CVD Risk Score Research Articles

Predicting for Cardiac Events Following Allogeneic Hematopoietic Stem Cell Transplantation in Adults

Introduction Cardiovascular (CV) complications occur after hematopoietic stem cell transplantation (HCT). Risk factors for events are unclear making it difficult to determine optimal pre-transplant screening. Solid organ transplants programs calculate pre-transplant risk to determine indication for further cardiac testing. Based on this, we investigated whether several commonly used CV risk calculators predicted for CV events after HCT. Methods This was a prospective case control study at a single academic institution. CV risk was estimated using the Framingham General CVD Risk Score (2008), ACC/AHA Pooled Cohort Hard CVD Risk (ASCVD; 2013) calculator, and JBS3 QRISK Lifetime calculator. Results Forty-eight patients transplanted between 2012 and 2016 were analyzed. 27 (56%) were female. Ages ranged from 53-74 with a median of 64. Diseases transplanted were: AML (38%), MDS (31%), Non-Hodgkin's lymphoma (15%), and others 47% had high risk for CVD (score>2) by Framingham score. 67% had high risk by ASCVD calculator (10 year risk >7.5%). 70% had high risk by QRISK Lifetime calculator. 9%were low risk by Framingham score, but high risk by QRISK Lifetime calculator. Cardiac events evaluated included atherosclerotic events (myocardial infarction and stroke), atrial fibrillation (a-fib), and others (other arrhythmia, CHF, drop in LVEF, and cardiac arrest). 40% had any cardiac event. 15% had an atherosclerotic event (MI or CVA). 21% had a-fib. Framingham Risk, ASCVD and QRISK calculators did not predict for either atherosclerotic events or any cardiac events after HCT [Table 1]. Risk factors for a-fib specifically, were also evaluated: history of MI, diastolic or systolic dysfunction, CHF, valvular disease, tobacco use, diabetes, and hypertension. Only CHF was a predictor for a-fib (p=0.08). Conclusion CVD risk calculators commonly used in the general population and by solid organ transplant programs did not predict for CV events post-HCT here. However, this analysis was limited by small study size. Study in a larger population is being planned to allow incorporation of transplant related variables to develop a HCT-specific multivariate risk calculator to accurately predict post-HCT CV events.

Contributions and Implications of the Tehran Lipid and Glucose Study.

Tehran Lipid and Glucose Study (TLGS), an epidemiological study of non-communicable disease with 20 years follow up in a developing country in nutrition transition is a unique study in 15000 family based individuals, 3 - 75 years of age in a part of large city of Tehran. The success rate of recruitment for 20 years, intervention for lifestyle change, and thyroid, reproduction and cardiometabolic genetic studies derived from TLGS have paved suitable path towards precision medicine. In this review, baseline findings and changes of risk factors for the development of NCD including body weight, nutrition, physical activity, blood pressure, tobacco smoking, serum glucose and serum lipids as well as metabolic syndrome, chronic kidney disease, quality of life and biochemical findings in TLGS cohort have been summarized. The results of community based intervention for lifestyle change caused decreases in the prevalence of metabolic syndrome and the incidence of diabetes.It is concluded that TLGS has served as a model for other cohort studies in Iran and the region; it has helped to mobilize scientists in developing countries; it has established locally needed definitions of NCD variables; has served as a model for cohort studies in developing countries in nutrition transition with all socioeconomic constraints and has helped manpower education and development of local CVD risk scores for implementation of NCD management.

Circulating angiogenic stem cells in type 2 diabetes are associated with glycemic control and endothelial dysfunction.

