Framingham Risk Score In Women Research Articles

970Comparison of lab-and non-lab based absolute cardiovascular disease risk scores in rural India

Abstract Background Over 75% of global cardiovascular (CVD) deaths occur in low-to-middle-income countries (LMICs). In limited resource settings non-lab-based CVD risk algorithms could be as effective as lab-based algorithms in identifying high-risk groups. We aimed to compare the concordance between lab-and non-lab-based absolute CVD risk algorithms in a LMIC setting. Methods The study was conducted in the Rishi Valley, Andhra Pradesh, India. Over 8,000 participants were surveyed between 2012-2015. The 10-year absolute CVD risk score was computed and compared using lab-and-non-lab based Framingham and WHO algorithms. Results In participants aged 35-74 years, absolute CVD risk score increased with age, and was greater in men than women, for all risk assessment tools. Using the Framingham lab-based algorithm, 15.6% were categorized as high-risk while 14.5% were at high-risk using the non-lab-based algorithm. The non-lab-based Framingham risk score had close agreement and strong correlation with the lab-based Framingham risk score in women (90%, Spearman’s rho (rs)=0.81) and men (83%, rs=0.89). Similarly, the non-lab-based WHO risk score had close agreement and strong correlation with the lab-based WHO risk score in women (95%, rs=0.83) and men (92% rs=0.84). In both cases, agreement was better in women than men (P < 0.05 for a two-sample test of proportions). Conclusions The effectiveness of non-lab-based Framingham and WHO algorithms are comparable to that of lab-based algorithms in discriminating high-and low-risk groups. However, the performance of non-lab-based risk score is better among women than men. Key messages Non-lab-based CVD risk algorithms could be effective and resource-efficient in LMIC settings, particularly among women.

Costs and effects of cardiovascular risk reclassification using the ankle-brachial index (ABI) in addition to the Framingham risk scoring in women

Background and aimsAnkle brachial index (ABI) is a simple and cheap parameter to assess the presence of atherosclerosis. It could also help correctly reclassify the cardiovascular risk when added to the Framingham risk score (FRS). Recent evidence has demonstrated improvement in prediction performance of ABI when added to FRS, particularly in women. However, no studies have been published yet evaluating the cost-effectiveness of this approach. This study attempts to fill in this gap by assessing the cost-effectiveness of ABI measurements in primary prevention in women. MethodsWe developed a Markov model to compare two different strategies for assessing the cardiovascular risk (low, intermediate and high) among women in the general population: 1) FRS strategy, and 2) FRS + ABI strategy; and the relative impact associated with interventions for preventing CV events in intermediate and high-risk categories. ResultsIn the base-case analysis, FRS + ABI reported an additional cost of € 110 and a gain of 0.0039 QALYs per patient, resulting in an ICER of € 27.986/QALY, when compared to FRS alone. The ICER improved to €1.641/QALY when using a lifetime horizon. The effectiveness of preventive CV disease interventions reported also a significant impact. A 32% reduction of CV events was the minimum value estimated to maintain FRS + ABI as a cost-effective strategy. ConclusionsThe addition of ABI to FRS is a cost-effective approach in women classified at low and intermediate risk with FRS only. This new approach gives the possibility to reclassify and allocate them into the appropriate risk group and treatment.

Are liver function biomarkers independently associated with Framingham risk score in women?

