Coronary Heart Disease Risk Prediction Research Articles

Clinical significance of serum apolipoproteins as a predictor of coronary heart disease risk in Korean men.

Although serum apolipoprotein measurement is known to be associated with coronary heart disease (CHD) risk, there is only limited information about the clinical significance of lipid profiles such as ApoA, ApoB and A/B ratio in predicting CHD risk in Asians. Therefore, this cohort study was conducted to evaluate the longitudinal effects of baseline serum apolipoprotein measurements on CHD risk in Korean men. Initially, an intermediate and high Framingham risk score (FRS)-free cohort of 23 918 healthy Korean men was followed until 2010. FRS was calculated for each man and divided into three levels of risk <10% (low), 10-19% (intermediate) and ≥20% (high). More-than-a-moderate CHD risk group (participants with FRS ≥ 10%) and high CHD risk group (participants with FRS ≥ 20%) were defined as our two dependent variables. Cox proportional hazards models were performed. In the more-than-a-moderate CHD risk group, the total and average follow-up periods were 83340·2 and 3·48 person-years, respectively, and 3763 (15·7%) incident cases developed between 2006 and 2010. In the high CHD risk group, the total and average follow-up periods were 87868·8 and 3·67 person-years, respectively, and 344 (1·4%) incident cases developed between 2006 and 2010. Multivariate-adjusted analyses showed a strong statistically significant relationship between the quintile groups of apolipoprotein B (ApoB), apolipoprotein A-1 (ApoA-1) and apolipoprotein B/apolipoprotein A-1 (ApoB/A-1) ratio and both the more-than-a-moderate CHD risk and high CHD risk. Serum ApoB, ApoA-1 and ApoB/A-1 ratio levels are independently associated with CHD risk in Korean men.

Clinical Utility of a Coronary Heart Disease Risk Prediction Gene Score in UK Healthy Middle Aged Men and in the Pakistani Population.

BackgroundNumerous risk prediction algorithms based on conventional risk factors for Coronary Heart Disease (CHD) are available but provide only modest discrimination. The inclusion of genetic information may improve clinical utility.MethodsWe tested the use of two gene scores (GS) in the prospective second Northwick Park Heart Study (NPHSII) of 2775 healthy UK men (284 cases), and Pakistani case-control studies from Islamabad/Rawalpindi (321 cases/228 controls) and Lahore (414 cases/219 controls). The 19-SNP GS included SNPs in loci identified by GWAS and candidate gene studies, while the 13-SNP GS only included SNPs in loci identified by the CARDIoGRAMplusC4D consortium.ResultsIn NPHSII, the mean of both gene scores was higher in those who went on to develop CHD over 13.5 years of follow-up (19-SNP p=0.01, 13-SNP p=7x10-3). In combination with the Framingham algorithm the GSs appeared to show improvement in discrimination (increase in area under the ROC curve, 19-SNP p=0.48, 13-SNP p=0.82) and risk classification (net reclassification improvement (NRI), 19-SNP p=0.28, 13-SNP p=0.42) compared to the Framingham algorithm alone, but these were not statistically significant. When considering only individuals who moved up a risk category with inclusion of the GS, the improvement in risk classification was statistically significant (19-SNP p=0.01, 13-SNP p=0.04). In the Pakistani samples, risk allele frequencies were significantly lower compared to NPHSII for 13/19 SNPs. In the Islamabad study, the mean gene score was higher in cases than controls only for the 13-SNP GS (2.24 v 2.34, p=0.04). There was no association with CHD and either score in the Lahore study.ConclusionThe performance of both GSs showed potential clinical utility in European men but much less utility in subjects from Pakistan, suggesting that a different set of risk loci or SNPs may be required for risk prediction in the South Asian population.

