaque in a certain vascular district, characterized by low echogenicity at B-mode ultrasound, is associated to a greater prevalence of unstable plaques in other vascular beds. Femoral plaque echogenicity of 246 claudicants with ankle/brachial index ≤0.90 was evaluated at B-mode ultrasound by visual analysis and by calculating the grayscale median (GSM) value. In these patients, the occurrence of myocardial infarction and stroke was prospectively assessed. Femoral GSM values and plaque types assessed by visual analysis were highly correlated by Spearman analysis (rho = 0.905, p < 0.001). During a median follow-up of 30 months, 32 patients (13%) had a major cardiovascular event. Compared with patients without events, those who experienced an event during the follow-up had a lower femoral plaque GSM value (42.9 ± 26.2 vs. 58.8 ± 19.3, p = 0.002) and a higher prevalence of hypoechoic femoral plaque at visual analysis (68.8% vs. 19.6%, p < 0.001). At Cox analysis, femoral GSM showed an inverse relationship with cardiovascular risk, even after adjustment for possible confounders (hazard ratio: 0.96, 95% confidence interval [CI]: 0.95 to 0.98, p < 0.001). Furthermore, patients with hypoechoic femoral plaques at visual analysis had a 7.24-fold increased cardiovascular risk compared with patients with hyperechoic plaques after adjustment for possible confounders (95% CI: 3.23 to 16.22, p < 0.001). This study demonstrates that the presence of hypoechoic atherosclerotic femoral plaques is associated with higher cardiovascular risk in lower extremity peripheral arterial disease patients.

Cardiovascular risk assessment of atypical antipsychotic drugs in a zebrafish model

The zebrafish model has been developed and evaluated for its ability to predict the toxicity of chemicals. Zebrafish additionally serve as an excellent model for assessing drug-induced cardiotoxicity, although zebrafish and mammalian hearts differ in structure. Recently, regulatory authorities have expressed concerns about a possible relationship between antipsychotics and risk of QTc interval prolongation, serious arrhythmia and sudden cardiac death. In the current study, we performed a cardiovascular risk assessment of six atypical antipsychotic drugs in zebrafish, specifically, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone. Visual endpoints, such as lethality, edema (the presence of heart and trunk edema), hemorrhage (clustering of a pool of blood in an area outside the normal circulation), abnormal body shape (including bent or misshapen caudal region of the larvae) and motility, were evaluated as general toxicity endpoints, and the heart beat rate calculated as the cardiovascular toxicity endpoint. The zebrafish model facilitates determination of the heart beat rate, and may thus be an attractive screening tool for cardiovascular risk assessment of atypical antipsychotic drugs to understand the variations in response to QT-prolonging drugs.

Implementing Cardiovascular Risk Reduction in Patients with Cardiovascular Disease and Diabetes Mellitus

The role of cardiovascular risk reduction in patients with diabetes mellitus is significant as several factors have been found to promote accelerated atherosclerosis in persons with diabetes including hyperglycemia-induced endothelial dysfunction, impaired fibrinolysis, increased platelet aggregation, plaque instability, dysfunctional arterial remodeling, and fibrotic and calcified coronary arteries. Recent attention has focused on identifying a cardiovascular biomarker that would propose a better noninvasive way to detect or visualize subclinical cardiovascular disease and prevent cardiovascular events. This article reviews the use of commonly used cardiovascular risk assessment tools and emerging biomarkers including coronary artery calcium scanning, metabolomics, genomics, and the role of optimal revascularization and risk reduction strategies and their impact on reducing risk in patients with cardiovascular disease and diabetes.

Detection of multiple cardiac markers with an integrated acoustic platform for cardiovascular risk assessment

This work describes the application of a newly emerged biosensing configuration incorporating a Surface Acoustic Wave device integrated with a multi-channel microfluidic module for the rapid and efficient analysis of cardiac markers. The examined cardiac markers of creatine kinase MB (CK-MB), cardiac reactive protein (CRP), D-dimer and pregnancy-associated plasma protein A (PAPP-A), comprise a group of both established and emerging heart disease proteins, that has never been probed before with any kind of biochip-related platform. The four markers were successfully detected; kinetics and affinity studies on their interactions with the surface immobilized antibodies are also presented. A concentration detection limit of less than 1 nM was achieved, with a dynamic range of more than two orders of magnitude, covering some of the pathological and healthy areas of interest. Mixtures of biomarkers applied to the device surface were used to prove the specificity of each binding event and investigate the microsystem's performance in the presence of complex fluids, towards future utilization with real samples. The simplicity and multiplexing ability of the integrated platform render the system ideal as a potential diagnostic tool for cardiovascular risk assessment, where simultaneous analysis of various protein markers is required.

