10-year Framingham Risk Score Research Articles

A Comparison of 5 Measures of Accelerated Biological Aging and Their Association With Incident Cardiovascular Disease: The CARDIA Study.

Accelerated biological aging is an increasingly popular way to track the acceleration of biology over time that may not be captured by calendar time. Biological aging has been linked to external and internal chronic stressors and has the potential to be used clinically to understand a person's personalized functioning and predict future disease. We compared the association of different measures of biological aging and incident cardiovascular disease (CVD) overall and by race. We used multiple informants models to compare the strength of clinical marker-derived age acceleration, 5 measures of epigenetic age acceleration (intrinsic and extrinsic epigenetic age acceleration, GrimAge acceleration, and PhenoAge acceleration), and 1 established clinical predictor of future CVD, Framingham 10-year risk score, with incident CVD over an 11-year period (2007-2018). Participants were 913 self-identified Black or White (41% and 59%, respectively) female or male (51% and 49%, respectively) individuals enrolled in the US-based CARDIA (Coronary Artery Risk Development in Young Adults) cohort study. The analytic baseline for this study was the 20-year follow-up examination (2005-2006; median age 45 years). We also included race-specific analysis. We found that all measures were modestly correlated with one another. However, clinical marker-derived age acceleration and Framingham 10-year risk score were more strongly associated with incident CVD than all the epigenetic measures. Clinical marker-derived age acceleration and Framingham 10-year risk score were not significantly different than one another in their association with incident CVD. The type of accelerated aging measure should be taken into consideration when comparing their association with clinical outcomes. A multisystem clinical composite shows associations with incident CVD equally to a well-known clinical predictor.

Abstract P350: Increased Trunk Fat and Decreased Limb Fat Linked to Elevated Cardiovascular Risk in Hong Kong Chinese Women

Introduction: Despite known links between overall body fat and cardiovascular disease (CVD) risk, the relationship involving regional body fat (arm, trunk, and leg) remains underexplored in Chinese populations. This study examined the associations between overall and regional body fat percentage (BFP) and CVD risk in Hong Kong Chinese women. Hypothesis: We hypothesized that higher overall and trunk BFP were associated with increased CVD risk, whereas higher arm and leg BFP predicted decreased risk. Methods: This study used baseline data of 3616 women (mean age 56.12±8.51) from an ongoing cohort named ‘MECH-HK’ (Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women). The recruitment was conducted between October 2019 and October 2021. BFP was measured using the bioelectrical impedance analysis device of Inbody 270 model. Framingham 10-Year Risk Score (FRS) was calculated to present the CVD risks. Multivariate linear models were used to estimate the BFP-FRS associations. Potential non-linear relationships were assessed with restricted cubic spline models. Results: Mean overall BFP was 32.55%, and regional BFP for arm, trunk and leg were 4.59%, 15.38% and 10.76%, respectively. Non-linear associations between overall BFP and FRS were observed (P for non-linear = 0.03). After adjustment for age, education level, monthly family income, smoking and drinking status, physical activity level, family history of CVD and BMI, the overall BFP was associated with increased FRS (β: 0.04, 95% CI: 0.00 to 0.08, P = 0.03) when overall BFP < 35%. However, no significant association was observed when overall BFP >= 35% (β:-0.07, 95% CI: -0.16 to 0.02, P = 0.13). Higher trunk BFP was associated with increased FRS (β: 0.30, 95% CI: 0.21 to 0.38, P < 0.001), while higher arm (β: -0.69, 95% CI: -0.98 to -0.40, P < 0.001) and leg (β: -0.38, 95% CI-0.50 to -0.25, P < 0.001) BFP were associated with decreased FRS. Conclusions: Increased overall (when < 35%) and trunk BFP and decreased arm and leg BFP are associated with elevated CVD risk.

Mortality in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE).

We report mortality outcomes in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) among people with type 2 diabetes diagnosed within 10 years and no recent history of cardiovascular events or cancer. Overall mortality rates and major causes of death were assessed over an average of 5 years of follow-up. Cause of death was adjudicated centrally by a committee masked to treatment assignment. We examined baseline covariates and the 10-year Framingham Risk Score for associations. Mortality rate was low (0.59 per 100 participant-years). Participants who died during follow-up were likely to be older, be male, have a history of hypertension, have a history of smoking, and have moderate albuminuria. The two most common underlying causes of death were "cardiovascular-cause" (a composite of underlying causes) (38.6%) and cancer (26.8%). There were no differences by treatment group. Among people with diabetes of relatively short duration, cause of death was varied. Attention to health risks beyond cardiovascular diseases is warranted.

