Framingham Risk Score Calculation Research Articles

Actual and Perceived Risk of Cardiovascular Disease among Sample of Iraqi Patients with Rheumatoid Arthritis

Background: Independent of conventional risk factors, patients with rheumatoid arthritis (RA) have a significantly increased risk of cardiovascular disease (CVD). Aims of the study: To evaluate the actual and perceived 10-year CVD risk among Iraqi patients with RA as well as their level of knowledge about CVD risk. Patients and methods: This cross-sectional study included 100 RA patients (85 females and 15 males) who visited Baghdad Teaching Hospital/Rheumatology Unit from January 2021 till July 2021. The Framingham Risk Score (FRS) was used to calculate the actual 10-year risk of CVD. The Heart Disease Fact-Rheumatoid Arthritis Questionnaire (HDFQ-RA) was used to assess the subjects’ cardiovascular disease knowledge. Results: Among a hundred Iraqi patients with RA, the median age was 51.23 ± 8.4 years. The findings of the study revealed that 23% had high risk for CVD and 27% & 50% had moderate and low risk respectively based on FRS calculator. The risk of CVD was significantly affected by the age of disease onset and seropositivity and steroid use (p value 0.001). When the perceived risk was compared to the actual risk of cardiovascular disease, there was a weak agreement between them, only 31% had corresponding answers. Conclusions: The study showed an elevated risk of CVD in rheumatoid arthritis patients, as well as a gap between actual and perceived CVD risk.

Actual and Perceived Risk of Cardiovascular Disease among Sample of Iraqi Patients with Rheumatoid Arthritis

Background: Independent of conventional risk factors, patients with rheumatoid arthritis (RA) have a significantly increased risk of cardiovascular disease (CVD). Aims of the Study: To evaluate the actual and perceived 10-year CVD risk among Iraqi patients with RA as well as their level of knowledge about CVD risk. Patients and methods: This cross-sectional study included 100 RA patients (85 females and 15 males) who visited Baghdad Teaching Hospital/Rheumatology Unit from January 2021 to July 2021. The Framingham Risk Score (FRS) was used to calculate the actual 10-year risk of CVD. The Heart Disease Fact-Rheumatoid Arthritis Questionnaire (HDFQ-RA) was used to assess the subjects' knowledge of cardiovascular disease. Results: Among hundred Iraqi patients with RA, the median age was 51.23 8.4 years. The study's findings revealed that 23% had a high risk for CVD and 27% & 50% had moderate and low risk, respectively, based on the FRS calculator. The risk of CVD was significantly affected by the age of disease onset and seropositivity and steroid use (p-value 0.001). When the perceived risk was compared to the actual risk of cardiovascular disease, there was a weak agreement between them; only 31% had corresponding answers. Conclusions: The study showed an elevated risk of CVD in rheumatoid arthritis patients and a gap between actual and perceived CVD risk.

The ten-year risk of developing cardiovascular disease among public health workers in North-Central Nigeria using Framingham and atherogenic index of plasma risk scores

BackgroundEstimation of total cardiovascular disease (CVD) risk with the use of risk prediction charts such as the Framingham risk score and Atherogenic index of plasma score is a huge improvement on the practice of identifying and treating each of the risk factors such as high blood pressure and elevated blood cholesterol. The estimation of the total risk highlights that CVD risk factors occur together and thereby predicts who should be treated. There is scarcity of data on the risk scoring of adults in Nigeria including health workers. Therefore, this study was done to estimate the cardiovascular risks of health workers in public health services in north-central Nigeria.MethodsA cross-sectional survey was performed using validated Framingham risk score calculator and calculation of risk based on the lipid profile of 301 randomly selected health workers in North-central Nigeria. Descriptive analysis was done using frequency counts and percentages while inferential statistics were done using chi square and correlation analyses using statistical Package for Social Sciences (SPSS) version 21.0. The confidence level was 95% and the level of significance was set at 0.05.ResultsThe 10-year risk of developing CVD was generally low in the health workers. Using Framingham risk score, 98.3% of health workers have low risk, 1.0% have moderate risk and 0.7% have high risk. Among the cadres of health workers, 1.5% of the nurses have moderate risk while 2.5% of the doctors and 3.3% of the CHEWs have high risk of developing CVD in 10 years. Using Atherogenic index of plasma scoring, only 2% of the health workers have high risk, 4.7% have intermediate risk while 93.4% have low risk. Across the cadres, 6.3% of the nurses and 3.3% of the CHEWs have intermediate risk while 2.4% of the nurses and 3.3% of the CHEWs have high risk. These findings were however not statistically significant.ConclusionsThe 10-year risk of developing cardiovascular disease was low in the health workers in this study using both Framingham’s risk score and atherogenic index of plasma scores.