Assessment of serum 25-hydroxy vitamin D improves coronary heart disease risk stratification in patients with type 2 diabetes

A growing body of evidence suggests an association between lower serum 25-hydroxy vitamin D (25(OH)VitD) levels and adverse cardiovascular events. Patients with type 2 diabetes mellitus (T2DM) are at increased risk for developing coronary heart disease (CHD). 25-Hydroxy vitamin D deficiency is highly prevalent, especially among patients with T2DM. This study aimed to evaluate the predictive value of serum 25(OH)VitD in improvement of CHD risk stratification in patients with T2DM. In an open cohort, community-dwelling T2DM patients were followed up for first CHD event. Patients were divided into 4 categories, based on 25(OH)VitD quartiles. Cox regression analysis was used to obtain hazard ratios. A total number of 2,607 T2DM patients were followed up for median time of 8.5 years. During follow-up, 299 patients experienced CHD events. Patients in the lowest quartile experienced more CHD events. Adjusted hazard ratios (95% CI) for developing CHD events were 0.77 (0.55-1.07) for second quartile, 0.52 (0.38-0.73) for third quartile, and 0.43 (0.31-0.60) for fourth quartile, compared with the first quartile. The incidence rate decreased as serum 25(OH)VitD increased, which remained significant after stepwise adjustments (P value for trend ≤.001). Addition of 25(OH)VitD to traditional risk factors in Framingham Risk Score successfully reclassified 29% of study population. Serum 25(OH)VitD is an independent predictor of future adverse CHD events in patients with T2DM. Addition of 25(OH)VitD status to Framingham Risk Score improves CHD risk prediction in patients with T2DM.

Lipoprotein ratios are better than conventional lipid parameters in predicting coronary heart disease in Chinese Han people.

Dyslipidaemia is the main risk factor for coronary heart disease (CHD). Plasma lipid levels are conven-tionally used to predict coronary risk globally, but further studies are required to investigate whether the lipoprotein ratios are superior to conventional lipid parameters as predictors for CHD. A hospital-based case-control study consisting of 738 CHD patients and 157 control subjects was conducted in a Chinese Han population. Demographic characteristics and plasma lipid or apolipoprotein data were collected. Univariate and multivariate logistic regression analyses were carried out to examine the relationship between the lipoprotein ratios and CHD risk. The CHD group had significantly higher age, non-high-density lipoprotein cholesterol (non-HDL-C), lipoprotein (a) [Lp(a)], triglyceride (TG)/HDL-C, total cholesterol (TC)/HDL-C, low-density lipoprotein cholesterol (LDL-C)/HDL-C, non-HDL-C/HDL-C, very low-density lipoprotein cholesterol (VLDL-C)/HDL-C, and apolipoprotein B100/apolipoprotein AI (apoB100/apoAI) than the control group (p < 0.05 for all). Moreover, the prevalence of male sex, smoking, and hypertension in the CHD group was significantly higher than in the control group. The results from univariate logistic regression analysis showed that the ratios of TC/HDL-C (OR 1.135, 95% CI 1.019-1.265), LDL-C/HDL-C (OR 1.216, 95% CI 1.033-1.431), non-HDL-C/HDL-C (OR 1.135, 95% CI 1.019-1.265), and apoB100/apoAI (OR 1.966, 95% CI 1.013-3.817) significantly increased the risk for CHD. By multivariate logistic regression analysis, the results were not materially altered and each of the four ratios was independently associated with CHD after adjustment for non-lipid coronary risk factors. ApoB100/apoAI showed the strongest association with CHD in both the univariate and multivariate logistic regression analyses. Our data indicate that the lipoprotein ratios are superior to conventional lipid parameters as predictors for CHD. Of the ratios, apoB100/apoAI is the best to predict CHD risk.

Relationship between bone mineral density and a 10-year risk for coronary artery disease in a healthy Korean population: the Korea National Health and Nutrition Examination Survey 2008-2010.