Circulating angiogenic cells (CACs) of various described phenotypes participate in the regeneration of the damaged endothelium, but the abundance of these cells is highly influenced by external cues including diabetes. It is not entirely clear which CAC populations are most reflective of endothelial function nor which are impacted by diabetes. To answer these questions, we enrolled a human cohort with variable CVD risk and determined relationships between stratified levels of CACs and indices of diabetes and vascular function. We also determined associations between CAC functional markers and diabetes and identified pro-angiogenic molecules which are impacted by diabetes. We found that subjects with low levels of CD34+/AC133+/CD31+/CD45dim cells (CAC-3) had a significantly higher incidence of diabetes (p = 0.004), higher HbA1c levels (p = 0.049) and higher CVD risk scores. Furthermore, there was an association between low CAC-3 levels and impaired vascular function (p = 0.023). These cells from diabetics had reduced levels of CXCR4 and VEGFR2, while diabetics had higher levels of certain cytokines and pro-angiogenic molecules. These results suggest that quantitative and functional defects of CD34+/AC133+/CD31+/CD45dim cells are associated with diabetes and vascular impairment and that this cell type may be a prognostic indicator of CVD and vascular dysfunction.

Contribution of the neighborhood environment to cross-sectional variation in long-term CVD risk scores in the Framingham Heart Study.

Few studies of the health impact of the built environment have examined downstream outcomes, such as cardiovascular disease. We analyzed the neighborhood-level proportional variance in the 10- and 30-year Framingham risk scores (FRS) in the Framingham Heart Study. Our analysis included 3,103 Offspring- and Generation 3 cohort participants 20–74 years old, inhabiting private residences in Massachusetts geocoded to neighborhoods (defined as 2000 US Census block groups) containing the residences of ≥5 participants. The outcome variables were log-transformed to mitigate the effects of the non-normal distributions. In order to remove the possible effects of neighborhood clustering by age and sex, we analyzed residuals of the transformed FRS regressed upon age and sex. Neighborhood-level intraclass correlations (ICCs) and 95% confidence intervals (CIs) of age- and sex-independent, log-transformed FRS were estimated using multilevel linear regression. Individual- and neighborhood-level variables were then added to models to evaluate their influence on ICCs. Analyses were repeated stratified by sex. Among 2,888 participants living in 187 neighborhoods, 1.73% (95% CI: 0.62, 4.72%) of the variance in 10-year FRS was explained at the neighborhood level. The neighborhood ICC was 2.70% (95% CI: 0.93, 7.56) among women but 0.23% (95% CI: 0.00, 99.47%) among men. In the analysis of the neighborhood-level variances in 30-year FRS among 2,317 participants residing in 164 neighborhoods, the ICCs were 3.31% (95% CI: 1.66, 6.47%), 6.47% (95% CI: 3.22, 12.58), and 0.74% (95% CI: 0.01, 33.31), among all participants, women, and men, respectively. In our homogenous middle-class white population in Massachusetts, residential neighborhoods explained a small proportion of the variance in CVD risk.

E-Sakto: Lowering the Cardiovascular Risk of Patients with Hypertension and Diabetes Through Public–Private Partnership

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Relation of Subclinical Hypothyroidism is Associated With Cardiovascular Events and All-Cause Mortality in Adults With High Cardiovascular Risk

The aim of this study was to determine the association between subclinical hypothyroidism and cardiovascular (CVD) events, and mortality using the atherosclerotic CVD risk score. We carried out an observational study in a prospective cohort that was followed up for 12 years. The study included 3,021 participants aged ≥ 40 years at baseline from the Ansung cohort, part of the Korean Genome and Epidemiology Study. Cox regression models were constructed to evaluate the hazards ratio (HR) and 95% confidence interval (CI) for all-cause mortality and CVD events in groups classified according to thyroid status. Subgroup analysis was performed with a cut-off age of 65 years or 7.5% of the 10-year atherosclerotic CVD risk score. The subclinical hypothyroidism group in the highest quartile of thyroid-stimulating hormone (>6.57 mIU/L) had a significantly increased risk of all-cause mortality (HR 2.12, 95% CI 1.27 to 3.56) and CVD events (HR 1.92, 95% CI 1.21 to 3.04) compared with euthyroid participants. Subgroup analysis by CVD risk revealed that participants with high CVD risk only had a high risk of all-cause mortality (HR 2.18, 95% CI 1.22 to 3.87) and CVD events (HR 2.42, 95% CI 1.35 to 4.33). Further analysis showed that participants aged <65 years with high CVD risk had the highest risk of all-cause mortality (HR 3.50, 95% CI 1.50 to 8.16) and CVD events (HR 3.37, 95% CI 1.46 to 9.57). Our results demonstrated that high thyroid-stimulating hormone levels were associated with a greater risk of mortality and new CVD risks, particularly among subjects with high CVD risk.