Comparison of white matter hyperintensity abnormalities and cognitive performance in individuals with low and high cardiovascular risk: Data from the Diabetes and Dementia (D2) study

AbstractBackgroundType 2 diabetes Mellitus (T2DM) is recognised as a major contributor to cognitive decline. People with T2DM demonstrate increased white matter hyperintensity (WMH) abnormalities on MRI compared to control individuals. We investigated associations between a validated vascular risk score: The Framingham Risk Score (FRS), WMH volumes and cognitive function in the Diabetes‐and‐Dementia (D2) study, a longitudinal cohort study of community dwelling people with T2DM.MethodOne hundred and twenty‐three non‐demented participants with T2DM (age 66.7±6.8 years, range 50‐80, 68M/55F) completed neuropsychological assessments, health questionnaires to allow FRS calculation, 24‐hour ambulatory blood pressure monitoring, and a 3T‐MRI scan. WMH were calculated using the functionality "run‐samseg" in FreeSurfer 7. Quality control on the traced lesions was performed using an in‐house semi‐automated MATLAB tool. Periventricular and deep WMH volumes were estimated based on the edited lesion traces. We divided participants into low (n=61) and high (n=62) FRS groups based on the median score (x=48.7). Differences in WMH volumes were compared between the FRS groups after correcting for sex and age. We compared cognitive performance between low/high FRS individuals across five composite cognitive domains: memory, language, visuospatial skills, executive function, and attention‐and‐processing‐speed. The composite score for each domain was the normalised z‐scores average for the respective tests.ResultParticipants with high FRS (implicating greater vascular risk) were significantly older (age F(1, 122)=14.97; p<0.001), were less likely to be female (sex χ2=16.73, p<0.001), and tend to have less than 12 years of education (χ2= 3.69, p = 0.041). Relative to individuals with low FRS, those with high FRS showed significantly higher WMH volumes (F(1, 121)=6.11; p=0.015). Significant differences were also identified for periventricular (F(1, 121)=6.16; p=0.014) and deep (F(1, 121)=4.25; p=0.042) WMH volumes. When the cognitive data were analysed, the low FRS group performed signifcantly better than the high FRS group only on the attention‐and‐processing‐speed factor (F(1,115)=5.17; p=0.025).ConclusionHigh cardiovascular risk, defined as a high FRS, in participants with T2DM was associated with greater WMH volume, a marker of white matter dysfunction, and with deficits in processing speed and attention. Subclinical cognitive deficits were common in our community dwelling cohort without known or preceding cognitive dysfunction.

Clinical and radiological testing for subclinical atherosclerosis in first-degree relatives of patients with premature coronary artery disease: feasibility and diagnostic yield

Abstract Background Premature atherosclerotic cardiovascular disease (ASCVD) is highly heritable. The screening of first-degree relatives (FDR) of patients with premature ASCVD is recommended but not routinely performed, and the diagnostic yield of different approaches to such screening is unknown. Purpose To determine the feasibility and diagnostic yield of clinical and radiological screening of FDRs of patients with premature coronary artery disease (CAD) in clinical setting. Method We recruited FDRs of patients with angiographically-proven CAD with stenosis of ≥50% who presented at the age of ≤50 years for males and ≤55 years for females. After clinical and laboratory assessment, patients with no personal history of cardiovascular disease underwent either coronary computed tomography angiography (CCTA), coronary calcium scoring assessment (CAC), or carotid ultrasound (CUS). Subclinical atherosclerosis was defined as 1) CAC score >100 Agatston units or >75% percentile for age and sex; 2) Stenosis >50% in at least one coronary artery or segment involvement scores >50th percentile in males and >75th in females; or, 3) Carotid plaque on ultrasonography. Results We enrolled 220 FDRs between 2017 and 2020, 129 completed clinical assessment (Figure 1). Of them, 28 (21.7%) had a personal history of ASCVD and 101 were tested for subclinical atherosclerosis. The characteristics of these patients are shown in Table 1. The most prevalent cardiovascular risk factors were dyslipidemia (40.6%), hypertension (22.8%), and obesity (21.8%). When assessed with the Framingham risk score calculator without adjustment for family history, only 5.1% and 28.6%, of patients had high or moderate cardiovascular risk, respectively. After adjusting for family history and the presence of statin-indicated conditions, 39.6% and 14.9% of patients were placed in high and moderate risk groups, respectively. Subclinical atherosclerosis was found in 43.6% of all patients (Figure 1) and 57.7% of patients over 40 years of age. The diagnostic yield of procedures was 29.6% for CUS, 37.8% for CCTA and 61.1% for CAC scoring. After the radiological assessment, 13.9% of patients were reclassified to a higher risk group (Table 1). Conclusion Non-invasive cardiovascular imaging detected subclinical atherosclerosis in 43.6% of healthy patients with a family history of premature ASCVD, moving 1 in 7 patients to a higher risk group and suggesting that this screening approach may improve risk prediction in this population. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research.St. Paul's Hospital Foundation and the Vancouver General Hospital Foundation. Figure 1Table 1