Bone mineral density (BMD) is associated with atherosclerosis and vascular calcification. If BMD is related independently to the risk of coronary heart disease (CHD), BMD could play an important role in CHD risk prediction. We assessed the hypothesis that BMD is related independently to the risk of CHD. We used data from the fourth and fifth Korea National Health and Nutrition Examination Surveys. The study sample included men and women aged 20-79 years, who did not have myocardial infarction, angina pectoris, stroke, or diabetes mellitus. We evaluated the relationship between BMD and the Framingham risk score for each sex. In the male population, femur neck BMD [coefficient=-2.167, 95% confidence interval (CI) -3.385 to -0.950, P=0.001] and lumbar spine BMD (coefficient=-1.539, 95% CI -2.546 to -0.532, P=0.003) showed an inverse correlation with the Framingham risk score after adjusting for covariates. In the female population, the relationship between BMD parameters and the Framingham risk score was not significant after adjusting for covariates. In the male population, those with femur neck BMD values in the first quartile had greater odds of a 10-year risk greater than or equal to 10% for CHD compared with those in the fourth quartile (odds ratio=1.942, 95% CI 1.315-2.869, P<0.001). BMD was correlated inversely with the 10-year risk for CHD in the healthy male population. This result suggests that in the male population, measurement of BMD could be useful for prediction of the risk of CHD.

Vaskularna starost i debljina intimo-medijalnog kompleksa karotidnih arterija

Measurement of carotid intima-media thickness with B-mode ultrasound is a noninvasive and highly reproducible technique for detecting and quantifying subclinical atherosclerosis. Several large, prospective, epidemiologic studies have shown that this method accurately identifies prevalence and incidence of cardiovascular disease, independently of traditional risk factors. The value of this method is that it can be used to determine patients' vascular age. Measurement of carotid intima-media thickness reveals current atherosclerotic burden, it is feasible in a clinical setting and it can be integrated into coronary heart disease risk assessment models. Vascular age is substitution for chronological age and it is used in order to improve coronary heart disease risk prediction taking current carotid atherosclerotic burden into account.

Risk of coronary heart disease in patients with HIV infection.

The lives of individuals infected with HIV who have access to combination antiretroviral therapy (cART) are substantially prolonged, which increases the risk of developing non-AIDS comorbidities, including coronary heart disease (CHD). In Europe and the USA, individuals with HIV infection have a ∼1.5-fold increased risk of myocardial infarction relative to uninfected individuals. In Africa, the relative risk of myocardial infarction is unknown, but broadened access to life-extending cART suggests that rates of CHD will rise in this and other resource-constrained regions. Atherogenesis in HIV is affected by complex interactions between traditional and immune risk factors. cART has varied, regimen-specific effects on metabolic risk factors. Overall, cART seems to lessen proatherogenic immune activation, but does not eliminate it even in patients in whom viraemia is suppressed. Current strategies to decrease the risk of CHD in individuals infected with HIV include early initiation of cART regimens with the fewest metabolic adverse effects, and careful management of traditional CHD risk factors throughout treatment. Future strategies to prevent CHD in patients with HIV infection might involve the use of HIV-tailored CHD risk-prediction paradigms and the administration of therapies alongside cART that will further decrease proatherogenic HIV-specific immune activation.

A multilocus genetic risk score predicts coronary heart disease risk in a Chinese Han population

Objective: Genome-wide association studies have identified multiple genetic loci associated with coronary heart disease (CHD) risk. However, whether these loci could improve the CHD risk prediction is unclear. Methods and results: The present case-control study (1146 CHD cases and 1146 controls) genotyped 19 recently discovered SNPs that associated with CHD risk. As a result, 10 SNPs were successfully replicated with odds ratios (ORs) ranging from 1.16 to 1.78 (P = 4.6 × 10−2 to 5.99 × 10−6). A genetic risk score was constructed to assess the combined effects of the susceptibility loci on CHD risk. Subject in the second tertile (OR = 1.32, 95% CI, 1.02–1.73, P = 3.84 × 10−2) and the third tertile (OR = 2.62, 95% CI, 2.00–3.43, P = 3.18 × 10−12) had an increased risk of CHD comparing with those in the first genetic risk score tertile after adjustment for traditional risk factors including family history of CHD. Addition of the genetic risk score to the traditional model significantly improved the net reclassification as measured by the net reclassification index (NRI) (4.82%, P = 0.0001), however, no significant improvement was observed in discrimination of CHD, the area under the receiver operating characteristic curve (AUC) increased from 0.811 to 0.822 (P = 0.18). Conclusions: A multilocus genetic risk score was associated with CHD risk in a Chinese Han population. This genetic risk score improved the net reclassification but not improved the CHD discrimination. The potential clinical use of this variations remains to be defined.