Abstract P368: Neighborhoods and Subclinical Cardiovascular Disease

Background: Research on the health impact of the built environment has focused on health behaviors such as diet and exercise, and conditions such as obesity and diabetes. Few studies have examined its influence on downstream outcomes such as cardiovascular disease. We investigated the proportional variance in the 10-year and 30-year Framingham risk score (FRS) attributable to neighborhoods in the Framingham Heart Study. Methods: Offspring- and Generation 3 cohort members’ homes at the time of exam 7 (Offspring, 1998-2001) or exam 1 (Generation 3, 2002-2005) were geocoded to 2000 Census block groups. We evaluated Framingham Offspring and Generation 3 cohort participants inhabiting private residences in block groups within Massachusetts containing the residences of 5 or more participants. Analyses of the 10-year FRS were further restricted to participants aged 30-74 at the time of the relevant exam and those of the 30-year FRS to participants 20-59 years old. Cardiovascular risk was determined on the bases of sex, age, systolic blood pressure, anti-hypertensive medication, smoking, diabetes, total cholesterol, and HDL. The outcomes were the standardized residuals of log-transformed FRS regressed on age and sex. We analyzed the percentage of variance of FRS explained at the block-group level and 95% confidence intervals using multilevel linear regression. An empty model was first used to estimate the total variance and the following factors were then added singly to evaluate their influence on the group-level FRS variance explained by education, body mass index, waist circumference, physical activity score, and depression (CES-D score ≥16). Analyses were repeated stratified by sex. Results: The analysis of 10-year FRS included a total of 2,882 participants in 188 census block groups. The block-group-level variance explained for this outcome was 1.77% (95% CI=0.69, 4.44). Upon the addition of BMI to the model, the variance explained dropped to 1.11% (95% CI=0.28%, 4.30%). None of the other covariates had a substantial impact. Among 1,363 women in 117 block groups, the block level group explained a total of 2.03% of the FRS variance at the block level group (95% CI=0.61, 6.56), which dropped to 0.64% (95% CI=0.03, 13.82) when BMI was added to the model. Results were somewhat stronger in analysis of the 30-year FRS. The group-level FRS variance explained by census blocks was 3.56% (95% CI=1.75, 7.12) among 2096 participants in 156 neighborhoods. Similar to the 10-year CVD risk score, the variance explained among women (959 in 97 block groups) was higher (6.06%, 95% CI=2.75, 12.83), but null among males. Conclusions: In this relatively homogenous suburban white population, census block groups explained a small percentage of the variance in CVD risk. The explained variance was higher among women (19% non-working vs. 5% of males), and largely explained by the clustering of obesity.

Effects of a Stress Management Program Based on Psychological Risk Factors of Cardiovascular Disease after Retirement in an Underpopulated Area: A Pilot Study

Background: To develop an effective health education program to prevent cardiovascular disease in middle-aged residents after retirement in underpopulated areas, we explored the effects of a stress management program based on the type A behavior pattern. Methods: This study was carried out in a rural city in Japan recognized as underpopulated and participants were civil servants aged 45 - 64 who joined a stress management program offered as part of staff training. Learning materials for the program were developed based on the type A behavior pattern. Measures for the impact evaluation were Bloom’s learning domains and stage of change for stress management practice. Measures for the outcome evaluation were KG’s Daily Life Questionnaire (KG Questionnaire), the Hospital Anxiety and Depression Scale (HADS) and the Framingham 10-year cardiovascular risk score (CVD risk score). We statistically analyzed changes in each item between time points. Results: Eighteen participants completed questionnaire surveys at pre-, post-, and 4 weeks post-program and eleven had complete blood pressure and weight measurements at pre- and post-program. In the impact evaluation, the Friedman test found significant differences between the three time points in all of Bloom’s learning domain scores and stage of change for stress management. In the post hoc analysis, a significant increase was seen between pre- and post-program and between pre- and 4 weeks post-program in cognitive domain score, psychomotor domain score and stage of change for stress management. In the outcome evaluation, a significant decrease in systolic blood pressure was seen between pre- and post-program. Conclusion: The present study suggested that a stress management program using learning materials based on type A behavior could promote stress management practices and reduce the risk of cardiovascular disease. This stress management program is expected to be useful as a health promotion activity for middle-aged residents after retirement in underpopulated areas.