A Cultural Dance Program Improves Hypertension Control and Cardiovascular Disease Risk in Native Hawaiians: A Randomized Controlled Trial.

BackgroundNative Hawaiians have higher hypertension (HTN) and cardiovascular disease (CVD) rates than non-Hispanic whites, calling for culturally responsive interventions to close this gap.PurposeWe tested the effects of a 6-month behavioral intervention, a cultural dance program based on hula (the customary dance of Hawai'i), for improving blood pressure (BP) and CVD risk among Native Hawaiians with uncontrolled HTN.MethodsIn a randomized controlled trial, we tested the effects of the hula-based intervention among 263 Native Hawaiians with uncontrolled HTN (systolic ≥ 140 or ≥ 130 mmHg if diabetes) and no CVD at enrollment. All participants received a brief culturally tailored heart health education before random assignment to the hula-based intervention (n = 131) or the education-only waitlist control (n = 132). Intervention received hula lessons and group-based activities for 6 months. Control received only 1-week education through 6 months.ResultsIntervention yielded greater reductions in systolic (−15.3 mmHg) and diastolic (−6.4 mmHg) BP than control (−11.8 and −2.6 mmHg, respectively) from baseline to 6 months (p < .05). At 6 months, 43% of intervention participants compared to 21% of controls achieved a HTN stage <130/80 mmHg (p < .001). The 10-year CVD risk reduction was two times greater for the intervention group than the control group based on the Framingham Risk Score calculator. All improvements for intervention participants were maintained at 12 months.ConclusionsThis trial represents one of the few rigorously conducted examinations of an Indigenous practice leveraged for health promotion, with implications for other ethnic populations.

Increased risk of Roma for 10-year development of CVDs based on Framingham Risk Score calculation

Abstract Background Increased mortality and short life expectancy of Roma are well known epidemiological findings which can be partially explained by the high prevalence of cardiovascular risk factors among them. This study assesses the prevalence of the cardiovascular disease (CVD) risk factors (age, sex, systolic blood pressure, smoking and diabetes status, elevated total and reduced high density lipoprotein cholesterol level (HDL-C)) and the estimation of 10-year risk of development of CVD (CVD in general, coronary heart disease (CHD), myocardial infarction (MI) and stroke) and that of death from CHD and CVD based on the Framingham Risk Score (FRS) in case of the Hungarian general (HG) and Roma (HR) populations. Methods A complex health survey incl. questionnaire based interview, physical examination and laboratory test was carried out in 2018 on the HG and HR populations. The prevalence of different cardiovascular risk factors was defined and FRS was computed and compared between the HG (n = 378) and HR (n = 386) populations. Results The prevalence of diabetes was significantly higher among Roma females compared to females of general population (17.8% vs. 7.7%; p = 0.001) while the average systolic blood pressure level was less elevated among Roma males (127.9 mmHg vs. 129.4 mmHg; p = 0.020). The prevalence of smoking (males: 63.1% vs. 33.7%; females: 67.6% vs. 31%; p &amp;lt; 0.001) and reduced HDL-C level (males: 40% vs. 25.9%, p = 0.014; females: 55.5% vs. 35.1%, p &amp;lt; 0.001) were significantly higher in both sexes among Roma. The 10-year estimated risk for development of CHD, MI and CVD and the death from CHD was significantly (P &amp;lt; 0.05) higher in both sexes among Roma compared to the general population while the average risk scores for stroke and death from CVD were significantly higher only among Roma men. Conclusions Our results show that both sexes in the Roma population have a significantly higher risk for 10-year development of CVD compared to the Hungarian general population. Key messages The Roma population have a significantly higher risk for 10-year development of cardiovascular diseases and death from them based on the Framingham Risk Score. The targeted cardiovascular interventions should be focus on reduce smoking and provide information on the recognition and treatment of diabetes and lipid disorders among Roma.