Plasma phospholipid fatty acid biomarkers of dietary fat quality and endogenous metabolism predict coronary heart disease risk: a nested case-control study within the Women's Health Initiative observational study.

BackgroundAlthough the relationship between dietary fat quality and coronary heart disease (CHD) risk has been evaluated, typically using diet questionnaires, results are inconsistent and data in postmenopausal women are limited. Plasma phospholipid fatty acid (PL‐FA) profiles, reflecting dietary intake and endogenous FA metabolism, may better predict diet–CHD risk.Methods and ResultsUsing a nested case‐control design, we assessed the association between plasma PL‐FA profiles and CHD risk in 2448 postmenopausal women (1224 cases with confirmed CHD and 1224 controls matched for age, enrollment date, race/ethnicity, and absence of CHD at baseline and after 4.5 years of follow‐up) participating in the Women's Health Initiative observational study. PL‐FA profile was measured using gas chromatography. Product/precursor ratios were used to estimate stearoyl‐CoA‐desaturase (16:1n‐7/16:0, 18:1n‐9/18:0), Δ6‐desaturase (20:3n‐6/18:2n‐6), and Δ5‐desaturase (20:4n‐6/20:3n‐6) activities, indicators of endogenous FA metabolism. Multivariate conditional logistic regression was used to obtain odds ratios (95% CIs) for CHD risk. While no associations were observed for the predominant PL fatty acid (16:0, 18:0, 18:1n‐9, and 18:2n‐6), plasma PL–saturated fatty acid (1.20 [1.08 to 1.32]) and endogenously synthesized PL ω6 fatty acids (20:3n‐6; 3.22 [1.95 to 5.32]), 22:5n‐6; 1.63 [1.20 to 2.23]) and Δ6‐desaturase (1.25 [1.11 to 1.41]) were positively associated with CHD risk. PL‐ω3 fatty acids (20:5n‐3; 0.73 [0.58 to 0.93], 22:5n‐3; 0.56 [0.33 to 0.94], 22:6n‐3; 0.56 [0.39 to 0.80]), 18:1n‐7 (0.54 [0.29 to 0.99]), and Δ5‐desaturase (0.78 [0.70 to 0.88]) were inversely associated with CHD risk. Results support current guidelines regarding regular fish consumption. Additional findings include associations between endogenously synthesized fatty acids and CHD risk, which were partly explained by changes in Δ6‐desaturase and Δ5‐desaturase indexes, suggesting that in vivo metabolism may also play an important role in predicting CHD risk in this cohort of postmenopausal women.Clinical Trial RegistrationURL: http://ClinicalTrials.gov, Unique identifier: NCT01864122.

Validated context-dependent associations of coronary heart disease risk with genotype variation in the chromosome 9p21 region: the Atherosclerosis Risk in Communities study.

Markers of the chromosome 9p21 region are regarded as the strongest and most reliably significant genome-wide association study (GWAS) signals for Coronary heart disease (CHD) risk; this was recently confirmed by the CARDIoGRAMplusC4D Consortium meta-analysis. However, while these associations are significant at the population level, they may not be clinically relevant predictors of risk for all individuals. We describe here the results of a study designed to address the question: What is the contribution of context defined by traditional risk factors in determining the utility of DNA sequence variations marking the 9p21 region for explaining variation in CHD risk? We analyzed a sample of 7,589 (3,869 females and 3,720 males) European American participants of the Atherosclerosis Risk in Communities study. We confirmed CHD-SNP genotype associations for two 9p21 region marker SNPs previously identified by the CARDIoGRAMplusC4D Consortium study, of which ARIC was a part. We then tested each marker SNP genotype effect on prediction of CHD within sub-groups of the ARIC sample defined by traditional CHD risk factors by applying a novel multi-model strategy, PRIM. We observed that the effects of SNP genotypes in the 9p21 region were strongest in a sub-group of hypertensives. We subsequently validated the effect of the region in an independent sample from the Copenhagen City Heart Study. Our study suggests that marker SNPs identified as predictors of CHD risk in large population based GWAS may have their greatest utility in explaining risk of disease in particular sub-groups characterized by biological and environmental effects measured by the traditional CHD risk factors.

