Framingham Risk Score In Patients Research Articles

Correlation of serum nicotinamide phosphoribosyl transferase with hypoxia and Framingham risk score in patients with obstructive sleep apnea-hypopnea syndrome.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an independent risk factor for atherosclerosis (AS), but the mechanism is different from classical AS risk factors. Nicotinamide phosphoribosyltransferase (NAMPT) is involved in the pathophysiology of AS via multiple pathways, and its expression is closely related to hypoxia. The association of NAMPT with hypoxia and the risk of cardiovascular morbidity in the patients of OSAHS remains to be defined. Therefore, we carried out this study to investigate the association of NAMPT with hypoxia and the risk of early cardiovascular disease [based on the Framingham risk score (FRS)] in patients with OSAHS. A total of 82 patients diagnosed with OSAHS were enrolled in this cross-sectional survey design, along with 18 healthy controls who were age- and gender-matched. The general characteristic parameters including height and weight as well as biochemical parameters including blood glucose and lipid were collected from the subjects. The Framingham vascular risk score calculates the risk of developing vascular disease based on the above indicators. Polysomnography was performed in patients with OSAHS, and blood oxygen saturation and apnea-hypopnea index (AHI) were collected, and patients were grouped by disease extent by AHI. The serum NAMPT level of the research subjects was detected using an enzyme-linked immunosorbent assay. Spearman correlation analysis and multiple linear regression to explore the independent correlations of hypoxia on serum NAMPT activity in OSAHS patients. Serum NAMPT level in patients with OSAHS increased with the severity of the disease. Correlation analysis showed that NAMPT was significantly positively correlated with FRS in patients with OSAHS (r=0.829, P<0.05). Multiple linear regression analysis with FRS as the outcome measure showed that NAMPT activity and minimum blood oxygen saturation were independent associated with the risk of developing cardiovascular disease (β=0.03, P=0.000; β=-0.13, P=0.034). Univariate and multivariate regression analyses revealed that hypoxia was significantly associated with NAMPT levels in OSAHS patients, and the oxygen desaturation index (ODI) was independent associated with the expression of NAMPT activity (β=4.09, P=0.000). In patients with OSAHS, hypoxia is independently associated with NAMPT. NAMPT increases the risk of cardiovascular morbidity in this population may be influenced by hypoxia.

Serum microRNA-204 levels are associated with long-term cardiovascular disease risk based on the Framingham risk score in patients with type 2 diabetes: results from an observational study.

BackgroundPrevious studies have demonstrated that microRNA-204 (miR-204) is involved in atherosclerosis and vascular calcification. However, the value of miR-204 as the predictive biomarker for cardiovascular disease (CVD) remains unclear. We aimed to evaluate the association between the circulating miR-204 level and ten-year CVD risk based on the Framingham risk score (FRS).MethodsIn this retrospective study, we enrolled 194 consecutive patients with type 2 diabetes mellitus (T2DM) without CVD in Beijing Anzhen Hospital between January 2015 and September 2016. We used the FRS to evaluate the risk of CVD for each patient. Circulating miR-204 levels were measured by quantitative real-time polymerase chain reaction.ResultsCirculating miR-204 levels were significantly lower in the group of patients (0.49 ± 0.13) at high risk of CVD (FRS > 20%) than in the low (FRS < 10%) and intermediate (FRS: 10%–20%) risk groups (0.87 ± 0.19 and 0.75 ± 0.25, respectively; P < 0.001). FRS was negatively correlated with miR-204 levels (r = –0.421, P < 0.001). According to multivariate logistic analyses, reduced miR-204 level was independently associated with an increased risk of CVD after adjusting for conventional risk factors (OR = 0.876, 95% CI: 0.807–0.950, P = 0.001). Receiver-operating characteristic curve analysis showed that the circulating miR-204 level can predict the high risk of CVD with higher specificity than the traditional risk factor of high systolic blood pressure or the protective factor of high-density lipoprotein cholesterol.ConclusionsOur study demonstrated that patients with lower circulating miR-204 levels were at high risk for CVD. After adjustment for potential confounders, miR-204 was independently associated with CVD in patients with T2DM.