Relationship Among Fatty Liver, Specific and Multiple‐Site Atherosclerosis, and 10‐Year Framingham Score

Despite a well-documented increase in the prevalence of subclinical atherosclerosis in patients with steatosis, the relationship among steatosis and atherosclerosis, specific atherosclerotic sites, multiple-site atherosclerosis, and cardiovascular risk prediction is incompletely understood. We studied the relationship among steatosis, atherosclerosis site, multiple-site atherosclerosis, coronary artery calcification (CAC), and 10-year Framingham Risk Score (FRS) in 2,554 patients with one or more cardiovascular risk factors (CVRF), free of cardiovascular events and other chronic liver diseases, and drinking less than 50 g alcohol/day. All patients underwent arterial ultrasound (carotid [CP] and femoral [FP] plaques defined as intima-media thickness (IMT) > 1.5 mm), coronary computed tomography scan (severe CAC if ≥ 100), 10-year FRS calculation, and steatosis detection by the fatty liver index (FLI, present if score ≥ 60). Patients with steatosis (36% of total) had higher prevalence of CP (50% versus 45%, P = 0.004) and higher CAC (181 ± 423 versus 114 ± 284, P < 0.001) but similar prevalence of FP (53% versus 50%, P = 0.099) than patients without steatosis. Steatosis was associated with carotid IMT and CAC, but not with FP, independent of age, diabetes, hypertension, and tobacco use (P < 0.001). Fifty-three percent of patients had at least 2-site atherosclerosis and steatosis was associated with at least 2-site atherosclerosis independent of age and CVRF (odds ratio = 1.21, 95% confidence interval 1.01-1.45, P = 0.035). Sixty-four percent of patients with steatosis had a FRS score of 10% or more. FLI was associated with FRS beyond the CVRF or the number of atherosclerosis sites (P < 0.001). Adding FLI to CVRF predicted an FRS greater than or equal to 10% better than CVRF alone (area under the receiver operating characteristic curve = 0.848 versus 0.768, P < 0.001). Conclusion: Steatosis is associated with carotid and coronary, but not femoral atherosclerosis, and with cardiovascular mortality risk. The multiple-site involvement and quantitative tonic relationship could reinforce the prediction of cardiovascular mortality or events over classical CVRF or imaging-based detection of atherosclerosis.

Ambiguity about Selection of Cardiovascular Risk Stratification Tools: Evidence from a North Indian Rural Population.

Background:Several nonlaboratory based cardiovascular disease (CVD) risk scoring tools are available for resource-limited settings, but the performance of these tools remains to be established in Indian population. This study aimed to assess and compare the performance of the World Health Organization (WHO)/International Society for Hypertension (ISH) risk prediction chart and the Framingham Risk Score (FRS) calculator in an Indian setting.Materials and Methods:This cross-sectional study was carried out among 283 participants aged 30–74 years who attended screening camps in the rural area of Punjab from October to December 2015. Nonlaboratory-based WHO/ISH risk prediction chart for South-East Asia Region and FRS calculator was used to assess the 10-year risk of cardiovascular event. Chi-square test for trend and quadratic weighted kappa were used for analysis.Results:Of total participants, 67.1% were female. Mean age of the study participants was 52.1 (standard deviation ± 11.6) years. Using the WHO/ISH risk prediction chart, 11.3% and 4.9% of the participants were found to have high and very high risk, respectively, whereas, FRS calculator predicted high risk in 13.8% and very high risk in 12.0% for developing CVD in next 10 years. Agreement level between two risk prediction tools was good (67.8%).Conclusion:Although the good agreement was seen between WHO/ISH risk prediction chart and FRS calculator, the proportions of participants having a high and very high risk of CVD identified by these risk prediction tools are significantly different. In resource constraint setting like India, CVD risk prediction tools should be validated for local population by prospective cohort studies to ensure judicious use of resources.