Evaluation of treatment effectiveness and 10-year cardiovascular disease risk level in hypertensive outpatients

Hypertension represents a substantial risk factor for the development of cardiovascular disease (CVD), stroke, and chronic kidney disease. CVD stands as the primary cause of global mortality. This study employed a prospective cross-sectional design spanning 4 weeks. Data were collected using a pro forma designed to capture patients’ sociodemographic and clinical information. Prescribers’ adherence to anti-hypertensive prescription guidelines, as per the JNC8 guideline, and patients’ attainment of target blood pressure (BP) goals were assessed. Framingham 10-year CVD risk score estimation was employed to estimate patients’ 10-year CVD risk levels. Among the patients, 51 (59.3%) had anti-hypertensive prescriptions that adhered to the JNC8 guidelines. However, a majority, 54 (62.8%), failed to achieve their JNC8 target BP goals, and 44 (51.2%) exhibited intermediate 10-year CVD risk levels. Furthermore, 71 (98.6%) of the patients did not receive the recommended statin and/or aspirin therapy, despite its necessity. An association was found between patients’ achievement of JNC8 target BP goals and their 10-year CVD risk levels. The majority of patients received anti-hypertensive prescriptions that aligned with JNC8 guidelines. Nonetheless, most of them did not attain their JNC8 target BP goals and exhibited intermediate to high 10-year CVD risk levels.

Prevalence of lifestyle cardiovascular risk factors and estimated framingham 10-year risk scores of adults with psychotic disorders compared to controls at a referral hospital in Eldoret, Kenya

IntroductionLifestyle factors such as smoking, alcohol use, suboptimal diet, and inadequate physical activity have been associated with increased risk of cardiovascular diseases. There are limited data on these risk factors among patients with psychosis in low- and middle-income countries.ObjectivesThis study aimed to establish the prevalence of lifestyle cardiovascular risk factors, and the 10-year cardiovascular risk scores and associated factors in patients with psychosis compared to controls at Moi Teaching and Referral Hospital in Eldoret, Kenya.MethodsA sample of 297 patients with schizophrenia, schizoaffective disorder, or bipolar mood disorder; and 300 controls matched for age and sex were included in this analysis. A study specific researcher-administered questionnaire was used to collect data on demographics, antipsychotic medication use, smoking, alcohol intake, diet, and physical activity. Weight, height, abdominal circumference, and blood pressure were also collected to calculate the Framingham 10-year Cardiovascular Risk Score (FRS), while blood was drawn for measurement of glucose level and lipid profile. Pearson’s chi-squared tests and t-tests were employed to assess differences in cardiovascular risk profiles between patients and controls, and a linear regression model was used to determine predictors of 10-year cardiovascular risk in patients.ResultsCompared to controls, patients with psychosis were more likely to have smoked in their lifetimes (9.9% vs. 3.3%, p = 0.006) or to be current smokers (13.8% vs. 7%, p = 0.001). Over 97% of patients with psychosis consumed fewer than five servings of fruits and vegetables per week; 78% engaged in fewer than three days of vigorous exercise per week; and 48% sat for more than three hours daily. The estimated 10-year risk of CVD was relatively low in this study: the FRS in patients was 3.16, compared to 2.93 in controls. The estimated 10-year cardiovascular risk in patients was significantly associated with female sex (p = 0.007), older patients (p < 0.001), current tobacco smoking (p < 0.001), and metabolic syndrome (p < 0.001).ConclusionIn the setting of Eldoret, there is suboptimal physical exercise and intake of healthy diet among patients with psychosis and controls. While the estimated risk score among patients is relatively low in our study, these data may be useful for informing future studies geared towards informing interventions to promote healthy lifestyles in this population.

