Framingham Function Research Articles

Albuminuria and polyvascular disease improve multivariate predictive models after an acute cardiovascular event. The AIRVAG cohort

Background and aimsThere is no consensus regarding risk stratification tools for secondary prevention in atherosclerotic cardiovascular disease. Our aim was to compare the discriminative performance of the Framingham, REGICOR, SCORE, and REACH risk functions and the Bohula-TIMI and SMART risk scores, as well as to assess the potential added value of other clinical variables for the prediction of recurrent events in patients with established vascular disease. MethodsA cohort of 269 patients with established vascular disease (52.8% coronary, 32% cerebrovascular, 15.2% PAD) was included. The survival functions of risk groups (low/medium/high) according to commonly used cutoff points for each function/score were compared, and hazard ratios for each were estimated using Cox regression. We calculated Δ Harrell’s C statistic, cat-NRI, and cNRI after adding new predictors to a base model including age, sex, total cholesterol, current smoking status, hypertension, and diabetes. ResultsAfter six years of follow-up (median 4.82 years), 61 events occurred (23%). High-risk groups had a higher risk of recurrent event: SMART (HR: 3.17 [1.55−6.5]), Framingham (HR: 3.08 [1.65−5.75]), REGICOR (HR: 2.71 [1.39−5.27]), SCORE (HR: 2.14 [1.01−4.5], REACH (HR: 5.74 [2.83−11.7]), B-TIMI (HR: 3.68 [0.88−15.3]). Polyvascular disease (three territories HR: 5.6 [2.2−14.25]), albuminuria (HR: 3.55 [2.06−6.11]), and heart failure (HR: 3.11 [1.34−7.25]) also increased risk. Discrimination (Harrell’s C) was low but improved after adding albuminuria and polyvascular disease. Both variables also improved the performance of the base model (cNRI.326 [.036; .607]). ConclusionsThe Framingham, REGICOR, SCORE, and REACH functions and the B-TIMI and SMART scores showed low yet similar performance in secondary prevention. Albuminuria and polyvascular disease improved the predictive performance of major classical cardiovascular risk factors.

La albuminuria y la enfermedad polivascular mejoran la capacidad predictiva de los modelos multivariados después de un evento cardiovascular agudo. Cohorte AIRVAG

Background and aimsThere is no consensus regarding risk stratification tools for secondary prevention in atherosclerotic cardiovascular disease. Our aim was to compare the discriminative performance of the Framingham, REGICOR, SCORE, and REACH risk functions and the Bohula-TIMI and SMART risk scores, as well as to assess the potential added value of other clinical variables for the prediction of recurrent events in patients with established vascular disease. MethodsA cohort of 269 patients with established vascular disease (52.8% coronary, 32% cerebrovascular, 15.2% peripheral artery disease) was included. The survival functions of risk groups (low/medium/high) according to commonly used cutoff points for each function/score were compared, and hazard ratios (HR) for each were estimated using Cox regression. We calculated Δ Harrell's C statistic, cat-NRI, and cNRI after adding new predictors to a base model including age, sex, total cholesterol, current smoking status, hypertension, and diabetes. ResultsAfter 6 years of follow-up (median 4.82 years), 61 events occurred (23%). High-risk groups had a higher risk of recurrent event: SMART (HR: 3.17 [1.55-6.5]), Framingham (HR: 3.08 [1.65-5.75]), REGICOR (HR: 2.71 [1.39-5.27]), SCORE (HR: 2.14 [1.01-4.5], REACH (HR: 5.74 [2.83-11.7]), B-TIMI (HR: 3.68 [0.88-15.3]). Polyvascular disease (3 territories HR: 5.6 [2.2-14.25]), albuminuria (HR: 3.55 [2.06-6.11]), and heart failure (HR: 3.11 [1.34-7.25]) also increased risk. Discrimination (Harrell's C) was low but improved after adding albuminuria and polyvascular disease. Both variables also improved the performance of the base model (cNRI: 0.326 [0.036; 0.607]). ConclusionsThe Framingham, REGICOR, SCORE, and REACH functions and the B-TIMI and SMART scores showed low yet similar performance in secondary prevention. Albuminuria and polyvascular disease improved the predictive performance of major classical cardiovascular risk factors.