Introduction/Objective. Given the contradictory results regarding the association of liver function biomarkers [e.g., alanine-aminotransferase (ALT), gamma-glutamyl transferase (GGT) and total bilirubin)] and the risk of cardiovascular disease (CVD), we aimed to explore the relationship between these biomarkers and Framingham risk score (FRS), an established tool used in the prediction of 10-year CVD risk in the cohort of women. Methods. A total of 278 women participated in this cross-sectional study. Anthropometric, biochemical parameters, and blood pressure were obtained. Results. There was a significant increase in ALT and GGT activity, as well as a decrease in total bilirubin level in the high-risk FRS group compared to moderate-, and low-risk FRS (p for trend = 0.025, p < 0.001, p < 0.001, respectively). Multivariate logistic regression analysis showed that body mass index, triglycerides, creatinine, and high sensitivity C-reactive protein levels were the independent predictors of FRS in women [odds ratio (OR) = 1.234, p = 0.001; OR = 2.856, p = 0.001; OR = 1.090, p = 0.002, and OR = 1.295, p = 0.045, respectively]. In contrast, total bilirubin, ALT and GGT lost their independent predictions for high CVD risk. Conclusion. Liver function biomarkers (i.e. ALT, GGT, and total bilirubin) are not independently associated with FRS. It seems that some other cardiometabolic disturbances might modulate this relationship.

Sex-Specific Associations of Testosterone With Metabolic Traits.

Background: Testosterone levels are differentially linked with diabetes risk in men and women: lower testosterone levels in men and higher testosterone levels in women are associated with type 2 diabetes, though, the mechanisms are not fully clear. We addressed sex-specific links between testosterone and major pathogenetic mechanisms of diabetes.Methods: We analyzed data of 623 subjects (202 male, 345 female without, and 76 female with oral contraceptive therapy [OCT]) for whom insulin sensitivity and insulin secretion were assessed by oral glucose tolerance test. Body fat percentage was assessed by bioelectrical impedance. Testosterone was measured by enzyme-linked immunoassay; free testosterone and Framingham risk score were calculated.Results: There were significant interactions between testosterone and sex for all tested metabolic traits. Increasing testosterone was associated with less body fat, elevated insulin sensitivity, and reduced glycemia, independent of adiposity in men. In women without OCT, testosterone correlated with more body fat, insulin resistance, and higher glucose concentrations. Testosterone was not associated with insulin secretion in either sex, but with lower Framingham risk score in men and higher Framingham risk score in women.Conclusions: Similar to diabetes risk, insulin resistance has different association directions with testosterone levels in males and females. Insulin resistance could therefore constitute the best biological candidate linking testosterone levels and diabetes prevalence. The question of antiandrogen therapy being able to improve metabolism, glucose tolerance and cardiovascular risk in women was not clarified in our study but should be reviewed with higher numbers in a carefully matched study to reduce the influence of confounding variables.

LONG-TERM PROGNOSTIC SIGNIFICANCE OF CORONARY ARTERY CALCIUM SCORES IN WOMEN AND MEN WITH A LOW-INTERMEDIATE FRAMINGHAM RISK SCORE

It is well established that the Framingham Risk Score (FRS) underestimates risk in women. Coronary artery calcium (CAC) scoring improves risk reclassification beyond the FRS in women and men. The primary aim of this analysis was to compare 15-year mortality by CAC in a cohort of 2,363 asymptomatic

Heavy Metals and the 10-year risk of coronary heart disease in the adults: the 2008 – 2010 Korea National Health and Nutrition Examination Survey

Background: The lifestyle factors including cigarette smoking, alcohol drink, diet and exercise, are considered main environmental influences on the cardiovascular disease, whereas the contribution of environmental exposure of metals is less clear. There are several studies have identified that exposure to metals is associated with coronary heart disease. However, sex differences exist in this respect is not well studied. Aims: We assessed the association between heavy metals and risk of coronary heart disease in Korean adults. Methods: Relationships between heavy metals (cadmium, lead, mercury) and risk of coronary heart disease were evaluated by linear multiple regression models, with glomerular filtration rate (GFR) as confounding factors – in 4,491 adults (2,227 men, 2,264 women), aged 30 years and older, who participated in the 2008 – 2010 Korea National Health and Nutrition Examination Study. Results: After adjustment for several factors, blood cadmium was the only major determinant of the FRS in men (beta=1.40, 95%CI: 0.96 ~ 1.85, p < 0.001), while 3 metals were not associated with the Framingham Risk Score in women. Conclusions: Sex differences exist regarding circulating levels of metals. Cadmium levels were significantly higher in males, while cadmium, lead, and mercury levels were not significantly in females. There are associations between metals and the 10-year risk of coronary heart disease, with cadmium levels being the most important for males in this population.