Antibody against apolipoprotein-A1, Metabolic-Associated Fatty Liver Disease and cardiovascular risk: a translational study

Abstract Background and aims Metabolic-Associated Fatty Liver Disease (MAFLD) represents a common cause of liver disease leading to increased cardiovascular disease (CVD) morbidity and mortality. Autoantibodies against apolipoprotein A-1 (AAA-1) are a possible novel CVD risk factor promoting inflammation and disrupting intracellular lipid homeostasis, two prominent pathogenic features of MAFLD. We aimed to evaluate the possible role of AAA-1 in MAFLD and their association with CVD risk. Methods HepaRG cells and liver sections from ApoE-/- mice exposed to AAA-1 were used for lipid quantification and conditional protein expression. Randomly selected sera from 312 subjects of a general population cohort were used to measure AAA-1. A Fatty Liver Index (FLI) ≥60 and a 10-year Framingham Risk Score (FRS) ≥20% were used as proxy of MAFLD and high CVD risk, respectively. Results In-vitro and mouse models showed tha-t AAA-1 interfered with triglyceride synthesis leading to steatosis. AAA-1 generated pro-inflammatory and pro-fibrotic responses. In the 112 participants with FLI≥60, AAA-1 were associated with higher FRS, alkaline phosphatase levels, lower HDL cholesterol and tended to display higher FLI values. Univariate linear and logistic regression analyses (LR) confirmed significant associations between AAA-1, FLI and FRS≥20%, while in adjusted LR, FLI was the sole independent predictor of FRS≥20% (OR:1.05,95%CI:1.01-1.09, P=0.003) and AAA-1 was not found to be an independent FLI predictor. Conclusion Despite inducing a MAFLD-compatible phenotype on in vitro and in mouse models and being associated with an increased CVD risk according to FRS, the present results suggest that the AAA-1 association with CVD risk in the general population is dependent on hepatic steatosis.

Abstract 14129: Identification of Highly Correlated Sub-Networks of Cardiovascular Ageing Imaging Markers With 10-Year Predicted Risk Scores

Introduction: While Framingham 10-year risk scores (FRS) estimates cardiovascular disease (CVD) risk in older adults, few studies have benchmarked these estimates against age-related changes in cardiac structure and function, which are complex and highly inter-related. We investigated associations between cardiovascular (CV) imaging markers and FRS, vascular age, calculated regression, and determined connectivity between them in a network analysis. Methods: Participants recruited from a community-based cohort without CVD completed standardized questionnaires that collected baseline clinical factors, from which FRS, vascular age and calculated regression were derived. Cardiac structural and functional parameters were obtained via echocardiography. Results: 202 participants (46.0% women, mean age 70.2 SD8.8) were included in this analysis. CV imaging markers correlated across a spectrum with FRS, vascular age and calculated regression. Predictive features and their associations by pearson correlation (nodes containing the variables; edges denoting links) (Fig 1) show significant associations. In ageing, this network showed that E/A ratio is inversely linked to FRS, vascular age and calculated regression while LVEF has a weak association with FRS and vascular age, without direct relationship with E/A ratio. While LAVI is associated with FRS and vascular age, LAVI is associated with E/E1 and not E/A ratio nor LVMI. Multivariate regression confirmed independent associations between FRS and vascular age with E/A ratio (b=-7.03, 95% CI -10.55, -3.52, p &lt; 0.001; b= -15.13, 95% CI -19.33, -10.93, p &lt; 0.001) and E/E prime ratio (b= 0.33, 95% CI 0.03 - 0.63, p = 0.033; b=0.66, 95% CI 0.30 - 1.02, p &lt; 0.001). Conclusion: This structural collation of associations depicted different sub networks of cardiovascular imaging features into context. FRS, vascular age and calculated regression were associated with imaging markers of CV ageing at various network levels.

Abstract 15806: An Age Index Derived From Heart Rate Metrics is Associated With Cardiovascular Risk Biomarkers

Introduction: Conventional cardiovascular (CV) risk scores depend on clinical and laboratory measurements, and therefore have limited accessibility in the general population. Consumer wearables provide heart rate measures which individually correlate with CV risk, but it is not known how well they align collectively with conventional clinical biomarkers. Objective: To demonstrate the alignment of a composite index based on heart rate metrics available from consumer wearables with clinical biomarkers and risk scores. Methods: As chronological age is a strong predictor of cardiovascular health, we trained a linear regression model on the UK Biobank (UKB) dataset to predict chronological age from sex, body mass index, resting heart rate (RHR), and mean HR, maximum HR, HR recovery and estimated VO2max during a cycle ergometry test. Data from 53,670 individuals aged 40-70 years were used: 30,247 for training and 23,423 for testing. A cardiovascular age (CVAge) index was obtained as the difference between chronological and predicted age of the individual: a positive/negative CVAge index indicates the CV health is better/worse than the age would suggest. Heart rate predictors and CVAge index were z-scored using age and sex data on the training set. Results: Individuals in the bottom quintile (“Poor CVAge index”) of the test set had higher systolic blood pressure (+5.0 mmHg), diastolic blood pressure (+3.0 mmHg), Framingham 10-year risk score (+1.8%) and ASCVD risk score (+0.8%), than those in the top quintile (“Very Good CVAge index”) - Figure 1. Conclusions: Continuous monitoring of heart rate metrics may help users track their heart health even in the absence of clinical and laboratory measurements.