Cardiovascular risk and validation of cardiovascular risk prediction functions in a cohort of patients with type 2 diabetes followed for 10 years in Badajoz (SPAIN). AN observational study

AimsTo analyse whether diabetes behaves as an equivalent of coronary risk and assess the performance of the original and REGICOR Framingham functions in a cohort of patients with type 2 diabetes observed for 10 years in primary care practices in Badajoz, Spain. MethodsObservational, longitudinal study. A total of 643 patients (mean age 64.0 years, 55.7% women), without evidence of cardiovascular disease were studied. We assessed the incidence of cardiovascular events and the patients’ 10-year coronary risk predicted-values at the time of their recruitment. ResultThe actual incidence rate of coronary events was 14.5% (15.1% in women and 13.7% in men, p = 0.616). Patients who suffered coronary events were older (66.3 vs 63.6 years, p < 0.05), had higher total cholesterol (236.3 vs 219.5 mg/dl, p < 0.01), fasting plasma glucose levels (177.6 vs 159.8 mg/dl, p < 0.01), glycated haemoglobin (7.3 vs 6.7%, p < 0.05) and also higher prevalence of high blood pressure, dyslipidemia and chronic renal disease. The original Framingham equation overpredicted risk by 88%, whereas the REGICOR Framingham function underpredicted risk by 24%. ConclusionsDiabetes in our cohort does not behave as a coronary heart disease equivalent and both the original and REGICOR Framingham coronary risk functions have little utility in a diabetic population.

Comparative performance of pooled cohort equations and Framingham risk scores in cardiovascular disease risk classification in a slum setting in Nairobi Kenya

BackgroundCardiovascular diseases (CVD) cause 18 million deaths annually. Low- and middle-income countries (LMICs) account for 80% of the CVD burden, and the burden is expected to grow in the region in the coming years. Screening for and identification of individuals at high risk for CVD in primary care settings can be accomplished using available CVD risk scores. However, few of these scores have been validated/recalibrated for use in sub-Saharan Africa (SSA). MethodsPooled cohort equations (PCE) and Framingham risk scores for 10-year CVD risk were applied on 1960 men and women aged 40 years and older from the AWI-Gen (Africa, Wits-INDEPTH Partnership for GENomic studies) study 2015. Low, moderate/intermediate or high CVD risk classifications correspond to <10%, 10–20% and >20% chance of developing CVD in 10 years respectively. Agreement between the risk scores was assessed using kappa and correlation coefficients. ResultsHigh CVD risk was 10.3% in PCE 2013, 0.4% in PCE 2018, 2.9% in Framingham and 3.6% in Framingham non-laboratory scores. Conversely, low CVD risk was 62.2% in PCE 2013 and 95.6% in PCE 2018, 84.0% and 80.1% in Framingham and Framingham non-laboratory scores, respectively. A moderate agreement existed between the Framingham functions (kappa = 0.64, 95% CI 0.59–0.68, correlation, rs = 0.711). There was no agreement between the PCE 2013 and 2018 functions (kappa = 0.05, 95% CI 0.04–0.06). ConclusionsNewer cohort-based data is necessary to validate and recalibrate existing CVD risk scores in order to develop appropriate functions for use in SSA.

Nonalcoholic fatty liver disease puts patients with psoriasis at greater cardiovascular risk.