Long term cardiovascular risk models’ combination

The correct diagnosis of cardiovascular disease is a key factor to reduce social and economic costs. In this context, cardiovascular disease risk assessment tools are of fundamental importance. This work addresses two major drawbacks of the current cardiovascular risk score systems: reduced number of risk factors considered by each individual tool and the inability of these tools to deal with incomplete information. To achieve these goals a two phase strategy was followed. In the first phase, a common representation procedure, based on a Naïve-Bayes classifier methodology, was applied to a set of current risk assessment tools. Classifiers’ individual parameters and conditional probabilities were initially evaluated through a frequency estimation method. In a second phase, a combination scheme was proposed exploiting the particular features of Bayes probabilistic reasoning, followed by conditional probabilities optimization based on a genetic algorithm approach. This strategy was applied to describe and combine ASSIGN and Framingham models. Validation results were obtained based on individual models, assuming their statistical correctness. The achieved results are very promising, showing the potential of the strategy to accomplish the desired goals.

Screening of HIV-infected patients for non-AIDS-related morbidity: an evidence-based model of practice

To develop guidelines to facilitate management of HIV infection as a chronic disease within the setting of a sexual health or other HIV outpatient clinic. We undertook a literature search to identify published guidelines and expert panel commentaries on screening and managing non-AIDS comorbidities in the general and HIV-infected population. We developed evidence-based guidelines for screening and management of non-AIDS comorbidities in HIV-positive clients attending the Sydney Sexual Health Centre (SSHC) that could be used in other HIV outpatient settings. Guidelines have been developed that describe the recommended tests and an interpretation of results, and outline actions to take if abnormal. A summary document can be placed in the medical notes to record completed tests, and resources such as lifestyle modification pamphlets and cardiovascular risk assessment tools made easily available in clinics. These guidelines are being used by nurses and doctors to facilitate the management of HIV as a chronic disease in the SSHC. This represents a significant shift in practice from the traditional role of a sexual health clinic, and is likely to become increasingly important in resource-rich countries such as Australia where individuals with HIV are expected to live beyond their seventh decade. This model could be used in other HIV outpatient settings including general practice.

Evaluation of a cardiovascular disease risk assessment tool for the promotion of healthier lifestyles

Although percentage risk formats are commonly used to convey cardiovascular disease (CVD) risk, people find it difficult to understand these representations. To compare the impact of providing a CVD risk message in either a traditional format (% risk) or using an analogy of risk (Heart-Age) on participants' risk perceptions and intention to make lifestyle changes. Four hundred and thirteen men and women were randomly allocated to one of two conditions; CVD risk as a percentage or as a Heart-Age score (a cardiovascular risk adjusted age). There was a graded relationship between perceived and actual CVD risk only in those participants receiving a Heart-Age message (P<0.05). Heart-Age was more emotionally impactful in younger individuals at higher actual CVD risk (P<0.01). Self-reported emotional reactions further mediated the relationship between risk perception and intention to make lifestyle changes. This study found that the Heart-Age message significantly differed from percentage CVD risk score in risk perceptions and was more emotionally impactful in those participants at higher actual CVD risk levels.

A literature review of the cardiovascular risk-assessment tools: applicability among Asian population

BackgroundCardiovascular diseases, the main causes of hospitalisations and death globally, have put an enormous economic burden on the healthcare system. Several risk factors are associated with the occurrence of cardiovascular...

Development and administration of a screening tool for cardiovascular risk assessment in community pharmacy

Cardiovascular disease (CVD) was the leading cause of death in 2005, causing 17.5 million deaths globally. In Ireland, 2006 figures indicate that CVD was responsible for 43% of all deaths, and 49% of deaths in people aged less than 65 years. It is predicted to remain the largest cause of death for the foreseeable future. It has been estimated that at least 25% of CVD patients have sudden death or non-fatal myocardial infarction without prior symptoms. It is important to try to develop a method for screening these asymptomatic people. If people at high risk of CVD can be identified early then they can be treated to reduce their risk. This will in turn reduce their incidences of cardiovascular instances (heart attack, stroke, etc.) and their burden on the health service. Screening tools are used to identify those people at high risk of developing CVD. These screening tools take a ...