Homocysteine and metabolic syndrome: From clustering to additional utility in prediction of coronary heart disease

BackgroundThe association between homocysteine (Hcy) and metabolic syndrome (MetS)-related disorders remains to be unveiled. First, the role of Hcy–MetS interaction in prediction of coronary heart disease (CHD) was assessed. Next, we investigated whether serum Hcy improves CHD risk-prediction beyond MetS and traditional risk factors (TRFs). DesignA prospective study of 5893 community-dwelling participants (two sub-cohorts, 3286 diabetic and 2607 non-diabetic; ∼8.5 years of follow-up). MethodsClustering of Hcy with MetS components was assessed using exploratory factor-analysis. Cox regression hazard ratio (HR) was used to predict CHD using Hcy level and MetS status. Baseline model included MetS and TRFs. Addition of Hcy and hyper-homocysteinemia (HHcy) to the baseline model was evaluated in two separate models. ResultsHcy was correlated with MetS components, especially with systolic blood pressure. The factor linking MetS to CHD is the factor through which Hcy is linked to MetS. HHcy and MetS interacted as risk factors for CHD. ConclusionHcy adds to the value of MetS and TRFs for CHD risk-prediction by reclassifying around 47.3–49.0% of the overall and 21.6–28.1% of the intermediate-risk population.

Comparison of four cardiovascular risk prediction functions among Chinese patients with diabetes mellitus in the primary care setting.

To assess the feasibility, convergent validity and sensitivity of four cardiovascular risk prediction functions in Chinese diabetic patients in the primary care setting. A cross-sectional study of 1,140 diabetic patients was carried out to compare four cardiovascular risk functions, which were respectively developed from the Framingham heart study, the USA-People's Republic of China Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology cohort (PRC), the United Kingdom Prospective Diabetes Study (UKPDS) and the Joint Asia Diabetes Evaluation program (JADE). Feasibility was assessed by the percentage of patients with complete data for risk prediction. Convergent validity was measured by Spearman's rank correlation, paired Wilcoxon signed-rank sum test and Bland-Altman plots. Effect size differences between clinical risk groups were used to assess the sensitivity. Risk prediction was feasible by the Framingham, UKPDS and PRC risk functions in more than 98% patients, whereas just 74% of patients had complete data for the JADE function. The annual total coronary heart disease (CHD) risk predicted by the JADE and the UKPDS functions showed excellent agreement with no significant difference, and a correlation of 0.8048. The Framingham and the PRC functions predicted significantly lower CHD risk than those by the UKPDS and the JADE functions. The UKPDS and the Framingham functions were more sensitive in differentiating clinical risk groups. The UKPDS risk engine showed good feasibility, convergent validity and sensitivity in predicting CHD risk in Chinese diabetic patients. The JADE function showed excellent agreement with the UKPDS risk engine, but it was less feasible in the primary care setting.

Sleep duration, C-reactive protein and risk of incident coronary heart disease – results from the Framingham Offspring Study

BackgroundBoth sleep-duration and C-reactive protein (CRP) are useful predictors of coronary heart disease (CHD). The increased CRP level is associated with the unusual sleep-duration. However, it is unclear whether CRP impacts the CHD risk prediction of sleep-duration. Methods and resultsA total of 3381 individuals from the Framingham Offspring Study, aged 30+, CHD-free, and without missing measurement of CRP and sleep-duration and being followed to the end of 2007 were included in this analysis. Hazards ratio (HR) from the Cox regression models was used to evaluate the strength of association between the sleep-duration, CRP levels, and risk of incident CHD. Compared to sleep-duration 7–8 h (n = 2512) after adjusting for age and gender, the HR (95% CL) of incident CHD were 1.42 (1.15, 1.76, p < 0.005) for sleep-duration ≤6 h (n = 588) and 1.23 (0.90, 1.70, p < 0.2) for sleep-duration ≥9 h (n = 281), respectively. A further adjustment for other covariates including CRP did not change the CHD risk association. When subjects were categorized into 9 groups by sleep-duration (≤6, 7–8, and ≥9 h) and CRP levels (<1, 1–3, and ≥3 mg/L), and compared to those whose sleep-duration was 7–8 h and CRP levels were <1 mg/L, the HRs of CHD were similar for sleep-duration in ≤6 h or ≥9 h categories regardless of their CRP levels. The increased CRP levels, however, did show an increased risk for CHD when sleep-duration was 7–8 h ConclusionThe levels of CRP do not significantly attenuate the association between sleep duration and incident CHD.