Psoriasis and nonalcoholic fatty liver disease (NAFLD) are inflammatory diseases associated with increased cardiovascular risk, but no studies have evaluated cardiovascular risk in patients with both. The objective was to assess cardiovascular risk in patients with psoriasis and NAFLD. Cross-sectional, single-centre study in patients with moderate to severe psoriasis. Participants underwent liver ultrasound to determine the presence of NAFLD. Cardiovascular risk was evaluated using the calibrated Framingham function and Systematic Coronary Risk Evaluation (SCORE) charts. Statistical analyses included a descriptive analysis, chi-square tests for comparing independent samples and stepwise multiple logistic regression to identify associations with the two risk scores. Psoriatic patients with NAFLD had significantly higher odds of moderate to very high 10-year cardiovascular risk compared to those without NAFLD, according to SCORE (71.5% versus 29.2%; odds ratio [OR] 6.0, 95% confidence interval [CI] 3.3-11.1; P<0.001). Using both the SCORE and Framingham assessment methods, moderate to very high cardiovascular risk was independently associated with metabolic syndrome (Framingham: adjusted odds ratio [ORa] 5.5, 95% CI 2.3-12.9, P<0.001; SCORE: ORa 4.7, 95% CI 1.9-11.7, P=0.001) and systemic treatment (Framingham: ORa 3.4, 95% CI 1.4-8.5, P=0.009; SCORE: ORa 3.2, 95% CI 1.2-8.2, P=0.021). Using SCORE, cardiovascular risk was also associated with NAFLD (ORa of 2.8, 95% CI 1.2-6.6, P=0.014). Psoriasis plus NAFLD confers higher cardiovascular risk at 10years than psoriasis alone. In comorbid patients, more intense diagnostic efforts and follow-up are justified.

Impact of smoking cessation on estimated cardiovascular risk in Spanish type 2 diabetes mellitus patients: The DIABETES study

AimsTo assess the cardiovascular risk according to the UKPDS risk engine; Framingham function and score comparing clinical characteristics of diabetes mellitus type 2 (DM2) patients according to their habits status. Patients and methodsA descriptive analysis was performed. A total of 890 Spanish patients with DM2 (444 smokers and 446 former-smokers) were included in a cross-sectional, observational, epidemiological multicenter nationwide study. Coronary heart disease risk at 10 years was calculated using the UKPDS risk score in both patient subgroups. Results were also compared with the Spanish calibrated (REGICOR) and updated Framingham risk scores. ResultsThe estimated likelihood of coronary heart disease risk at 10 years according to the UKPDS score was significantly greater in smokers compared with former-smokers. This increased risk was greater in subjects with poorer blood glucose control, and was attenuated in women ≥60 years-old. The Framingham and UKPDS scores conferred a greater estimated risk than the REGICOR equation in Spanish diabetics. ConclusionsQuitting smoke in patients with DM2 is accompanied by a significant decrease in the estimated risk of coronary events as assessed by UKPDS. Our findings support the importance of quitting smoking among diabetic patients in order to reduce cardiovascular risk.

Impacto de la cesación tabáquica en el riesgo cardiovascular estimado de pacientes con diabetes mellitus tipo 2: El estudio DIABETES

AimsTo assess the cardiovascular risk according to the UKPDS risk engine; Framingham function and score comparing clinical characteristics of diabetes mellitus type 2 (DM2) patients according to their habits status. Patients and methodsA descriptive analysis was performed. A total of 890 Spanish patients with DM2 (444 smokers and 446 former-smokers) were included in a cross-sectional, observational, epidemiological multicenter nationwide study. Coronary heart disease risk at 10 years was calculated using the UKPDS risk score in both patient subgroups. Results were also compared with the Spanish calibrated (REGICOR) and updated Framingham risk scores. ResultsThe estimated likelihood of coronary heart disease risk at 10 years according to the UKPDS score was significantly greater in smokers compared with former-smokers. This increased risk was greater in subjects with poorer blood glucose control, and was attenuated in women ≥60 years-old. The Framingham and UKPDS scores conferred a greater estimated risk than the REGICOR equation in Spanish diabetics. ConclusionsQuitting smoke in patients with DM2 is accompanied by a significant decrease in the estimated risk of coronary events as assessed by UKPDS. Our findings support the importance of quitting smoking among diabetic patients in order to reduce cardiovascular risk.