Lipid Profiles and Framingham Risk Score in Patients with Coronary Artery Bypass Graft Surgery undergoing Cardiac Rehabilitation Program

Coronary artery disease (CAD) is one of the major predictors of future cardiovascular events (CVEs). In addition, biomarkers such as high-sensitivity C-Reactive Protein (hsCRP), fibrinogen, homocysteine, and free fatty acid (FFA) correlate well with a future CVE. The Framingham Risk Score is a gender-specific algorithm used to estimate the 10-year cardiovascular risk of an individual. Cardiac rehabilitation is an instrument of medical management in cardiovascular diseases; beyond prevention, it can improve heart and muscle functioning in patients that were undergoing CABG, and cardiac and vascular adaptation. Over a 2-year period, 120 subjects were randomized and comprehensively evaluated. The mean age of the patients under study was 65.70 � 9.91 years old. For the Framingham cardiovascular risk score, the mean value in the Phase I was 16.5, while the mean value in Phase III was 10.6. The difference registered after cardiac surgery and the value in 6 months after the onset of cardiac rehabilitation program was important and statistically significant, as p [ 0.05. Fibrinogen showed significant phase-to-phase reductions of plasmatic values. Lipid profile values showed a statistically significant decrease. The renal filtration function evaluated by plasma creatinine showed statistically significant improvement and, in terms of absolute values, creatinine level was reduced in a range between 0.2-0.4 mg/dL. Also, it was recorded a significantly lower level of blood urea. By comparing the Phase I and Phase III results, we observed that the median 10-year Framingham cardiovascular risk score was approximately 6% lower (p [0.05), reflecting the survival benefit gained by patients under the intensive cardiovascular recovery program.

Association between Pulse Wave Velocity and the Framingham Risk Score in Patients with different Glucose Metabolism Status

Objective: To investigate the relationship between different glucose metabolism status and Pulse Wave Velocity (PWV)and further explore the relationship between PWV, HOMA-IR and the Framingham risk score of 10-year (FRS). Methods: 105 subjects were divided into three groups: normal glucose tolerance group (G1, n=47); pre-diabetes group (G2, n=32)and type 2 diabetes mellitus (DM) group (G3, n=26)General clinical data and biochemical parameters of each subject were collected. PWV was measured using the Complior SP. FRS was calculated with the lipids excel spreadsheets from Framingham Heart Study homepage. The correlation of different glucose metabolism status, PWV and FRS were analyzed and compared. Results: A positive correlation was found between carotid-to-femoral PWV (cf-PWV) and age, (Systolic Blood Pressure) SBP, 2-hr plasma glucose (2h PG). There is a direct connection between homeostasis model assessment of insulin resistance (HOMA-IR) and HOMA-IR (CP). FRS was difference among three groups. A correlation was found between FRS and cf-PWV, 2h PG, HOMA-IR (CP). Conclusion: HOMA-IR (CP) and cf-PWV are positive correlation with FRS, which is a predictor of cardiovascular disease (CVD). Hence HOMA-IR (CP) and cf-PWV may have a good clinical value for indicating vascular structure and function and further evaluating the 10-year risk of CVD.

Assessment of cardiometabolic risk factors and its association with Framingham risk score in Indian patients with type 2 diabetes mellitus