Assessing 10-year coronary heart disease risk in people with Type 2 diabetes mellitus: Framingham versus United Kingdom Prospective Diabetes Study

Aims: Previous studies have suggested that the Framingham coronary heart disease risk prediction equation underestimates risk among people with Type 2 diabetes. We compared the 10-year absolute risks of coronary heart disease (CHD) using a Framingham equation and a United Kingdom Prospective Diabetes Study (UKPDS) equation in adults with Type 2 diabetes. Methods: Participants were from a cross-sectional survey of a randomly selected population. There were 461 people with newly (n = 132) or previously diagnosed (n = 329) diabetes aged 35 to 74 years with no past history of cardiovascular disease or nephropathy. We examined predicted 10-year CHD risk by age, gender, and newly or previously diagnosed diabetes. Results: Overall the mean 10-year CHD risks predicted by the two equations were similar. Among men, the UKPDS and Framingham scores were almost identical below 60 years of age but at older ages, the UKPDS score was 4% - 11% higher than Framingham. For women, the Framingham score was higher than the UKPDS score between ages 40 and 65 years, but the UKPDS score was about 4% - 5% higher for women aged 70 years and over. The UKPDS equation tended to give higher risk estimates in people with a predicted 10-year Framingham CHD risk above 15%. Conclusion: Framingham CHD risk scores tended to be lower than UKPDS scores primarily in people above standard thresholds for drug treatment, so the clinical impact of underestimating risk is likely to be limited. Moreover, the UKPDS equation predicted lower risks than Framingham for women and newly diagnosed diabetes at otherwise low to moderate CHD risk, which could result in later initiation of therapy in these groups if the UKPDS score was used instead of the Framingham score.

Identification of Cardiovascular Risk Components in Urban Chinese with Metabolic Syndrome and Application to Coronary Heart Disease Prediction: A Longitudinal Study

BackgroundMetabolic syndrome (MetS) is proposed as a predictor for cardiovascular disease (CVD). It involves the mechanisms of insulin resistance, obesity, inflammation process of atherosclerosis, and their complex relationship in the metabolic network. Therefore, more cardiovascular risk-related biomarkers within this network should be considered as components of MetS in order to improve the prediction of CVD.MethodsFactor analysis was performed in 5311 (4574 males and 737 females) Han Chinese subjects with MetS to extract CVD-related factors with specific clinical significance from 16 biomarkers tested in routine health check-up. Logistic regression model, based on an extreme case-control design with 445 coronary heart disease (CHD) patients and 890 controls, was performed to evaluate the extracted factors used to identify CHD. Then, Cox model, based on a cohort design with 1923 subjects followed up for 5 years, was conducted to validate their predictive effects. Finally, a synthetic predictor (SP) was created by weighting each factor with their risks for CHD to develop a risk matrix to predicting CHD.ResultsEight factors were obtained from both males and females with a similar pattern. The AUC to classify CHD under the extreme case-control suggested that SP might serve as a useful tool in identifying CHD with 0.994 (95%CI 0.984-0.998) for males and 0.998 (95%CI 0.982-1.000) for females respectively. In the cohort study, the AUC to predict CHD was 0.871 (95%CI 0.851-0.889) for males and 0.899 (95%CI 0.873-0.921) for females, highlighting that SP was a powerful predictor for CHD. The SP-based 5-year CHD risk matrix provided as convenient tool for CHD risk appraisal.ConclusionsEight factors were extracted from sixteen biomarkers in subjects with MetS and the SP adds to new insights into studies of prediction of CHD risk using data from routine health check-up.