WITHDRAWN: Estimating the Calibrating Coefficient of the Framingham Score to Predict Risk of Coronary Heart Disease in the Taiwanese Population

Background: The Framingham score, which was developed in the United States, is often calibrated and used in various countries to predict 10-year risk of coronary events, based on the measurements of age, sex, total cholesterol, high-density lipoprotein cholesterol (HDL-C), smoking status, and systolic blood pressure. However, no calibration coefficient is currently available for Taiwan. Methods: Data from the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH) were used to calibrate the Framingham equation for Taiwanese usage and compared with coefficients of the Chinese Multi-provincial Cohort Study (CMCS). Coronary events were identified through the link to National Health Insurance claim data and the national death registry for 2011. The risk factors were total cholesterol (mg/dL), systolic blood pressure (mmHg), cigarette smoking (yes/no), and diabetes (yes/no). The mean of these risk factors and the baseline survival probability were derived from TwSHHH. They were applied to the Framingham score function. Finally, the ratio of observed/ predicted was applied to calibrate the predicted probabilities. Results: When applying the Framingham function, agreement between the predicted and observed risk matched reasonably well in Taiwanese males, but not in females. The CMCS coefficients did not fit the Taiwanese population well. We recommend using 0.7958 and 1 as calibration coefficients for males and females, respectively. Conclusion: We generated Framingham calibration coefficient for the Taiwanese population. We recommend that the mean of predictors and the baseline survivorship derived from TwSHHH should be used in the model. Nonetheless, it is crucial to develop a risk function specific for this population.

Concordancia entre los modelos de SCORE y Framingham y las ecuaciones AHA/ACC como evaluadores de riesgo cardiovascular

MotivationIn Colombia, different models of cardiovascular risk assessment are currently being used. The motivation of this study is to analyse the concordance between the ACC/AHA 2013 equation, SCORE and adjusted Framingham, as well as the impact of using one or another in the amount of patients classified as high risk and the amount of patients requiring pharmacological management. Methods800 patients between 40 and 74 years old were assessed, from the primary prevention clinic of the Hospital Militar Central in Bogotá (Colombia), who were free of cardiovascular events. 10-year risk for atherosclerotic vascular disease was estimated according to the equations proposed by ACC/AHA 2013 guides, the risk of cardiovascular death according to the SCORE function of the European guide and the coronary risk according to the adjusted Framingham function recommended by the Colombian guide. The indication of pharmacological management was considered with an ACC/AHA or adjusted Framingham risk of>7.5%. A >20% Framingham or a >5% SCORE risk were considered high risk. ResultsAccording to Framingham there was a 5.9% of high-risk patients, according to SCORE equations for low-risk countries an 18.7% and according to SCORE equations for high-risk countries, a 31.2%. The Kappa coefficient showed a low concordance between adjusted Framingham and each of the SCORE equations (0.28 and 0.22 respectively). According to the ACC/AHA guide recommendations, hypolipidemic treatment would be indicated in 40.8% of patients, versus a 50.6% following the Colombian guide indications (adjusted Framingham). Kappa coefficient was 0.5735. ConclusionsNowadays there is a poor agreement between the different cardiovascular risk assessment scales used in Colombia, thus generating uncertainty when it comes to making therapeutic choices. Data from this study show the need to validate the validate the SCORE and ACC/AHA models in Colombia and Latin America.

The Framingham function overestimates the risk of ischemic heart disease in HIV-infected patients from Barcelona