Longer time to peak glucose during the oral glucose tolerance test increases cardiovascular risk score and diabetes prevalence.

IntroductionThe pattern of glucose levels during an oral glucose tolerance test (OGTT) may be useful for predicting diabetes or cardiovascular disease (CVD). Our aim was to determine whether the time to peak glucose during the OGTT is associated with CVD risk scores and diabetes.MethodsIndividuals with impaired fasting glucose (IFG) were enrolled in this observational study. Participants were grouped by the measured time to peak glucose (30, 60, 90 and 120 min) during the 75g OGTT. The primary outcome was 10-year CVD risk scores (using the Framingham risk score calculator). Secondary outcomes evaluated effect of time to peak glucose on prevalence of diabetes and indicators of glucose homeostasis.ResultsA total of 125 patients with IFG underwent OGTTs. Framingham 10-year risk score for the 90-min group was 1.7 times higher than for the 60-min group (6.98±6.56% vs. 4.05±4.60%, P = 0.023). Based on multivariate linear regression, time to peak glucose at 90 min was associated with a higher Framingham risk score than 60-min group (β coefficient: 2.043, 95% confidence interval: 0.067–6.008, P = 0.045). The percentages of patients with HbA1c ≥6.5%, isolated post-challenge hyperglycemia (IPH) and diabetes (combined IPH and HbA1c ≥6.5%) were significantly increased with longer times to peak glucose. Prevalence of diabetes was higher in the 90-min group than in the 60-min group (31.5% vs. 5.7%, P = 0.001).ConclusionsIn subjects with IFG, those with a longer time to peak glucose had a higher Framingham 10-year risk score and were associated with a greater likelihood of IPH and diabetes.

SAT0118 Using an Electonic Medical Record Decision Tool to Improve Cardiovascular Risk Screening in Rheumatoid Arthritis

BackgroundCardiovascular disease (CVD) is the leading cause of death among individuals with rheumatoid arthritis (RA) (1). The 2010 EULAR guidelines recommended annual CV risk assessment for all RA patients in...

2317 THE EFFECT OF SIMULTANEOUS PANCREAS KIDNEY TRANSPLANTATION ON THE 10-YEAR CARDIOVASCULAR DISEASE RISK OF TYPE 1 DIABETIC PATIENTS

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Renal Vascular Surgery (II)1 Apr 20132317 THE EFFECT OF SIMULTANEOUS PANCREAS KIDNEY TRANSPLANTATION ON THE 10-YEAR CARDIOVASCULAR DISEASE RISK OF TYPE 1 DIABETIC PATIENTS Alex Jiang, Tom McGregor, Neal Rowe, Vivian McAlister, Paul Martin, Alp Sener, and Patrick Luke Alex JiangAlex Jiang London, Canada More articles by this author , Tom McGregorTom McGregor London, Canada More articles by this author , Neal RoweNeal Rowe London, Canada More articles by this author , Vivian McAlisterVivian McAlister London, Canada More articles by this author , Paul MartinPaul Martin London, Canada More articles by this author , Alp SenerAlp Sener London, Canada More articles by this author , and Patrick LukePatrick Luke London, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2258AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is uncertain whether pancreas transplantation in type 1 diabetics with renal impairment improves overall patient health and survival. The aim of this study was to look at the impact of pancreas transplant on simultaneous pancreas kidney (SPK) recipients using the Framingham Risk Score (FRS) for 10-year cardiovascular disease (CVD) risk. METHODS A retrospective review was performed on 55 SPK transplant patients. 20 solitary kidney (SK) recipients were analyzed as controls. The two groups were matched in terms of type 1 diabetes status and age. The FRS for 10-year CVD risk was calculated and compared between the two groups pre-operatively and one-year post-operatively. Individual risk factors were also compared separately to determine which factors conferred the most significant influence on cardiac risk reduction. This included systolic blood pressure (SBP), cholesterol levels and anti-hypertensive medications. RESULTS Using the FRS calculator, we determined that pre-operative risk score for SPK transplant group was 12.5±8.4% compared with 8.8±7.0% one-year post-operatively (p = 0.0002). There was no statistically significant difference in SK transplant group when comparing the pre and post-operative CVD risks. One year post-operatively, SPK patients had decreased their total number of antihypertensive medications by a mean of at least one agent (p = 0.0000003) and had reduced their dependences on statins (p = 0.001). SPK transplantation also lowered ‘patients' triglyceride levels from 1.42±0.82 mmol/L to 1.08±0.51 mmol/L (p = 0.007). Additionally, SPK recipients had significantly lower HbA1c level compared to SK recipients one-year post-operatively (5.7±1.0 vs 7.3±1.6 %, p = 0.01). However, there was no significant statistical difference between pre and post-operative SBP, LDL or HDL values. CONCLUSIONS SPK transplantation has a positive impact on patient health based on the analysis of FRS for 10-year CVD risk one-year post-operatively. It reduced the CVD risk from intermediate (10-20%) to low (<10%) risk range. Resulting impact of pancreas transplantation on cardiovascular complications including myocardial infarction, stroke and death continue to be studied. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e950 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Jiang London, Canada More articles by this author Tom McGregor London, Canada More articles by this author Neal Rowe London, Canada More articles by this author Vivian McAlister London, Canada More articles by this author Paul Martin London, Canada More articles by this author Alp Sener London, Canada More articles by this author Patrick Luke London, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Effect of the Change in the Framingham Risk Score Calculator Between the 2006 and 2009 Canadian Lipid Guidelines