Impact on clinical practice of the Joint British Societies’ cardiovascular risk assessment tools

The aim of this study was to evaluate the Joint British Societies' (JBS 2) Factfile, cardiovascular risk assessment paper charts and electronic risk calculator posted to health professionals in general practice. Phase one: surveys on use of the JBS 2 charts and calculator; views on improving use and acceptability. Phase two: six focus groups and two semi-structured interviews on use of the JBS 2 charts and calculator; views on expression of risk, communication of risk and risk management. Phase one: general practitioners (GPs) and practice nurses. Phase two: GPs, practice nurses and nurse practitioners recruited via the survey; eligible patients invited by GPs. Primary care. A high response rate (81.3%, 825/1015) was obtained to a national on-line survey of GPs using Pearl Medical Blackberries((R)). The JBS 2 charts were used by around 1 in 5 GPs and the electronic risk calculator by around 1 in 6. Patients and health professionals found the concept of risk difficult, preferred relative to absolute risk and liked the JBS 2 electronic risk thermometer and its ability to illustrate how changes in risk factors affect risk levels. Communication of risk in visual terms was a key to understanding the concept. The most important factor was risk management; how to motivate and support patients to maintain healthy lifestyles and concordance with medication was as important as communication of risk. Health professionals need training in both aspects. To maximise the use of cardiovascular risk assessment tools, multiple approaches are needed; it is not sufficient to distribute them in the post. Communicating and managing cardiovascular risk is difficult; to be effective more time is needed than is available in a routine GP appointment. Practice nurses may be well suited for this role. Costs of training and continuing support need to be built into the overall costs of the national programme for cardiovascular screening now known as NHS Health Checks.

Mesure de l’accumulation cutanée des produits avancés de la glycation: un progrès pour la prédiction du risque cardiovasculaire ?

Aims/hypothesis The UK Prospective Diabetes Study (UKPDS) risk engine has become a standard for cardiovascular risk assessment in type 2 diabetes mellitus. Skin autofluorescence was recently introduced as an alternative tool for cardiovascular risk assessment in diabetes. We investigated the prognostic value of skin autofluorescence for cardiovascular events in combination with the UKPDS risk engine in a cohort of patients with type 2 diabetes managed in primary care.

Skin autofluorescence provides additional information to the UK Prospective Diabetes Study (UKPDS) risk score for the estimation of cardiovascular prognosis in type 2 diabetes mellitus

The UK Prospective Diabetes Study (UKPDS) risk engine has become a standard for cardiovascular risk assessment in type 2 diabetes mellitus. Skin autofluorescence was recently introduced as an alternative tool for cardiovascular risk assessment in diabetes. We investigated the prognostic value of skin autofluorescence for cardiovascular events in combination with the UKPDS risk engine in a cohort of patients with type 2 diabetes managed in primary care. Clinical, UKPDS risk engine and skin autofluorescence data were obtained at baseline in 2001-2002 in the type 2 diabetes group (n = 973). Follow-up data concerning fatal and non-fatal cardiovascular events (primary endpoint) were obtained till 2005. Patients were classified as 'low risk' when their 10 year UKPDS risk score for fatal cardiovascular events was <10%, and 'high risk' if >10%. Skin autofluorescence was measured non-invasively with an autofluorescence reader. Skin autofluorescence was classified by the median (i.e. low risk < median, high risk > median). The incidence of cardiovascular events was 119 (44 fatal, 75 non-fatal). In multivariate analysis, skin autofluorescence, age, sex and diabetes duration were predictors for the primary endpoint. Addition of skin autofluorescence information to that from the UKPDS risk engine resulted in re-classification of 55 of 203 patients from the low-risk to the high-risk group. The 10 year cardiovascular event rate was higher in patients with a UKPDS score >10% when skin autofluorescence was above the median (55.8% vs 38.9%). Skin autofluorescence provides additional information to the UKPDS risk engine which can result in risk re-classification of a substantial number of patients. It furthermore identifies patients who have a particularly high risk for developing cardiovascular events.