Background: Cardiovascular risk (CVR) assessment helps to identify patients at high CVR. The Framingham CVR score (FRS) is the most widely used methods but may overestimate risk in regions with low incidence of cardiovascular disease. The objective was to compare the 10-year performance of the original and the adapted REGICOR – Framingham CVR functions in HIV-infected individuals.Methods: We carried out a longitudinal study of HIV-infected patients with CVR evaluation in a hospital in Barcelona between 2003 and 2013. Statistics: Risk probability was calculated using the FRAMINGHAM function and REGICOR adaptation to the Spanish population, and individuals were categorized in three groups (low, 0 < 5%; moderate, 5–10%; and high, >10%). For each risk group, the number of events over 10 years was calculated using the Kaplan–Meier method, and the expected number of events was calculated by multiplying the frequency of participants in the group by the mean of the probabilities from the risk function. We used the X2 goodness-of-fit test to assess agreement between observed and expected.Results: Six hundred and forty-one patients were followed up for a median of 10.2 years, and 20 ischemic heart events (IHE) were observed. The mean (95% CI) number of IHEs per 1000 person-years was 3.7 (2.06–5.27). The estimates from the Framingham and REGICOR functions were 40 and 14 IHEs, respectively. The estimate from the original Framingham function differed significantly from the observed incidence (p < 0.001), whereas that from the REGICOR-adapted function did not (p = 0.15). In terms of the number of cardiovascular events (38 events observed), the REGICOR function significantly underestimated risk (p = 0.01), whereas the estimate from the Framingham function was similar to observed (p:0.93).Conclusions: The FRS significantly overestimates risk of IHE events in our HIV-infected patients, while the REGICOR function is a better predictor of these events. In terms of cardiovascular events, the REGICOR function significantly underestimates risk, whereas the FRS is a better estimator. We recommend using CVR scales and adjusting them to the origin of the population being studied.

Effects of health intervention program on cardiometabolic risk profiles from health evaluation center in Asian population: a longitudinal study and propensity analysis.

BackgroundHealth intervention program (HIP) based on diet and lifestyle modifications had been shown to improve cardiovascular risks. The effects of such program on a variety of cardiometabolic outcome measures conducted in a strict analysis remained relatively unexplored.Materials and methodsA total of 2,660 participants (mean age: 43.3 ± 10 years, 63.6 % male) underwent annual health survey from our health evaluation department. We implemented health intervention program (HIP) in which diet and lifestyle modifications including smoking cessation and advised physical activities were introduced. We further studied the effects of HIP on several cardiometabolic outcome measures including Framingham, metabolic scores and renal function in terms of Egfr with a mean follow-up period of 38.5 months. Propensity score (PS) matching (HIP vs non-HIP group) was used to avoid effects of case selection bias.ResultsTotally 1,004 (502 subjects for each group) left after PS matching protocol (both HIP and non-HIP group). The HIP group showed significant decline of waist circumference (−1.46 ± 0.61, p = 0.016), post-prandial glucose (−6.77 ± 2.06, p = 0.001), and total cholesterol level (−4.42 ± 2.15, p = 0.04), with borderline increase in eGFR (1.72 ± 0.94, p = 0.068) after an average of 1.91 ± 1.14 year follow up period. Exercise behavior significantly increased for those who received HIP when compared to the non-HIP group (44.6 vs 52.4 %, p = 0.014). PS matching and difference-in-difference (DID) analysis further confirmed the beneficial effects of ATP III reduction by HIP (−0.36 ± 0.06, p < 0.05).ConclusionWe demonstrated in our study that several cardiometabolic profiles can be substantially improved after health intervention introduction at the health evaluation center, supporting the beneficial evidence of such health intervention programs implementation based on primary prevention view points.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-015-0325-2) contains supplementary material, which is available to authorized users.

Estimation of 10-Year Risk of Coronary Heart Disease in Nepalese Patients with Type 2 Diabetes: Framingham Versus United Kingdom Prospective Diabetes Study.