Background Recent Canadian lipid guidelines changed the methodology used for calculating the Framingham Risk Score (FRS). We assessed the impact this would have on management when related to baseline lipid profiles and the possible need for statin drug therapy. Methods Patients with their FRS calculated between November 2006 and March 2010 were considered. There were 247 patients categorized as either low or intermediate risk. Results The study population consisted of 91 men and 156 women with a mean (SD) age of 52.7 ± 15.0 years. The average FRS was 5.6 ± 4.8 vs 11.5 ± 8.3 (2006 vs 2009) ( P < .00010). The number of FRS patients categorized as low and intermediate risk requiring some form of lipid-lowering treatment increased from 35 (14.2%) to 81 (32.8%), a 2.3-fold increase. Of 41 high-risk patients, 40 had a baseline low-density lipoprotein cholesterol of ≥2.0 mmol/L and would qualify for not only health behaviour interventions but also statin drug treatment. Conclusions The new FRS increases the number of 2006 patients with low and intermediate scores who move from low to high risk (n = 11, 5.9%), from low to intermediate risk (n = 50, 26.9%), and from intermediate to high risk (n = 30, 49.2%), leading to a 2.3-fold increase in the need for lipid-lowering treatment. Therapies intended to improve lipid profiles and potentially patient outcomes include both health behaviour interventions alone or in combination with lipid-lowering drug therapy. Given the relationship between low-density lipoprotein cholesterol and cardiovascular events is linear, treating more patients is likely to lead to a further reduction in cardiovascular events.

Assessment of Claims of Improved Prediction Beyond the Framingham Risk Score

With heightened interest in predictive medicine, many studies try to document information that can improve prediction of major clinical outcomes. To evaluate the reported design and analysis of studies that examined whether additional predictors improve predictive performance when added to the Framingham risk score (FRS), one of the most widely validated and cited clinical prediction scores. Two independent investigators searched 1908 articles citing the article that described the FRS in 1998 until September 2009 through the ISI Web of Knowledge database. Articles were eligible if they included any analyses comparing the predictive performance of the FRS vs the FRS plus some additional predictor for a prospectively assessed outcome. Data Analyses We recorded information on FRS calculation, modeling of additional predictors, outcomes assessed, population evaluated, subgroup analysis documentation, and flaws in the methods that may have affected the reported improvements in predictive ability. We also evaluated the correlation of reported design and analysis features with the predictive model discrimination and improvements with the additional predictors. We evaluated 79 eligible articles. Forty-nine studies (62%) did not calculate the FRS as it has been proposed, 15 (19%) modeled the additional predictor in more than 1 way and presented only the best-fit or area-under-the-curve (AUC) results for only 1 model, 41 (52%) did not examine the original outcome that the FRS was developed for, 33 (42%) studied a population different from what the FRS was intended for, and 25 (32%) claimed improved prediction in 1 subgroup but only 7 (9%) formally tested subgroup differences. Evaluation of independence in multivariable regressions, discrimination in AUC, calibration, and reclassification were reported in 77, 36, 7, and 7 studies, respectively, but these methods were adequately documented in only 60, 13, 4, and 2 studies, respectively. Overall, 63 studies (80%) claimed some improved prediction. Increase in AUC was larger when the predictive performance of the FRS was lower (rho = -0.57, P < .001). Increase in AUC was significantly larger when evaluation of independence in multivariable regression or discrimination in AUC analysis was not adequately documented and when the additional predictor had been modeled in more than 1 way and only 1 model was reported for AUC. The majority of examined studies claimed that they found factors that could offer additional predictive value beyond what the FRS could achieve; however, most had flaws in their design, analyses, and reporting that cast some doubt on the reliability of the claims for improved prediction.