Antibody against apolipoprotein-A1, non-alcoholic fatty liver disease and cardiovascular risk: a translational study

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a common liver disease increasing cardiovascular disease (CVD) morbidity and mortality. Autoantibodies against apolipoprotein A-1 (AAA-1) are a possible novel CVD risk factor promoting inflammation and disrupting cellular lipid homeostasis, two prominent pathogenic features of NAFLD. We explored the role of AAA-1 in NAFLD and their association with CVD risk.MethodsHepaRG cells and liver sections from ApoE−/− mice exposed to AAA-1 were used for lipid quantification and conditional protein expression. Randomly selected sera from 312 subjects of the Prevention of Renal and Vascular End-stage Disease (PREVEND) general population cohort were used to measure AAA-1. A Fatty Liver Index (FLI) ≥ 60 and a 10-year Framingham Risk Score (FRS) ≥ 20% were used as proxy of NAFLD and high CVD risk, respectively.ResultsIn-vitro and mouse models showed that AAA-1 increased triglyceride synthesis leading to steatosis, and promoted inflammation and hepatocyte injury. In the 112 PREVEND participants with FLI ≥ 60, AAA-1 were associated with higher FRS, alkaline phosphatase levels, lower HDL cholesterol and tended to display higher FLI values. Univariate linear and logistic regression analyses (LRA) confirmed significant associations between AAA-1, FLI and FRS ≥ 20%, while in adjusted LRA, FLI was the sole independent predictor of FRS ≥ 20% (OR: 1.05, 95%CI 1.01–1.09, P = 0.003). AAA-1 was not an independent FLI predictor.ConclusionsAAA-1 induce a NAFLD-compatible phenotype in vitro and in mice. Intricate associations exist between AAA-1, CVD risk and FLI in the general population. Further work is required to refine the role of AAA-1 in NAFLD and to determine if the AAA-1 association with CVD is affected by hepatic steatosis.

Ten-Year Cardiovascular Disease Risk Score and Cognitive Function Among Older Adults: The National Health and Nutrition Examination Survey 2011 to 2014.

Background The Framingham 10-year cardiovascular disease risk score, which is based on age, sex, smoking, total cholesterol, high-density lipoprotein-cholesterol, blood pressure, and diabetes, has been found to be associated with cognitive health, but these findings have not been validated in a representative sample in the United States. We aimed to examine the associations of Framingham risk score with cognitive function among older adults in a nationally representative sample, as well as by race or ethnicity, education, and family income. Methods and Results A total of 2254 older adults ≥60 years (57% female, 79% non-Hispanic White) in the National Health and Nutrition Examination Survey 2011 to 2014 were included in the final sample for analysis. All components of the Framingham risk score were obtained with questionnaire or measured in the laboratory. Cognitive function was examined using the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Task (immediate and delayed memory), Digit Symbol Substitution Test, and Animal Fluency Test. Multivariable linear regression models were used to assess the associations between Framingham risk score and test-specific and global cognition Z scores. Each incremental 5% in Framingham 10-year cardiovascular disease risk was associated with lower Z scores for Digit Symbol Substitution Test (β=-0.06 [95% CI, -0.09 to -0.03]), delayed memory (β=-0.05 [95% CI, -0.08 to -0.01]), immediate memory (β=-0.07 [95% CI, -0.10 to -0.03]), and global cognition (β=-0.05 [95% CI, -0.09 to -0.02]). Socioeconomic status, particularly race or ethnicity and monthly income levels, were strong effect measure modifiers of the associations. Conclusions Lower cardiovascular risk factors are associated with better cognitive function.

Cardiovascular risk factors among Jordanian patients with rheumatoid arthritis: A cohort study.