Coronary artery calcium score improved cardiovascular disease risk prediction in asymptomatic patients

This study examined whether coronary artery calcium score (CACS) has a better accuracy than the cardiovascular risk prediction chart (CRPC), and evaluate the reclassification improvement of CACS if it isused as a screening tool compared with the CRPC. CACS has a better accuracy than the CRPC and reclassified a considerable proportion (39%) of a symptomatic patient into correct cardiovascular risk categories. CACS should be assessed in asymptomatic people with5-year CVD risk score of 5-10% and 10-15%.

Cardiac Autonomic Function, Cardiovascular Risk and Physical Activity in Adolescents.

The aims of this study were to investigate in adolescents: 1) the relationships of physical activity (PA) and cardiorespiratory fitness (CRF) to traditional CVD risk factors, rest and recovery autonomic function; and 2) whether autonomic function strengthens the associations between PA, CRF and CVD risk. Fifty-four (22 girls) adolescents had traditional CVD risk factors, rest and recovery autonomic function evaluated. CRF was measured using a steep ramp cycle test and PA was assessed with accelerometers. Resting HRV (and RMSSD30) and heart rate recovery (T30, HHRτ) were used. Clustered traditional (CVDRtrad) and autonomic (CVDRauto) risk scores were created and added to form a composite clustered CVD risk score (CVDRcom). PA and CRF were significantly and negatively associated with traditional CVD risk factors. Moderate (MPA) and vigorous (VPA) were positively related to resting RMSSD, and negatively related to T30 and HHRτ (all P<0.05). RMSSD30 recovered faster in the high compared to low median split for VPA. Stronger associations for CVDRcom compared to CVDRtrad were observed for MPA (CVDRcom: r2=0.32, P=<0.001; CVDRtrad: r2=0.17, P=0.002), and VPA (CVDRcom: r2=0.18, P=0.001; CVDRtrad: r2=0.06, P=0.08). These findings strengthen the proposed additional beneficial effects of PA on autonomic function above traditional CVD risk factors.

Awareness, treatment, and control of dyslipidemia in rural South Africa: The HAALSI (Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa) study.

Dyslipidemia is a primary driver for chronic cardiovascular conditions and there is no comprehensive literature about its management in South Africa. The objective of this study was to assess the prevalence, awareness, treatment, and control of dyslipidemia in rural South Africa and how they are impacted by different behaviors and non-modifiable factors. To fulfill this objective we recruited for this cohort study adults aged ≥40 years residing in the Agincourt sub-district of Mpumalanga Province. Data collection included socioeconomic and clinical data, anthropometric measures, blood pressure (BP), HIV-status, point-of-care glucose and lipid levels. Framingham CVD Risk Score was ascribed to patients based upon categories for 10 year cardiovascular risk of low (<3%), moderate (≥3% and <15%), high (≥15% and <30%), and very high (≥30%).LDL cholesterol control by risk category was defined according to South African Guidelines. Multivariable logistic regression models were built to identify factors that were significantly associated with dyslipidemia and awareness of dyslipidemia From 5,059 respondents a total of 4247 subjects (83.9%) had their cholesterol levels measured and were included in our analysis. Overall, 67.3% (2860) of these met criteria for dyslipidemia, only 30 (1.05%) were aware of their condition, and only 21 subjects (0.73%) were on treatment. The majority have abnormalities in triglycerides (59.3%). As cardiovascular risk increased the rates of lipid control according to LDL level dropped. Multivariate logistic regression analyses showed that being overweight was predictive of dyslipidemia (OR 1.76; 95%CI 1.51–2.05, p<0.001) and dyslipidemia awareness (OR 2.58; 95%CI 1.19–5.58; p = 0.017). In conclusion, the very low awareness and treatment of dyslipidemia in this cohort indicate a greater need for systematic screening and education within the population and demonstrate that there are multiple opportunities to allay this burden.