The present study was conducted to assess biochemical markers and Framingham risk score (FRS) (30-year risk of cardiovascular diseases) in patients with type 2 diabetes mellitus (T2DM) and compare with hypertensive and healthy controls. We also evaluated the influence of systolic blood pressure and duration of DM on biochemical markers and their correlation with the FRS in patients with T2DM. The study groups consisted of patients with T2DM (>5 years) with hypertension (n = 55), newly diagnosed T2DM <2 years without hypertension (n = 28), hypertensive controls (n = 31), and healthy controls (n = 30). After detailed medical history, all the participants were subjected to anthropometric measurements and biochemical estimations like blood sugar (fasting and post-prandial), glycosylated hemoglobin (HbA1c), creatinine, blood urea nitrogen, lipid profile, and microalbumin levels, and FRS was calculated. The blood sugar, HbA1c, cholesterol (total and low-dense lipoprotein), microalbumin, as well as FRS were elevated in patients with T2DM compared to healthy controls (p < 0.05). A significant correlation was observed between the FRS and blood sugar, HbA1c, and microalbumin in patients with long-term T2DM. Also, duration of DM significantly influenced levels of serum triglycerides, HbA1c, and microalbumin. This study reveals that elevated blood sugar, HbA1c, and microalbumin levels are associated with increased risk of cardiovascular diseases in patients with long-term diabetes mellitus.

Association between red cell distribution width and the risk of heart events in patients with coronary artery disease.

Red cell distribution width (RDW) has been found to be a novel prognostic biomarker in patients with coronary artery disease (CAD); however, the association between RDW and the risk of heart events in patients with CAD is yet to be fully elucidated. Thus, the aim of the present study was to determine whether an elevated RDW was associated with the Framingham risk score (FRS) in patients with CAD. Data were retrospectively collected from Affiliated Dongyang Hospital of Wenzhou Medical University (Dongyang, China). The patients had undergone a coronary angiography and their clinical data were integrated. The patients (male, 260; female, 132) were divided into two groups based on the results of the coronary angiography, namely the CAD (n=283) and control groups (n=109). The FRS was calculated for all the subjects, and complete blood count testing with biochemical measurements was performed. The mean RDW level was 13.7±1.8% in the CAD group and 13.1±1.0% in the control group, while the mean FRS was 9.0±4.9 in the CAD group and 6.4±3.9 in the control group. The RDW and FRS were significantly higher in the CAD group compared with the control group (P<0.001). No statistically significant differences were observed between the groups with regard to the hematocrit, mean corpuscular volume, platelets, glucose, urea, albumin, aspartate aminotransferase, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and N-terminal pro-brain natriuretic peptide (P>0.05). The RDW was shown to significantly correlate with the red blood cell (RBC) count (r=−0.133, P=0.029), hemoglobin level (r=−0.207, P=0.001) and TG level (r=0.226, P<0.001) within the laboratory parameters, as well as the FRS (r=0.206, P<0.001). In the stepwise multivariate linear regression, which included the RBC count, hemoglobin level, TG level and RDW, the FRS was predicted by hemoglobin (r2=0.034, P=0.001), TG (r2=0.059, P<0.001) and RDW (r2=0.030, P=0.003) parameters. Therefore, a novel association was revealed between higher levels of RDW and an elevated FRS in patients with CAD, which raises the possibility that a simple marker, RDW, may be associated with an increased risk of heart events in CAD patients.

The prevalence of cardiovascular disease risk factors and the Framingham Risk Score in patients undergoing percutaneous intervention over the last 17 years by gender: time-trend analysis from the Mayo Clinic PCI Registry.

Objectives:This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic.Methods:We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score.Results:Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for β-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively.Conclusions:Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.

Correlation between the intima-media thickness and Framingham risk score in patients with sleep apnea syndrome.

In the present study, we want to demonstrate the correlation between obstructive sleep apnea syndrome (OSAS) whose independent effect on carotid artery intima-media thickness (IMT) was demonstrated, with Framingham risk score (FRS) showing the overall cardiovascular risk. IMT of the carotid artery was measured with ultrasonography and 10-year risk of coronary heart disease (CHD) was defined with FRS in 90 consecutive patients referred to our sleep clinic and who underwent polysomnography (PSG), with vascular risk factors and without a clinical atherosclerotic disease. IMT and FRS were found to be statistically significantly increased in the severe OSAS group compared to the other two groups. Carotid IMT was found to be significantly positively correlated with, apnea-hypopnea index (AHI), oxygen desaturation index (ODI) and time duration with oxygen saturation (SpO2) <90%, and negatively correlated with minimum oxygen saturation at sleep (minimum SpO2) and mean SpO2. In control and mild OSAS group IMT and FRS have significantly positive correlation (r: 0.501, P: 0.027; r: 0.625, P<0.001), while in severe OSAS group no significant correlation was detected between IMT and FRS (r: 0.321, P: 0.06). In the regression analysis AHI and ODI were found to be an independent predictor of carotid IMT. ODI was found to have an independent effect on the progression of atherosclerosis. Increased carotid IMT in severe OSAS group could not be explained with the classical risk factors. In this respect, FRS might be insufficient to determine correctly the cardiovascular risk and protection strategies against the disease in OSAS patients.