To determine the frequency of risk factors for cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) in Jordan. During this study, 158 patients with RA were enlisted from the outpatient rheumatology clinic at King Hussein Hospital of the Jordanian Medical Services, from 1 June 2021, to 31 December 2021. Demographic data and disease duration were recorded. After 14 h of fasting, venous blood samples were drawn to determine the levels of cholesterol, triglyceride, high-density lipoprotein, and low-density lipoprotein. History of smoking, diabetes mellitus, and hypertension was recorded. Body mass index and Framingham's 10-year risk score (FRS) were calculated for each patient. Disease duration was noted. The mean age of the male population was 49.29 years and that of the female population was 46.06 years. Most of the study population were female (78.5%) and 27.2% of the study population had one modifiable risk factor. The most frequent risk factors observed in the study were obesity (38%) and dyslipidemia (38%). Diabetes mellitus was the least frequent risk factor, with a frequency of 14.6%. The FRS differed significantly between the sexes, with the risk score of men being 9.80, whereas that of women was 5.34 (p < .00). Regression analysis revealed that age increased the odds ratio of diabetes mellitus, hypertension, obesity, and a high-to-moderate FRS by 0.7%, 10.9%, 0.33%, and 10.3%, respectively. Rheumatoid arthritis patients have increased chances of developing cardiovascular risk factors leading to cardiovascular events.

Cardiovascular disease risk assessment among adults attending HIV Clinic at Korle-bu Teaching Hospital

Background: The risk of developing chronic cardiovascular diseases (CVDs) is a significant public health concern for people living with HIV (PLWH). This recognition has been in place for over a decade. The lack of resources in some settings means that most older PLWH will receive limited care, requiring further research to identify CVD risk and accurate estimation methods. Such research enables the identification of optimal models of care, improving outcomes for this population. Objective: This study aimed to perform a CVD risk assessment (using three different assessment tools) on PLWH attending the HIV clinic at the Korle-bu Teaching Hospital (KBTH). Methods: A hospital-based cross-sectional study involving 311 PLWH was conducted at the HIV Clinic of the KBTH using a questionnaire adopted from the WHO STEP wise approach to chronic disease risk factor surveillance. Blood pressure, anthropometric measurements and fasting blood samples were taken for metabolic/biochemical parameters. A retrospective chart review of clinical folders for HIV and ART-related data was done. To determine the level of risk for cardiovascular disease (CVD), three estimation methods were used: the 10-year Framingham risk score(FRS), the 10-year WHO/International Society of Hypertension (ISH)risk prediction chart, and the 5-year Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) cardiovascular risk score. Results: The estimated 10-year moderate to high risk of CVD was 20.6% using the FRS, 13.2% using the WHO/ISH risk score, and 52.4% using the D:A:D score. The majority of study participants were classified as having a low risk of cardiovascular disease (CVD) according to the FRS and WHO/ISH scoring systems. However, the D:A:D cardiovascular scoring system identified that over 50% of the participants were at a moderate to high risk of developing CVD. Conclusion: This study indicates that when using the D:A:D risk assessment system, over 50% of the individuals who participated were found to have moderate-to-high risks of CVD. This underscores the importance of conducting a cardiovascular risk assessment before initiation of antiretroviral therapy as well as regular assessments to promptly identify and manage these risk factors, thereby aiding in preventing the occurrence of cardiovascular events. Additionally, the findings highlight the need for CVD management to be included in the HIV clinic

Impact of Patient Visualization of Cardiovascular Images on Modification of Cardiovascular Risk Factors: Systematic Review and Meta-Analysis

BackgroundIt is unclear whether detection and patient visualization of cardiovascular (CV) images using computed tomography to assess coronary artery calcium or carotid ultrasound (CU) to identify plaque and intima-medial thickness merely prompts prescription of lipid-lowering therapy or whether it motivates lifestyle change among patients. ObjectivesThis systematic review and meta-analysis sought to investigate whether patient visualization of CV images (computed tomography or CU) has a beneficial impact on improving overall absolute CV risk as well as lipid and nonlipid CV risk factors in asymptomatic individuals. MethodsThe key words “CV imaging,” “CV risk,” “asymptomatic persons,” “no known or diagnosed CV disease,” and “atherosclerotic plaque” were searched in PubMed, Cochrane, and Embase in November 2021. Randomized trials that assessed the role of CV imaging in reducing CV risk in asymptomatic persons with no known CV disease were eligible for study inclusion. The primary outcome was a change in 10-year Framingham risk score from the trial commencement to the end of the follow-up following patient visualization of CV images. ResultsSix randomized controlled trials (7,083 participants) were included; 4 studies used coronary artery calcium and 2 used CU to detect subclinical atherosclerosis. All studies used image visualization in the intervention group to communicate CV risk. Imaging-guidance was associated with a 0.91% improvement in 10-year Framingham risk score (95% CI: 0.24%-1.58%; P = 0.01). Significant reductions in low-density-lipoprotein, total cholesterol, and systolic blood pressure were observed (all P < 0.05). ConclusionsPatient visualization of CV imaging is associated with overall CV risk reduction and improvement of individual risk factors: cholesterol and systolic blood pressure.