Abstract P115: Increased Diastolic Blood Pressure Post-mild Exercise is Associated With Early Structural and Functional Cardiovascular Abnormalities

Background: Previous research has suggested that an increase in SBP post-mild exercise is correlated with early structural and functional cardiovascular abnormalities. Purpose: To determine if an increase in diastolic blood pressure post-mild exercise (DBP PME) is associated with early structural and functional cardiovascular abnormalities. Methods: 1416 untreated, asymptomatic subjects were screened for early indicators of cardiovascular disease using the Early CVD Risk Score (ECVDRS), also known as Rasmussen Risk Score (RRS), which consists of a panel of 10 tests; large (C1) and small (C2) artery stiffness, resting BP and post mild exercise (PME), CIMT, abdominal aorta and left ventricle ultrasounds, retinal photography, microalbumuria, ECG, and pro-BNP. 267 subjects were normotensive. Of those subjects, 12 had a increase in DBP PME, 23 had no change in DBP PME, and 232 had a decline in DBP PME. Focus was placed on the three known tests recommended for early CVD assessment; C1, C2 and CIMT. Results: As seen in Figure 1.0, a rise in diastolic blood pressure PME is statistically evident for an increased risk of early structural and functional cardiovascular abnormalities. A significant increase in abnormalities was noted with C2 and CIMT with subjects whose DBP increased PME. Conclusion: Assessment of diastolic blood pressure PME is an easy, noninvasive, inexpensive test that can be performed by any health care practitioner to evaluate the risk of CVD in patients. Any increase in diastolic blood pressure PME should warrant physicians on the urgency to further investigate and treat patients to divert the progression of CVD.

Abstract P371: Incremental Changes in Systolic Blood Pressure Post-mild Exercise, in Normotensive Subjects, is Associated With Significant Structural and Functional Cardiovascular Abnormalities

Background: Abnormal rise in systolic blood pressure (SBP) post-mild exercise (PME) has been associated with early structural and functional cardiovascular abnormalities. Purpose: To determine if the differential amount of rise in SBP PME, in normotensive subjects, effected the risk of early structural and functional cardiovascular abnormalities. Methods: 1416 untreated, asymptomatic subjects were screened for early indicators of cardiovascular disease using the Early CVD Risk Score (ECVDRS), also known as Rasmussen Risk Score (RRS), which consists of a panel of 10 tests; large (C1) and small (C2) artery stiffness, resting BP and post mild exercise (PME), CIMT, abdominal aorta and left ventricle ultrasounds, retinal photography, microalbumuria, ECG, and pro-BNP. 996 subjects were normotensive. Of those subjects, 30 subjects had an abnormal rise in SBP PME between 30-40mmHg and 14 had an abnormal rise in SBP PME &gt;40 mmHg. Focus was placed on the three tests recommended for early CVD assessment; C1, C2 and CIMT. Results: As seen in Figure 1.0, an abnormal rise in SBP PME greater than 40mmHg is associated with a statistically significant increase in risk of early structural and functional cardiovascular abnormalities in untreated, asymptomatic, normotensive subjects opposed to those who only had an increase between 30-40mmHg. Conclusion: Assessment of SBP PME is an easy, noninvasive, inexpensive test that can be performed by any health care practitioner to evaluate the risk of CVD in patients. Based on the severity of the increase in SBP PME should warrant physicians on the urgency to further investigate and treat patients to divert the progression of CVD.

Cardiovascular disease risk and prevention amongst Syrian refugees: mixed methods study of M\xe9decins Sans Fronti\xe8res programme in Jordan