Background:Predicting future coronary heart disease (CHD) risk with the help of a validated risk prediction function helps clinicians identify diabetic patients at high risk and provide them with appropriate preventive medicine.Aim:The aim of this study is to estimate and compare 10-year CHD risks of Nepalese diabetic patients using two most common risk prediction functions: The Framingham risk equation and United Kingdom Prospective Diabetes Study (UKPDS) risk engine that are yet to be validated for Nepalese population.Patients and Methods:We conducted a hospital-based, cross-sectional study on 524 patients with type 2 diabetes. Baseline and biochemical variables of individual patients were recorded and CHD risks were estimated by the Framingham and UKPDS risk prediction functions. Estimated risks were categorized as low, medium, and high. The estimated CHD risks were compared using kappa statistics, Pearson's bivariate correlation, Bland-Altman plots, and multiple regression analysis.Results:The mean 10-year CHD risks estimated by the Framingham and UKPDS risk functions were 17.7 ± 12.1 and 16.8 ± 15 (bias: 0.88, P > 0.05), respectively, and were always higher in males and older age groups (P < 0.001). The two risk functions showed moderate convergent validity in predicting CHD risks, but differed in stratifying them and explaining the patients' risk profile. The Framingham equation predicted higher risk for patients usually below 70 years and showed better association with their current risk profile than the UKPDS risk engine.Conclusions:Based on the predicted risk, Nepalese diabetic patients, particularly those associated with increased numbers of risk factors, bear higher risk of future CHDs. Since this study is a cross-sectional one and uses externally validated risk functions, Nepalese clinicians should use them with caution, and preferably in combination with other guidelines, while making important medical decisions in preventive therapy of CHD.

Plasma B-type natriuretic peptide is a useful tool for assessing coronary heart disease risk in a Japanese general population

B-type natriuretic peptide (BNP) has been reported to be associated with cardiovascular prognosis in a community-based population. In addition, accumulation of individual cardiovascular risk factors is important in predicting an individual's risk of future cardiovascular disease. However, there have been few reports showing that BNP is a comprehensive marker of the accumulation of cardiovascular risk factors. We studied 1530 community-dwelling subjects without obvious heart diseases or renal dysfunction (mean age 62 ± 15 years; 569 men and 961 women) who participated in an annual health checkup in a rural Japanese community. Coronary heart disease (CHD) risk was estimated, and patients were placed into the following three groups based on the Framingham function: low risk, moderate risk and high risk. The prevalence of moderate- and high-risk subjects for CHD rose in both genders with increasing plasma BNP levels. The area under the receiver operating characteristic curve showed a modest ability of plasma BNP levels to detect these subjects (0.755 and 0.700 for men and women, respectively). The optimal thresholds for the identification of subjects with moderate- and high-risk disease were BNP concentrations of 12.0 and 22.0 pg ml(-1), with sensitivities of 70% and 66% and specificities of 71% and 63% for men and women, respectively. In conclusion, subjects with high plasma BNP levels were at higher risk for CHD in a population without obvious heart disease or renal dysfunction.

Validación de los modelos de predicción de Framingham y PROCAM como estimadores del riesgo cardiovascular en una población colombiana

AimsTo assess whether the Framingham and PROCAM risk functions were applicable to Colombian population. MethodsWe performed an external validation study within a historical cohort, including the patients of the primary prevention clinic from the Hospital Militar Central in Bogotá (Colombia). It comprised 1013 patients who were aged 30 to 74 years, free of cardiovascular disease at baseline (1984 to 1996) and followed over 10 years for cardiovascular disease events (coronary death, myocardial infarction, angina pectoris). We compared the number of predicted and observed 10-year cardiovascular disease events (calibration). Finally, we estimated the ability of the risk functions to separate high risk from low risk subjects (discrimination). ResultsIn patients with low and intermediate risk, the number of cardiovascular disease events predicted by Framingham risk function overestimated those observed (predicted to observed ratio 1.31), with a low ability to separate high risk from low risk subjects (c-statistic 0.65). The PROCAM risk function adjusted by sex had better ability to separate high risk from low risk subjects (c-statistic 0.74) with good calibration (predicted to observed ratio 1.07). We do not have enough high risk patients to extrapolate our results in that population. ConclusionThe Framingham risk function must be used with caution to estimate the absolute cardiovascular disease risk in Colombian low and intermediate risk population without any cardiovascular disease history because of its overestimation and low discrimination abilities. The PROCAM risk function adjusted by sex is a better option to estimate hard cardiovascular disease risk.