Endothelial function predicts 5-year adverse outcome in patients hospitalized in an emergency department chest pain unit.

Although endothelial function is a marker for cardiovascular risk, endothelial dysfunction assessment is not routinely used in daily clinical practice. A growing challenge has emerged in identifying patients prone to cardiovascular events. We aim to investigate whether abnormal endothelial function may be associated with adverse 5-year outcomes in patients presenting to a chest pain unit (CPU). Following endothelial function testing using EndoPAT 2000 in 300 consecutive patients without a history of coronary artery disease, patients underwent coronary computerized tomographic angiography (CCTA) or single-photon emission computed tomography according to availability. Mean 10-year Framingham risk score (FRS) was 6.6 ± 5.9%; mean 10-year atherosclerotic cardiovascular disease (ASCVD) risk was 7.1 ± 7.2%; median reactive hyperemia index (RHI) as a measure of an endothelial function 2.0 and mean was 2.0 ± 0.4. During a 5-year follow-up, the 30 patients who developed major adverse cardiovascular events (MACE), including all-cause mortality, nonfatal myocardial infarction, hospitalization for heart failure or angina pectoris, stroke, coronary artery bypass grafting, and percutaneous coronary interventions, had higher 10-year FRS (9.6 ± 7.8 vs. 6.3 ± 5.6%; P = 0.032), higher 10-year ASCVD risk (10.4 ± 9.2 vs. 6.7 ± 6.9%; P = 0.042), lower baseline RHI (1.6 ± 0.5 vs. 2.1 ± 0.4; P < 0.001) and a greater degree of coronary atherosclerotic lesions (53 vs. 3%, P < 0.001) on CCTA compared with patients without MACE. Multivariate analysis demonstrated that RHI below the median was an independent predictor of 5-year MACE (odds ratio 5.567, 95% confidence interval 1.955-15.853; P = 0.001). Our findings suggest that noninvasive endothelial function testing may contribute to clinical efficacy in triaging patients in the CPU and in predicting 5-year MACE. NCT01618123.

Assessment of incidence of cerebral vascular diseases and prediction of stroke risk in chronic obstructive pulmonary disease patients using multimodal biomarkers.

Early assessment of cerebrovascular disease in chronic obstructive pulmonary disease (COPD) patients is an important issue for a favorable influence on the quality of life. This cross-sectional case-control study was conducted on 38 eligible COPD patients (mean age 55.5 ± 11.5, 25 males, and 13 females) and 26 age-/sex-matched healthy controls. All participants were subjected to stroke risk screening instruments that included the Stroke Riskometer™, the Framingham 10-Year Risk Score, the stroke risk screening tool (the Department of Disease Control of Thailand), the My Risk Stroke Calculator, and Q Stroke. Radiologically, diffusion tensor imaging (DTI) and echo-gradient MRI (T2 star) T2 star imaging were done. Color-coded duplex sonography was done. Laboratory investigations included C-reactive protein (CRP), serum amyloid A, plasma fibrinogen level, serum IL6, 8-Isoprostane, vWF and urinary albumin creatinine ratio. Stroke risk screening instruments revealed a significant increase in COPD patients. DTI showed a significant bilateral reduction in fractional isotropy and a significant bilateral increase in mean diffusivity of white matter through many areas in COPD patients. Patients also had a significant increase of intima-media thickness, presence of atherosclerotic focal thicknesses or plaques on duplex sonography. There was a significant elevation of CRP, serum amyloid A, plasma fibrinogen level, serum IL6, 8-isoprostane, von Willebrand factor (vWF), and urinary albumin creatinine ratio in COPD patients. COPD patients had an increased risk for stroke that could be assessed on stroke risk screening instruments, DTI, T2 star, duplex sonography, and laboratory investigation and could be correlated with the severity of the disease.