BackgroundThe growing burden of non-communicable diseases (NCDs) presented new challenges for medical humanitarian aid and little was known about primary health care approaches for these diseases in humanitarian response. We aimed to evaluate Médecins Sans Frontières (MSF’s) use of total CVD risk based prevention strategies amongst Syrian refugees in northern Jordan to identify opportunities to improve total CVD risk based guidance for humanitarian settings.MethodsWe evaluated CVD risk assessment and management in two outpatient NCD clinics in the Irbid governorate of Jordan using a mixed methods design with qualitative and quantitative strands of equal priority, integrated during data collection and interpretation. World Health Organisation/International Society of Hypertension (WHO/ISH) CVD risk charts requiring measured cholesterol were used in the clinics and in our analysis. An electronic database of routine clinical information was used to determine the CVD risk profile of the clinic population, the pattern and concordance of lipid-lowering treatment prescriptions, and the prevalence and accuracy of documented CVD risk scores. This was combined with semi-structured interviews with MSF health workers, which were recorded, transcribed verbatim, and analysed thematically.ResultsWe reviewed the clinical records of 2907 patients. One fifth (20.9%; 95% CI 19.5, 22.4) of patients had a history of CVD while 56.8% (95% CI 54.9, 58.6) of patients had a WHO/ISH risk of <10%. Only 23.3% (95% CI 21.9, 25.0) of patients had a documented WHO/ISH risk score of which 65% were correct. 60.4% (95% CI 58.6, 62.2) of patients were eligible for lipid-lowering treatment and 48.3% (95% CI 45.9, 50.6) of these patients were prescribed it. Analysis of interviews with sixteen MSF staff identified nine explanatory themes. Providers had confusion about when and how to use the risk charts, tended to favour lifestyle intervention over drug treatment, and had uncertainty about the role of lipid-lowering treatment in primary but not secondary prevention. Patients were reluctant to start, stop, or change medication and were less able to modify risk factors and benefit from health education because of their social and economic context.ConclusionsFour priority areas to improve CVD risk-based guidance for prevention in humanitarian settings include: practical training for health workers on total CVD risk assessment and associated guidance; supporting the use of CVD risk charts as a communication tool and task sharing; contextualising risk scoring in a broader, single consultation, total CVD risk-based algorithm; and targeting popular health myths amongst the community.

Cardiovascular risk at health checks performed opportunistically or following an invitation letter. Cohort study.

BackgroundA population-based programme of health checks has been established in England. Participants receive postal invitations through a population-based call–recall system but health check providers may also offer health checks opportunistically. We compared cardiovascular risk scores for ‘invited’ and ‘opportunistic’ health checks.MethodsCohort study of all health checks completed at 18 general practices from July 2013 to June 2015. For each general practice, cardiovascular (CVD) risk scores were compared by source of check and pooled using meta-analysis. Effect estimates were compared by gender, age-group, ethnicity and fifths of deprivation.ResultsThere were 6184 health checks recorded (2280 invited and 3904 opportunistic) with CVD risk scores recorded for 5359 (87%) participants. There were 17.0% of invited checks and 22.2% of opportunistic health checks with CVD risk score ≥10%; a relative increment of 28% (95% confidence interval: 14–44%, P < 0.001). In the most deprived quintile, 15.3% of invited checks and 22.4% of opportunistic checks were associated with elevated CVD risk (adjusted odds ratio: 1.94, 1.37–2.74, P < 0.001).ConclusionsRespondents at health checks performed opportunistically are at higher risk of cardiovascular disease than those participating in response to a standard invitation letter, potentially reducing the effect of uptake inequalities.

Are statins beneficial for primary prevention in adults with an elevated hs-CRP and an intermediate Framingham CVD risk score?

Are statins beneficial for primary prevention in adults with an elevated hs-CRP and an intermediate Framingham CVD risk score?

Abstract P207: Association Between a 20-year CVD-risk Score Based on Modifiable Lifestyles and Total and Cause Specific Mortality Among US Men and Women