A coronary heart disease prediction model: the Korean Heart Study

ObjectiveThe objectives of this study were to develop a coronary heart disease (CHD) risk model among the Korean Heart Study (KHS) population and compare it with the Framingham CHD risk...

Cardiovascular risk factors among bipolar disorder patients admitted to an inpatient unit of a tertiary care hospital in India

ObjectiveThe study aimed to examine the prevalence of cardiovascular risk factors in patients with bipolar disorder. MethodsBy consecutive sampling, 93 inpatients (aged ≥20 years) diagnosed with bipolar disorder were evaluated for 10 year coronary heart disease (CHD) risk and 10-year cardiovascular mortality risk (CMR) on the Framingham (10-year all CHD events) function/risk equation and Systematic Coronary Risk Evaluation (SCORE) respectively. ResultsTen-year CHD risk was 3.36% and 10-year CMR was estimated to be 1.73%. One tenth (10.7%) of the sample was found to have very high/high CHD risk (≥10) and 6.45% of the sample had high CMR risk (≥5). More than half (54.88%) of patients had metabolic syndrome. Compared to females, males had higher Framingham function score (4.09±5.75 vs 1.59±1.05, U value – 634.5*, p<0.05) and had higher very high/high CHD risk (≥10) (15.1% vs 0, χ2 4.58, p<0.05). ConclusionsFindings of the present study suggest the presence of cardiovascular risk factors and higher rate of metabolic syndrome in patients with bipolar disorder. Considering this fact, there is an urgent need for routine screening for cardiovascular risk factors in these patients. Mental health professionals should be aware of these risks; there is need to develop preventive strategies to reduce the cardiovascular risk in this 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.

The Association of Resistin with Coronary Disease in the General Population

To explore the association between resistin expression and the incidence of ischemic heart disease in the general population. A follow-up study of 6636 adults recruited randomly from the general population. The serum resistin concentration was higher in women (6.1 ng/mL; CI95%=6.0-6.2) than in men (5.6 ng/mL; CI95%=5.5-5.7). Individuals in the 5th quintile or higher of resistin (RQ5) were younger (P＜0.001) and had a lower prevalence of arterial hypertension (P＜0.001), abdominal obesity (P＜0.001), diabetes (P＜0.001) and dyslipidemia (P＜0.001). The cardiovascular risk estimated by the Framingham function was also lower in the RQ5 subgroup (P＜0.001); however, the prevalence of smoking was higher (P＜0.001), as was the prevalence of low HDL cholesterol (P＜0.001). After 3.5 years of follow-up, the RQ5 subgroup had a higher incidence of acute myocardial infarction (AMI, RR=1.9; CI95%=1.01-3.54). In the population without diabetes, the RQ5 subgroup had a higher risk of AMI (RR=2.4; CI95%=1.10-5.17), and the risk of AMI was highest in women in this group (4.97; CI95%=1.33-18.57). The risk levels were significant in the Cox models adjusted for age, sex and smoking; and the hazard ratio was 2.5 for AMI (CI95%=1.29-4.70) in the sample of patients matched by sex and smoking status. Resistin may be a risk marker for ischemic heart disease in the general population. The serum resistin concentration is higher in women, and the associated increase in the risk of AMI based on the resistin level is also higher in women than in men.

CPC-134 The Effect of Abacavir on Cardiovascular Risk of a Spanish HIV-Infected Cohort

BackgroundThere is evidence that antiretroviral therapy (ART) increases cardiovascular risk (CVR). There is controversy over the effect of abacavir (ABC) on CVR. The use of abacavir has been associated with...

CPC-027 Cardiovascular Risk Profile of a Spanish HIV-Infected Cohort on Antiretroviral Therapy and the Effect of Protease Inhibitors

BackgroundThere is evidence that antiretroviral therapy (ART) increases cardiovascular risk (CVR). The use of protease inhibitors (PIs), specially indinavir and lopinavir/ritonavir, has been associated with a higher incidence of myocardial...