The Importance of Non-Coronary Atherosclerosis

Coronary atherosclerosis leading to coronary heart disease (CHD) is now responsible for the largest burden of morbid and mortal disease in developed countries, and this is increasing so in developing countries around the world. It is now well recognized that computed tomography (CT) scans can quantitatively assess coronary artery calcium (CAC), a direct marker of coronary atherosclerosis, and CAC can substantially aid in risk prediction of both CHD and other cardiovascular disease (CVD) outcomes. Of course, this might be expected since CAC is actually a direct measure of coronary atherosclerosis, as opposed to a risk factor for CHD such as cigarette smoking or dyslipidemia. Atherosclerosis is a generalized disease and as such also affects other arterial beds throughout the body. This observation raises the question as to whether measurement of atherosclerosis outside of the coronary arteries is of value in risk prediction or disease prognosis for CHD or CVD. Extensive research has shown that the answer is yes; that is, selected measurements of non-coronary atherosclerosis provide incremental and independent information beyond both standardized risk scores employing risk factors, as well as beyond measurement of CAC. Thus, measurements of non-coronary atherosclerosis, both subclinical and clinical, can aid in the prediction of, and determining prognosis for, CHD as well as other CVD events. The epidemiologic and clinical value of non-coronary atherosclerosis will be illustrated with data from research into four selected non-coronary atherosclerosis measures. These measures are the ankle-brachial index (ABI), which is the ratio of the systolic blood pressure at the ankle to that in the arm; subclavian stenosis (SS), which is determined by a significant systolic blood pressure difference between the left and right arms; renal artery calcification (RAC) assessed by CT scan, and abdominal aortic calcification (AAC) assessed by CT scan. Data to be presented come from both US and international studies, and will address the significance of these four measure both in persons without known CVD and in persons with a clinical diagnosis of CVD.

Abstract 17986: Multiple Single Day Blood Pressure Measurements and Their Impact on Coronary Heart Disease, Stroke, and Heart Failure Risk Prediction: The Atherosclerosis Risk In Communities (ARIC) Study

BACKGROUND: Although systolic blood pressure (SBP) varies through the day, single SBP measures are used in all coronary heart disease (CHD), heart failure (HF) and stroke risk prediction equations. Changes in SBP clearly affect estimated risk. However, the magnitude of change in risk when different SBP measures performed within one day are used in risk equations is not known. METHODS: Same day multiple SBP measurements (sitting, standing and supine) were performed by certified technicians using a Dinamap device in 11,075 ARIC study participants (mean age 53.9 ± 5.7 years, 57% with history of smoking, 10% diabetic and 31% hypertensive). We estimated 10 year CHD, HF and stroke risks for each SBP measure and classified individuals as 0-5%, 5-10%, 10-20% and &gt;20% risk.Then, we evaluated changes in individual risks within a day. Results: (Table): Substituting mean sitting SBP for standing and supine SBP in the Framingham CHD Risk Score (FRS) reclassified 8.3% and 10.2% of the subjects, and in the ARIC Coronary Risk Score (ACRS), 7.1% and 9.6%, respectively. Similarly, when stroke and HF risks were evaluated using ARIC risk scores 11.7% and 12.3% were reclassified when standing SBP was used, and 10.7% and 11.7% were reclassified with supine SBP measures. The maximum changes in an individual’s estimated 10 year risk were 21%, 26% and 24% for CHD, stroke and HF risk, suggesting greater than one risk category (e.g.,low to high risk) change in a day. When different sitting SBP measures (taken within minutes of each other) were used, 6.7%, 6.5%, 6.5% and 8.0% of subjects were reclassified when FRS, ACRS, ARIC stroke and HF risks were estimated. CONCLUSION: SBP changes within a day can result in statistically significant changes in estimated CHD, stroke, and HF risk. Our study has implications for the use of a single SBP measure to determine an individual’s cardiovascular risk, and raises questions on the utility of current risk prediction algorithms in patient management.

Coronary Heart Disease Risk in Volunteer Firefighters in Victoria, Australia

ABSTRACT Coronary heart disease (CHD) is a major problem for firefighters, even when considering the healthy worker effect (HWE). Although volunteer firefighters outnumber paid personnel, previous research has focused on paid US firefighters. By contrast, no CHD data for Australian firefighters exist. Risk factor data were collected from 2,943 Australian volunteer firefighters and CHD risk was compared with reference “low-risk” and Australian population data. Predicted CHD risk for male and female firefighter was 19.2% and 5.1%, respectively. Female firefighters high blood pressure and fasting glucose was significantly lower than the general population, whereas all other risk factors was similar to the general population. Firefighters’ CHD risk was greater than other volunteer and paid emergency services, but the prevalence for most risk factors was similar to the general population. Therefore, Australian volunteer firefighters may not benefit from the HWE.