Background: The previously validated Healthy Heart Score, based on modifiable health behaviors (diet, physical activity, alcohol intake, smoking, and body weight), effectively predicted the 20-year risk of CVD in mid-adulthood. While these lifestyle behaviors are independently associated with many chronic diseases, it remains unknown whether the Healthy Heart Score may extend to an association with overall mortality risk. Thus, we examined the Healthy Heart Score and total and cause-specific mortality in the Nurses’ Health Study (NHS) and Health Professional Follow-up Study (HPFS). Methods: We conducted a prospective analysis among 58,319 women in the NHS (1984-2010) aged 30-55 y and 30,713 in men in the HPFS (1986-2010) aged 40-75 y free of cancer and CVD at baseline. The Healthy Heart Score was calculated at baseline and included 9 factors that best estimated CVD risk: current smoking, higher BMI, low physical activity, lack of moderate alcohol consumption, low intakes of fruits and vegetables, cereal fiber, and nuts, and high intakes of sugar-sweetened beverages and red and processed meats). Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) and adjusted for various demographics, medical history, medication use and total energy. Results: During 2,075,504 years of follow-up, there were 19,181 total deaths, including 11,464 in women and 7,717 in men. Compared to participants with the lowest predicted 20-year CVD risk based on the Healthy Heart Score (1 st quintile, median CVD risk: 0.01%), participants with the highest predictive CVD risk (5 th quintile, median CVD risk: 0.03%) had a pooled HR (95%CI) of 2.26 (1.86, 2.13) for total mortality; 2.89 (95 CI%, 1.93, 4.32) for CVD mortality; and 2.55 (95% CI 2.39, 2.72) for cancer mortality. Participants in the 5 th quintile vs . the 1 st quintile of the Healthy Heart Score had also a significantly greater risk of death due to CHD (3.40 [2.20, 5.26]), stroke (1.77 [1.00, 3.14]), lung cancer (6.02 [2.83, 12.79]), breast cancer (1.45 [1.13, 1.85]), colon cancer (1.51 (1.17, 1.94)), respiratory disease (3.94 (1.03, 15.14)), and diabetes (3.63 (2.00, 6.59)). Conclusion: The Healthy Heart Score, comprised of 9 self-reported, modifiable lifestyle predictors of CVD, is strongly associated with a greater risk of all-cause and cause-specific mortality. This risk score is a potentially useful tool for risk assessment and counseling of healthy lifestyles to promote longevity

Prevalence of abdominal aortic aneurysms and its relation with cardiovascular risk stratification: protocol of the Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese (RoCAV) population based study.

BackgroundRecent meta-analyses suggested that screening program for abdominal aortic aneurysms (AAA) in 65-year old males is cost-effective at prevalence of about 1%. Since some events occur also in females and among the youngers, screening could be feasible among those at higher risk, such as smokers or individuals with a family history of AAA. The RoCAV (Risk of Cardiovascular diseases and abdominal aortic Aneurysms in Varese) Project is a population-based study aimed to evaluate AAA prevalence in Northern Italy in males over-65 years as well as among females and younger males, and to identify new markers for risk stratification by collecting a large set of CVD risk factors. The aims of the project are: (i) cross-sectional evaluation of AAA prevalence (ii); evaluation of standard CVD risk score as criteria for selecting subgroup at higher risk to be included in a screening program; (iii) identification of new risk markers and risk score algorithm for AAA and CVD risk stratification; (iv) cost-effective evaluation during the follow-up.MethodsMales aged 50–75 years and females aged 60–75 years, resident in the city of Varese (Lombardy Region), were randomly selected from the civil registry. Among 5198 successfully invited, 3777 subjects accepted to participate and were finally recruited (participation rate 63.8%) from June 2013 to May 2016. Trained operators administered a computerized anamnestic questionnaire, measured anthropometric parameters (BMI, body circumferences, skinfolds), blood pressure, ankle-brachial index, pulse wave velocity and performed abdominal aortic ultrasound scan, ECG and spirometry. All methods were internationally validated. A blood sample was collected and stored in biobank. A follow-up will be carried out through linkage with electronic records.DiscussionParticipation rate and data quality assessment were as expected and will reasonably allow to reach the project aims. The expected impact in public health of the RoCAV project will be the potential implementation of a AAA screening program to the whole region as well as the formulation of new criteria for risk assessment of AAA and CVD.

Cardiometabolic health, prescribed antipsychotics and health-related quality of life in people with schizophrenia-spectrum disorders: a cross-sectional study.