Lifestyle Modification Program for Cardiovascular Risk Patients in Indonesia

Purpose: Unhealthy lifestyle leads to an increased risk of contracting cardiovascular disease (CVD). This study aimed to determine the effectiveness of the LIFESTYLE modification program developed by the researcher. The program was designed in response to the needs of Indonesian patients. LIFESTYLE is an acronym for L-ose weight, I-dentify your risk, F-ood choice, E-xercise frequently, S-top smoking and alcohol, T-hink positive, Y-es to a healthy lifestyle, L-et’s control regularly, and E-veryone is supporting you.&#x0D; Method: This study employed the quasi-experimental design, specifically pretest-posttest method along with time series. Fifty-eight (58) participants were purposively chosen and given a 12-week LIFESTYLE modification program in a community health center called Puskesmas in Indonesia. CVD risk and physiological parameters such as blood pressure, waist circumference, total blood cholesterol, and body mass index (BMI) were observed before, during, and after the intervention. CVD risk was estimated using Framingham 10-year CVD risk score of non-laboratory-based test.&#x0D; Results: The mean for CVD risk and physiological parameters decreased after the participants underwent the LIFESTYLE modification program. The analysis of variance (ANOVA) revealed that there was a significant difference in the participants’ systolic blood pressure and total cholesterol (p&lt;.001) before, during, and after the intervention.&#x0D; Conclusion: The 12-week LIFESTYLE modification program is effective in increasing knowledge of cardiovascular risk and observing a healthy lifestyle. Also, this program facilitates early identification of risks for CVD and improves selected physiological parameters.

The association between cardiovascular risk factors and coronary CT angiography findings for predicting obstructive coronary artery disease in Korean patients with stable chest pain

Abstract Background/Introduction The 2019 European Society of Cardiology (ESC) guidelines currently recommend the use of coronary computed tomography angiography (CCTA) as the initial test for diagnosing coronary artery disease (CAD) in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone. Purpose The purpose of this study is to identify the prevalence of obstructive CAD in patients with stable chest pain, and the correlation between several clinical cardiovascular disease (CVD) risk factors and CCTA findings presented by Coronary Artery Disease Reporting and Data System (CAD-RADS). Methods The present study is a single-center retrospective cross-sectional study. A total of 1,892 patients with stable chest pain who underwent CCTA were enrolled in this study. Diamond-Forrester classification, Framingham risk score (FRS), atherosclerotic CVD (ASCVD) 10-year risk score, coronary artery calcium score (CACS) and CAD-RADS category were obtained from every patient. Results Among 1,892 patients (mean age, 60.5±8.6 years; men, 59.3%), 356 (18.8%) had obstructive CAD according to CCTA. Patients with high and intermediate ASCVD 10-year risk score had 2.59 times (aOR 2.59, 95% CI; 1.58 to 4.23) and 1.66 times (aOR 1.66, 95% CI; 1.04 to 2.65) higher odds of having obstructive CAD than patients with low ASCVD 10-year risk score, respectively (adjusted for Diamond-Forrester classification and CACS group). Higher ASCVD risk scores were significantly associated with higher CAD-RADS category (p&amp;lt;0.001), and patients with CAD-RADS category 3 had ASCVD 10-year risk score of 20.1±12.7. CACS showed the highest discrimination in presence of obstructive CAD, followed by ASCVD 10-year risk score, FRS, and Diamond-Forrester classification (AUC: 0.821 [95% CI; 0.797–0.845]; 0.711 [95% CI; 0.683–0.740]; 0.675 [95% CI; 0.646–0.704]; 0.600 [95% CI; 0.569–0.632], respectively). Conclusion This is the first study of CCTA findings in stable chest pain patients in Korea. The prevalence of obstructive CAD in patients with stable chest pain was 18.8%. Higher ASCVD score is significantly associated with presence of obstructive CAD and higher CAD-RADS category. As coronary stenosis of 50%-69% had a mean ASCVD score of 20.1, we should consider CCTA for identifying obstructive CAD in patients with ASCVD score over 20 with stable chest pain. Funding Acknowledgement Type of funding sources: None.

Accelerated brain aging in individuals with diabetes: Association with poor glycemic control and increased all-cause mortality