Changes in predicted cardiovascular disease risk after biliopancreatic diversion surgery in severely obese patients

ObjectiveTo determine the impact of biliopancreatic diversion with duodenal switch (BPD-DS) surgery on cardiovascular risk profile and predicted cardiovascular risk in severely obese patients. Materials/MethodsWe compared 1-year follow-up anthropometric and metabolic profiles in severely obese who underwent BPD-DS (n=73) with controls (severely obese without surgery) (n=33). The 10-year predicted risk for coronary heart disease (CHD) was estimated using the Framingham risk-tool. We assigned 10-year and lifetime predicted risks to stratify subjects into 3 groups: 1) high short-term predicted risk (≥10% 10-year risk or diagnosed diabetes), 2) low short-term (<10% 10-year risk)/low lifetime predicted risk or 3) low short-term/high lifetime predicted risk. ResultsDuring the follow-up period, body weight and body mass index decreased markedly in the surgical group (−52.1±1.9kg and −19.0±0.6kg/m2 respectively, p<0.001) vs. (−0.7±1.0kg and −0.3±0.4kg/m2, p=0.51). Weight loss in the surgical group was associated with a reduction in HbA1C (6.2% vs. 5.1%), HOMA-IR (61.5 vs. 9.3), all lipoprotein levels, as well as blood pressure (p<0.001). The 10-year CHD predicted risk decreased by 43% in women and 33% in men, whereas the estimated CHD risk in the non surgical group did not change. Before surgery, none of the women and only 18% of men showed low short-term/low lifetime predicted risk, whereas a significant proportion of subjects had high short-term predicted risk (36% in women and 12% in men). Following surgery, 52% of women and 55% of men have a low short-term/low lifetime predicted risk. ConclusionsThese results highlight the cardiovascular benefits of BPD-DS and suggest a positive impact on predicted CHD risk in severely obese patients. Long-term studies are needed to confirm our results and to ascertain the effects on CHD risk estimates after BPD-DS surgery.

Elevated High-Sensitivity C-Reactive Protein as a Risk Marker of the Attenuated Relationship Between Serum Cholesterol and Cardiovascular Events at Older Age

The relationship between cholesterol and coronary heart disease (CHD) is attenuated at older age. We analyzed cholesterol level as a predictor of CHD in 8,947 participants from the Atherosclerosis Risk in Communities (ARIC) Study, a large multicenter cohort study that enrolled participants in 1987-1989 at 4 field centers in Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and Minneapolis, Minnesota. Participants in the present analysis had no history of CHD and were stratified by age (<65 or ≥65 years) and high-sensitivity C-reactive protein (hs-CRP) level (<2 or ≥2 mg/L). Visit 4 (1996-1997) was the baseline for this analysis, with follow-up through 2008. Cholesterol level was significantly associated with CHD among younger participants, and cholesterol level was similarly predictive of CHD among older participants with an hs-CRPlevel of <2 mg/L. In contrast, among older participants with an hs-CRP level of 2 mg/L or higher, the association of CHD with total cholesterol level was borderline significant (hazard ratio = 1.14, 95% confidence interval: 1.00, 1.29), and the association of CHD with low-density lipoprotein cholesterol level was nonsignificant (hazard ratio = 1.10; 95% confidence interval: 0.96, 1.26). Among older persons with an elevated hs-CRP level, cholesterol level was significantly less predictive of CHD (P < 0.05), whereas for those with an hs-CRP levelof <2 mg/L, there was no significant difference compared with younger participants. In conclusion, we found that among the young-old, the association of cholesterol level with CHD was strong when hs-CRP level was not elevated and weak when hs-CRP level was elevated. Therefore, hs-CRP level could be useful for stratifying the young-old to assess the strength of cholesterol level in CHD risk prediction.