BackgroundPeople with schizophrenia–spectrum disorders (SSD) often have high levels of obesity and poor cardiometabolic health. Certain types of antipsychotics have been shown to contribute towards weight gain and there is some equivocal evidence that obesity is related to poor health-related quality of life (HRQoL) in people with SSD. It is also still uncertain if antipsychotic polypharmacy/higher doses of antipsychotics are linked with HRQoL and/or increased risk of obesity/Cardiovascular Disease (CVD). Therefore, this study aimed to examine potential relationships between prescribed antipsychotic medication regimens, cardiometabolic health risks and HRQoL in community-based Chinese people with SSD.MethodThis cross-sectional study reports the results of baseline measurements of a random sample of patients in an ongoing controlled trial of physical health intervention for people with severe mental illness. Data from these randomly-selected participants (n = 82) were analysed to calculate 10-year CVD relative-risk (using QRISK®2 score), estimate the prevalence of metabolic syndrome and contextualize patients’ prescribed antipsychotics (types, combinations and Daily Defined Dose equivalent). Patients self-reported their HRQoL (SF12v2) and their obesity condition was assessed by waist-circumference and Body Mass Index (BMI).ResultsTwo-thirds of patients had a BMI ≥23 kg/m2, almost half were centrally obese and 29% met the criteria for metabolic syndrome. The individual relative-risk of CVD ranged from 0.62 to 15, and 13% had a moderate-to-high 10-year CVD risk score. Regression models showed that lower physical HRQoL was predicted by higher BMI and lower mental HRQoL. Higher Defined Daily Dose, clozapine, younger age and male gender were found to explain 40% of the variance in CVD relative risk.ConclusionThe findings indicate that cardiometabolic health risks in people with SSD may be more common than those reported in the general Hong Kong population. The results also provide further support for the need to consider antipsychotic polypharmacy and higher doses of antipsychotics as factors that may contribute towards cardiometabolic risk in Chinese patients with SSD. Clinicians in Hong Kong should consider using routine CVD risk screening, and be aware that younger male patients who are taking clozapine and prescribed higher Defined Daily Dose seem to have the highest relative-risk of CVD.Trial registrationClinicaltrials.gov NCT02453217. Prospectively registered on 19th May 2015.

OS 06-07 COMBINING SHORT- AND LONG-TERM RISK SCORES IN PRIMARY PREVENTION OF MAJOR CARDIOVASCULAR DISEASE EVENTS IN LOW INCIDENCE POPULATIONS

Objective: To evaluate the clinical utility of the CAMUNI-MATISS 20-year risk score, recently validated for the Italian population, as additional screening tool for individuals at “low” (ESC-SCORE Project predicted 10-year risk ≤ 1%; no preventive action), “intermediate” (ESC-SCORE 1–4%; lifestyle modification/statin treatment) and “high” risk (ESC-SCORE≥ 4% or diabetes; statin treatment) according to the Italian regulation. Design and method: 40–65 years old initially CVD-free participants to 7 population-based cohorts enrolled in Northern and Central Italy between 1986 and 1996 were followed-up (median 16 years, IQR: 12–20) to the first occurrence of coronary event or ischemic stroke (fatal or non-fatal), coronary or carotid revascularizations. The CAMUNI-MATISS 20-year score includes age, total- and HDL-cholesterol, systolic blood pressure, anti-hypertensive treatment, smoking and diabetes. We estimated the Net Benefit (NB), a weigthed difference between true and false positives. To assess the utility of the CAMUNI-MATISS score, weights were set such that the NB of using the ESC-SCORE risk alone was zero. Results: Study sample included 3935 men (468 events, observed 20-year risk: 15%) and 4393 women (210 events, 20-year risk: 7%). The “intermediate” risk category accounted for 76% of men, 40% of which could have been selected for preventive action based on their predicted 20-year risk, with a Net Benefit of 4.1 (95% CI: 2.7–5.6). In the “high” risk category (21% of men), the NB of the 20-year risk score to trigger treatment intensification was 7.1 (1.8–10.9). The “low” and “intermediate” risk categories accounted for 74% and 21% of women, respectively. About 40% in each category could have been selected for preventive action based on their predicted 20-year risk, with a Net Benefit of 1.3 (95%CI:0.6–2.1) and 4.1 (2.7–5.6), respectively. Conclusions: In the Italian population, a combination of validated short- and long-term CVD risk scores allows selecting for preventive action initiation/intensification individuals whose risk is currently not fully addressed, and reducing un-necessary, costly overtreatment.