Performance of the Framingham Risk Score in patients receiving hemodialysis

The Framingham Risk Score (FRS), calculated by considering conventional risk factors of cardiovascular diseases, was developed to predict coronary heart disease in various populations. However, reverse epidemiology has been raised concerning these risk factors in predicting high cardiovascular mortality in hemodialysis patients. Our objectives are to determine whether FRS is associated with overall and cardiovascular mortality and the role of new risk markers when they were added to a FRS model in hemodialysis patients. This study enrolled 201 hemodialysis patients aged 20-80 years old. The FRS is used to identify individuals categorized as low (<6% 10-year risk), intermediate (6-20% risk) or high risk (>20% risk). Medical records were reviewed to collect clinical information. Data of ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) were obtained by an ABI-form device. The mean follow-up period was 4.4 ± 1.5 years. Intermediate risk predicted overall hazard ratio (HR) (2.157, P = 0.039) and cardiovascular mortality (HR= 5.023; P = 0.004) versus low risk, but 'high' risk did not. High risk (vs low risk) predicted cardiovascular events (HR = 2.458, P = 0.05). Besides, the addition of ABI < 0.9 (P = 0.021) and baPWV (P = 0.014) to a FRS model significantly improved the predictive value for overall mortality. In hemodialysis patients, intermediate risk but not high risk categorization by FRS predicted overall and cardiovascular mortality, and high risk predicted cardiovascular events. ABI < 0.9 and baPWV provided additional predictive values for overall mortality. Future study is needed to develop hemodialysis-specific equations and assess whether risk refinement using ABI < 0.9 and baPWV leads to a meaningful change in clinical outcomes.

Abstract P180: Comparison of the Framingham Risk Score With Coronary Artery Disease Burden in Hispanics

Background: The Framingham risk score (FRS) predicts the 10-year risk of having a myocardial infarction (MI). However, the accuracy of the FRS in hispanics has not been throughly evaluated. We compared coronary artery disease (CAD) severity with FRS by ethnic groups in patients undergoing cardiac catheterization. Methods: We performed a cross-sectional analysis of 178 consecutive patients who were referred for elective coronary angiography at Jackson Memorial Hospital in Miami. We measured the components of the FRS and evaluated ethnicity by self-report. We evaluated CAD severity based on the coronary angiography results. We defined severe CAD if the patients had &gt;= 70% luminal obstruction in a vessel or &gt;=50% in the left main coronary artery. We also evalauted severity as a continuos score of the number of vessels with narrowings&gt;=50%. We calculated the median and interquartile range (IQR) of FRS and correlated with the CAD severity and the p-value for trend as well as analysis of variance to determine if FRS differed by ethnicity adjusted for confounders. Results: We identified 110 patients who identified as Hispanic and 68 patients identified as non-hispanics. At baseline, Hispanics had a mean FRS of 10.0±3.8 and non-Hispanics had a mean FRS of 10.3±5.9 (p=0.70). In Hispanics the median FRS for patients with &gt;= 70% stenosis was 10% (IQR 8.5-13) compared to &lt;70% stenosis 9 % (IQR 5-13). In non-Hispanics with &gt;= 70% stenosis the median FRS was 12.5% (IQR 10-16) compared to those with &lt;70% stenosis 8 % (IQR 4-11). The same differences were seen when using &gt;=50% stenosis (table). Conclusions: The FRS does not correlate with coronary artery disease severity in Hispanics but does correlate with CAD severity in non-Hispanics. Median and IQR of FRS by degree of stenosis and ethnicity Severity of stenosis * Hispanics Non-Hispanics &gt;=70% 10 (8.5-13) 12.5 (10-16) &gt;=60% 9 (5-13) 8 (4-11) &gt;=50% 10 (9-13) 12 (9-15) &lt;50% 9 (6-13) 8 (5-14) * p&lt;0.01 for comparisons between severe CAD and non-severe CAD by ethnicity