BackgroundDiabetes has been linked to accelerated brain aging, i.e., neuroimaging-predicted age of brain is higher than chronological age. This report evaluated whether accelerated brain aging in diabetes is associated with higher levels of glycated hemoglobin (HbA1c) and increased mortality. MethodsBrain age in Dallas Heart Study (n = 1949) was estimated using T1-weighted magnetic resonance imaging (MRI) scans and a previously-published Gaussian Processes Regression model. Accelerated brain aging (adjusted Δ brain age) was computed as follows: (brain age adjusted for chronological age)-minus-(chronological age). Mortality data until 12/31/2016 were obtained from the National Death Index. Associations of adjusted Δ brain age with diabetes in full sample and with HbA1c in individuals with diabetes were evaluated. Proportion of association between diabetes and all-cause mortality that was accounted for by adjusted Δ brain age were evaluated with mediation analyses. Covariates included Framingham 10-year risk score, race/ethnicity, income, body mass index, and history of myocardial infarction. ResultsDiabetes was associated with] higher adjusted Δ brain age [estimate= 1.79; 95% confidence interval (CI): 0.889, 2.68]. Among those with diabetes, higher HbA1c (log-base-2-transformed) was associated with higher adjusted Δ brain age (estimate=3.88; 95% CI: 1.47, 6.30). Over a median follow-up of 97.5 months, 24/246 (9.8%) with diabetes and 63/1703 (3.7%) without diabetes died. Adjusted Δ brain age accounted for 65.3 (95% CI: 39.3, 100.0)% of the association between diabetes and all-cause mortality. ConclusionAccelerated brain aging may be related to poor glycemic control in diabetes and partly account for the association between diabetes and all-cause mortality.

The effect of anti TNF alpha (certolizumab) treatment on insulin resistance, lipid parameters and cardiovascular risk in patients with axial spondyloarthritis (ankylosing spondylitis)

Objectives: To evaluate the effects of certolizumab treatment on insulin resistance (IR), lipid parameters, and cardiovascular (CV) risk in patients with ankylosing spondylitis (AS).&#x0D; Methods: This prospective study included 80 consecutive patients with AS (52 males, 28 females) and 74 control subjects (48 males, 26 feemales). The AS patients and control group were compared in respect of basal values. All AS patients with active disease were treated with certolizumab. Biochemical profiles were obtained before and after 24 weeks of certolizumab treatment. Homeostatic model assessment-insulin resistance (HOMA-IR) was used to measure IR and the quantitative insulin sensitivity control index (QUICKI) was used to measure insulin sensitivity. The Framingham equation was used to evaluate CV risk factors.&#x0D; Results: A statistically significant increase was determined in total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) values after 24 weeks of certolizumab treatment. No statistically significant change was determined in the plasma atherogenic index (PAI) and low-density lipoprotein cholesterol (LDL-C) values. A statistically significant decrease was determined in HOMA-IR and an increase in QUICKI. When the Framingham risk scoring was compared with the baseline values, a statistically significant decrease in risk was found at week 24.&#x0D; Conclusions: Certolizumab therapy was associated with a significant increase in HDL-C, TC, and TG levels without any significant change in PAI and LDL-C, and was determined to increase insulin sensitivity and lower insulin resistance. There was also a significant reduction in SBP and 10-year Framingham risk scores at 24 weeks after the start of certolizumab therapy.

Evaluation of Persistent Efficacy of Diabetes Remission and Decline of Cardiovascular Risk After Laparoscopic Sleeve Gastrectomy: a Preliminary 1-Year Study.

Laparoscopic sleeve gastrectomy (LSG) is a relative safe procedure in bariatric surgery. However, relatively few studies had been assessed its comprehensive efficacies. In the current study, the efficacies of LSG were comprehensively explored on glycemic control and cardiovascular disease (CVD) risk reduction. A total of 95 obese patients, who owned body mass index (BMI) of more than 35, were recruited. All of them primarily underwent LSG from 2014 to 2016. Type 2 diabetes mellitus (T2DM) remission was defined as levels of glycated hemoglobin (A1C) and fasting blood glucose (FBG) of less than 6.4% and 125mg/dL, respectively. The further efficacies of LSG on CVD and coronary heart disease (CHD) risks were explored by using original- and recalibrated Framingham 10-year CHD risk scores and the other 3 well-established CVD risk prediction models. Systolic blood pressure (SBP), serum FBG, A1C, triglyceride (TG), BMI, and body weight showed significantly declined and high-density lipoprotein-cholesterol (HDL) displayed twice higher than beginning level after LSG. The 71 of 95 patients with obesity were T2DM; 62 of them exhibited persistent DM remission until 1year after LSG. Cardiovascular age, general cardiovascular risk (GCVR), and atherosclerotic cardiovascular disease risk (ASCVD) also showed significant decrements after LSG. We also observed significant reductions in estimated CVD and CHD risks. LSG resulted in a persistent T2DM remission and corrected metabolic abnormalities. Subsequently, LSG also benefits declined risks of CVD and 10-year CHD developments. LSG may be helpful for primary CVD care in obese patients with BMI of more than 35.