Relations between digital thermal monitoring of vascular function, the Framingham risk score, and coronary artery calcium score

Digital thermal monitoring (DTM) of vascular function was shown to correlate with the presence of known coronary artery disease (CAD). We evaluated whether DTM can identify at-risk, asymptomatic patients with significant coronary artery calcium (CAC) or increased Framingham risk score (FRS). Two hundred thirty-three consecutive asymptomatic subjects (58 +/- 11 years; 62% men) without known CAD underwent DTM, CAC, and FRS calculation. DTM measurements were obtained during and after a 5-minute suprasystolic arm-cuff occlusion. After cuff-deflation temperature rebound (TR) and area under the temperature curve (AUC) were measured and correlated with FRS and CAC. TR was lower in patients with FRS > 20% and CAC >or= 100 as compared with FRS < 10% and CAC < 10, respectively (P < 0.05). After adjustment for age, sex, and traditional cardiac risk factors, the odds ratio of the lowest compared with the upper 2 tertiles of TR was 3.96 for FRS >or= 20% and 2.37 for CAC >or= 100 compared with low-risk cohorts. The area under the receiver operating characteristic (ROC) curve to predict CAC >or= 100 increased significantly from 0.66 for FRS to 0.79 for TR to 0.89 for TR + FRS. Vascular dysfunction measured by DTM strongly correlates with FRS and CAC independent of age, sex, and traditional cardiac risk factors and was superior to FRS for the prediction of significant CAC.

Implications of Cardiac Risk and Low-Density Lipoprotein Cholesterol Distributions in the United States for the Diagnosis and Treatment of Dyslipidemia

Updated guidelines from the National Cholesterol Education Program Adult Treatment Panel III stratify patients into 5 groups of coronary heart disease (CHD) risk that determine intensity of lipid-lowering therapy. The present study assesses the distribution of low-density lipoprotein cholesterol (LDL-C) in the United States across the 5 groups of CHD risk as defined in the updated guidelines. Subjects included 7399 individuals 20 to 79 years of age in the 1999 to 2002 National Health and Nutrition Examination Survey representing 171 million individuals in the United States. CHD risk, LDL-C levels, and goal achievement were determined per Adult Treatment Panel III guidelines. CHD risk assessment incorporated a medical condition review, risk factor summation, and Framingham Risk Score calculation. Percentages were weighted to represent population estimates, and SEs were adjusted for the survey design. The distribution of individuals by CHD risk included 61.1% at lower risk, 10.6% at high risk, and 5.7% at very high risk. From Adult Treatment Panel III criteria, only 5.4% of the population was at "intermediate" risk. Two thirds (66.3%) met their Adult Treatment Panel III-defined LDL-C goal. Of those at high and very high risk, 23% and 26%, respectively, met the goal of LDL-C <100 mg/dL, whereas only 3.1% and 4.6% had an LDL-C <70 mg/dL (or non-high-density lipoprotein C <100 mg/dL). Most adult US residents are at lower 10-year CHD risk and meet risk-adjusted LDL-C goals. However, large portions of the high-risk population are undertreated. The commonly described population at intermediate risk is small. A novel method of identifying patients who might benefit from additional testing to determine their treatment strategy is provided.

Analyzing the national cholesterol education program adult treatment panel III report: is new better?

he recently released Executive Summary of theThird Report of the National Cholesterol Edu-cation Program (NCEP) Expert Panel on Detection,Evaluation, and Treatment of High Blood Choles-terol in Adults (Adult Treatment Panel III [ATP III])summarizes an evidence-based report that expandson the clinical and scientific rationale for intensivecholesterol-lowering therapy in clinical practice. Rep-resenting 20 months of work by an expert panelcomprising 27 leading clinicians and researchers, theexecutive summary