P03-267 - Assessment of microalbuminuria and ankle-brachial index in outpatients with schizophrenia treated with antipsychotics - a possible predictors of cardiovascular disease

Schizophrenia and related psychoses are associated with excess morbidity and mortality from cardiovascular (CV) disease. Microalbuminuria (MA) is associated with an increased risk of CV disease and mortality. This association is independent of other known CV risk factors such as hypertension, dyslipidemia, obesity, smoking, and impaired renal function. The ankle brachial index (ABI), which is the ratio of systolic pressure at the ankle to that in the arm, is quick and easy to measure and has been used to confirm the diagnosis and assess the severity of peripheral artery disease. Low ABI has been related to an increased incidence of total and CV mortality and CV events. The objective of prospective pilot study was to determine MA and ABI as well as the prevalence of CV risk factors (glucose tolerance status, lipids levels, obesity, hypertension, smoking) and assessment of Framingham risk score in patients with schizophrenia treated with antipsychotic drugs. The study included thirty-three outpatient subjects (female, n = 16), aged 21–66 years. The exclusion criteria included urinary infection and presence of diabetes mellitus. Three patients (7,7%) has abnormal (&gt;26 mg/d) levels of MA, non of ABI.In conclusion, stratification by MA can help identify a high-risk subset of nondiabetic patients with schizophrenia in risk of CV events.

Usefulness of the Framingham Risk Score in Patients With Chronic Psoriasis

Psoriasis is a chronic inflammatory skin disease associated with increased cardiovascular morbidity and mortality. The Framingham risk score is a validated and composite measurement that predicts the absolute risk of developing major cardiovascular events at 5 and 10 years. The objective of this study was to estimate the Framingham cardiovascular risk score in patients with psoriasis. A cross-sectional study in 234 adult patients with psoriasis and 234 age- and gender-matched patients with skin diseases other than psoriasis was performed. The Framingham risk score includes age, gender, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, smoking status, and diabetes mellitus. Framingham risk score was significantly higher in patients with psoriasis than in controls at 5 years (mean ± SD 5.3 ± 4.4 vs 3.4 ± 3.3, p <0.001) and at 10 years (11.2 ± 8.1 vs 7.3 ± 6.3, p <0.001). The risk was higher for patients >50 years of age. Patients with psoriasis were more frequently smokers and diabetics and had more commonly atherogenic dyslipidemia than controls (p <0.05). Presence of psoriasis was independently associated with a higher Framingham score (coefficient 1.6, 95% confidence interval [CI] 0.6 to 2.5, p = 0.001). There was no correlation between severity or duration of psoriasis and Framingham risk score (coefficient 0.009, 95% CI -0.02 to 0.04, p = 0.6; coefficient 0.02, 95% CI 0.007 to 0.04, p = 0.7, respectively). In conclusion, patients with psoriasis have an intermediate risk of developing major cardiovascular events and thus interventions aimed to correct modifiable cardiovascular risk factors are warranted.

Metabolic Changes in Protease Inhibitor-Naive Patients Treated for 1 Year With Lopinavir/Ritonavir

To the Editor: Certain metabolic complications are common in HIV-positive patients treated with antiretroviral therapy. These alterations, especially hypercholesterolemia, could increase the cardiovascular risk (CVR), as measured by the Framingham risk score (FRS). Lopinavir coformulated with ritonavir (LPV/r) is an effective and potent protease inhibitor (PI) with a high genetic barrier, which can produce hypercholesterolemia, hypertriglyceridemia, and insulin resistance.1 To assess the CVR, using the FRS in patients treated with LPV/r, we designed a prospective, open-label, 1-arm study lasting 12 months. Seventy-three (71.2% male) consecutive PI-naive patients were included in the study and received treatment with LPV/r combining a nucleoside/nucleotide backbone. Exclusion criteria were PI-experienced, pregnant, or breast-feeding patients; those receiving concomitant treatments with investigational drugs or with agents that might have potential major interactions with LPV/r; and, finally, patients younger than 18 years of age. The inclusion period was from January 2001 to January 2002. The route of HIV transmission among the 73 included patients was heterosexual intercourse in 39.4%, injection drug abuse in 38.0%, homosexual intercourse in 19.7%, vertical transmission in 1.4%, and others (unknown) in 1.4%. The concurrent antiretroviral therapy was lamivudine in 41.8%, zidovudine in 24.3%, stavudine (d4T) in 11.4%, tenofovir in 11.4%, didanosine in 8.1%, and abacavir in 2.7%. Patients were evaluated clinical and analytically at baseline and every 3 months thereafter. Patients had the following baseline characteristics: duration of HIV infection for 62.9 ± 65.7 months, CD4 T-lymphocyte count of 263 ± 263 cells/μL, CD4 T-lymphocyte percentage of 14.2 ± 9.6%, and plasma HIV-1 RNA level of 415,512 ± 960,152 copies/mL. Initially, the average CVR factor was 1.7 ± 0.9. The number of risk factors per patient was 0 CVR in 5 patients (6.8%), 1 in 24 patients (32.9%), 2 in 32 patients (53.8%), 3 in 11 patients (15.1%), 4 in 0 patients, and 5 in 1 patient (1.4%). The salient CVR was smoking (72.6%). Other common CVRs were age (men older than 45 years of age) in 15.1% of patients and hypertension in 11.1% of patients. The family heart disease history showed that 2.7% of the fathers of patients had ischemic heart disease, and the figure was 4.1% in the case of the mothers of patients. None of the patients had diabetes. Taking into account all CVRs, the FRS was initially 4.4 ± 6.9. At baseline, the levels of cholesterol, high-density lipoprotein (HDL) cholesterol (HDLc), low-density lipoprotein (LPL) cholesterol (LDLc), triglycerides (TGs), and glucose were 165.0 ± 49.4 mg/dL, 35.5 ± 13.6 mg/dL, 99.2 ± 41.6 mg/dL, 160.9 ± 89.0 mg/dL, and 93.1 ± 12.7 mg/dL, respectively. The immunologic, virologic, and metabolic data at the end of the study (12 months) are shown in Table 1. We found a significant increase in total cholesterol, HDLc, and LDLc. TGs also showed an increase that was not significant. No cases of diabetes were diagnosed. LPV/r was discontinued in 19 cases: 12 of them because of side effects (diarrhea and/or digestive alterations in 10 cases) and 5 because of loss to follow-up. Twenty-eight patients were treated for dyslipemia, of whom 25 were treated only with diet and 3 were treated with diet and specific lipid-lowering drugs. Statins were used in 3 to achieve the National Cholesterol Education Project (NCEP) Adult Treatment Panel III (ATPIII) goals. We found no significant increase in the CVR, using the FRS. Accordingly at baseline, the CVR was 4.4; however, after 12 months on the LPV/r-based regimen, the CVR stood at 6.3. This increase was not significant (P = 0.059).TABLE 1: Patients' Data at Baseline and 12 Months of Follow-UpWe know that d4T can induce dyslipemia.2 To assess if the lipid profile could change when the backbone included d4T in an LPV/r-based regimen, the patients were divided into 2 groups: a d4T group and a non-d4T group. Twelve and 45 patients, respectively, completed the treatment for 12 months in each group. No significant difference was found between the 2 groups in the lipid profile. In conclusion, correct management of metabolic complications permits the use of LPV/r without a significant increase in CVR. In fact, the use of LPV/r is recommended in a PI-based regimen in different guidelines for treating antiretroviral-naive patients.3-5 Although a PI-based regimen can produce dyslipemia, correct management of modifiable CVR factors, such as a smoking habit, hypertension, or diabetes, is equally essential. In this series, more than 70% of patients were smokers. Maria José Galindo, MD, PhD* José Verdejo, MD† Miguel Gonzalez-Muñoz, PhD‡ Ana Ferrer, MD* Rosa Polo, MD, PhD§ *Infectious Diseases Department Hospital Clinico Universitario Valencia, Spain †Internal Medicine Service Hospital Madrid Torrelodones Madrid, Spain ‡Department of Immunology Hospital Carlos III Madrid, Spain §National Plan of AIDS Madrid, Spain

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Change in Framingham Risk Score in Patients With Schizophrenia

To examine the change in Framingham risk score (FRS) arising from short-term treatment with ziprasidone or olanzapine. Hospitalized adults with a primary DSM-IV diagnosis of schizophrenia or schizo-affective disorder were randomly assigned to 6 weeks of double-blind treatment with ziprasidone or olanzapine from November 21, 1998 to September 28, 2000. Data on fasting lipid levels were collected at screening and endpoint, and blood pressure was measured at screening and baseline and weekly until week 6 of treatment (or last visit). FRS for patients aged ≥30 years was calculated using an algorithm derived from the Framingham Heart Study. Baseline-to-endpoint least-squares mean changes in age-adjusted FRS by gender were compared using analysis of covariance (baseline adjusted). Men who received olanzapine demonstrated a mean increase in their total cholesterol levels (+18.5 mg/dL; N = 53) and low-density lipoprotein cholesterol levels (+13.0 mg/dL; N = 45), whereas men who received ziprasidone demonstrated a mean decrease in their total cholesterol levels (-8.5 mg/dL; N = 44) and low-density lipoprotein cholesterol levels (-7.2 mg/dL; N = 40) (p = .0006 and p = .004, respectively). Additionally, men who received olanzapine showed an increase in baseline FRS (+7.69%; N = 53), whereas men who received ziprasidone showed a decrease in baseline FRS (-11.06%; N = 42) (p = .09). In women, treatment differences in FSR numerically favored ziprasidone but were not statistically significant. Neither treatment had a significant effect on blood pressure. In short-term treatment, olanza-pine was associated with a significant worsening of lipid profile compared with ziprasidone, with a consequent increase in FRS versus ziprasidone. These findings, coupled with the significant weight gain in patients treated with olanzapine versus ziprasidone, warrant investigation in longer-term trials.

Reduction in Framingham cardiovascular risk with concomitant treatment of hypertension/dyslipidemia with amlodipine/atorvastatin

Although recent consensus guidelines have stressed the importance of simultaneous management of multiple cardiovascular risk factors, the actual effects of such strategies have not been adequately tested. The Respond study assessed the efficacy of concurrent treatment of concomitant hypertension/dyslipidemia. Respond is a double-blind, double-dummy, placebo-controlled trial undertaken in 15 countries, which randomized 1,660 patients with hypertension and dyslipidemia to 1 of 15 combinations of amlodipine (placebo, 5, or 10 mg) and atorvastatin (placebo, 10, 20, 40, 80 mg). The main efficacy assessment was the mean change from baseline to end point in systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C). A key secondary analysis was change from baseline to end point in Framingham risk score in patients without coronary heart disease (CHD) or a risk equivalent (n = 861). At 8 weeks, combination-treated patients experienced dose-related and statistically significant reductions in SBP, LDL-C, and Framingham risk score, resulting in 7.7–11.2 mean percentage point reductions at end point (from mean baseline levels of 15.8–18.5%) in the estimated 10-year risk of developing CHD (Table). Mean reduction in estimated 10-year Framingham CHD risk score (percentage points) Mean reduction in estimated 10-year Framingham CHD risk score (percentage points) Simultaneous treatment of concomitant hypertension/dyslipidemia with amlodipine/atorvastatin is a highly effective strategy for reducing Framingham risk score.