Abstract 30: Behavioral Change after Heart Disease Risk Assessment in Women

Background: Heart disease is the leading killer of women in the United States. Unfortunately, most women are unaware of their individual risk. Studies have shown that awareness of cardiovascular (CV) disease risks correlates with positive behavior changes, including increased physical activity and weight loss. Methods: The Change of Heart (COH) Program is a university hospital based CV disease risk assessment program. The assessment included baseline weight, height, blood pressure, lipid profile, fasting glucose, and Framingham risk score in women 18 years of age and older. A 90-minute individual discussion of risk and recommendations for healthy lifestyle changes were given. Follow up questionnaires and newsletters designed to assess and encourage heart-healthy behavioral changes were given at 3 and 6 months after the initial visit to participants. We compared baseline vs. follow up self-reported activity levels and readiness for change. Results: At baseline, participants’ average age was 50.6 years, they exercised between 1 to 3 hours each week, and most had either never smoked or had quit smoking. When asked what they thought a woman’s greatest health problem was, 62% answered Heart Disease/Heart Attack. Additionally, 59% of participants felt moderately informed about women’s heart disease and 54% would call 911 if they thought they were having a heart attack. We found a statistically significant improvement in willingness to increase physical activity (p < 0.001), practice good eating habits (p < 0.001), avoid smoking (p <0.01), lose or maintain healthy weight (p <0.001), lower and maintain cholesterol levels (p < 0.001) and blood pressure (p < 0.001) over the course of the study. Conclusion: In a population of women who felt that they were moderately well informed on heart disease, only 62% knew that a woman’s greatest health risk was heart disease or a heart attack. Most women showed improvements in readiness for positive heart-healthy behavioral changes. This emphasizes the ability for a cardiovascular risk reduction program to positively influence a woman’s willingness for behavioral change.

Gender differences for associations between circulating levels of metals and coronary risk in the elderly

Several studies have pointed out associations between various metals and cardiovascular disease. Since cardiovascular disease prevalence is different between males and females, we investigated whether circulating levels of metals related differently to coronary risk in men and women. In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, coronary risk was assessed by the Framingham Risk Score together with circulating blood levels of 11 different trace and heavy metals in 1016 subjects aged 70 years. Circulating levels of cadmium, copper and manganese were significantly higher in women than in men, while mercury, zinc and lead were significantly lower following adjustment for kidney function (measured by glomerular filtration rate, GFR). No significant differences between women and men were seen regarding levels of aluminium, molybdenum, cobalt, chromium and nickel. When all 11 metals were entered as independent variables together with GFR in multiple models in the Framingham Risk Score as the dependent variable, cadmium was the major determinant of the Framingham Risk Score in women (p<0.0001, followed by zinc p=0.03), while copper was the major determinant of the Framingham Risk Score in men (p<0.0001, followed by inverse relations vs. aluminium p=0.01 and nickel p=0.01). There are gender differences in levels of metals and also regarding the association between metals and coronary risk, with cadmium levels being most important for women and copper levels for men in this elderly population.

Metabolic syndrome and carotid intima media thickness in the Health 2000 Survey

Background and purpose Metabolic syndrome has been associated with increased carotid intima-media thickness (CIMT) and cardiovascular disease (CVD). The objective of this study was to examine metabolic syndrome as a determinant of CIMT in men and women and to compare the Framingham risk score (FRS) and metabolic syndrome as risk factors for increased carotid atherosclerosis. Methods The study population consisted of 1353 Finnish men and women aged 45 years and above who participated in Finnish population-based Health 2000 Survey. CIMT was used as a marker of subclinical atherosclerosis. The National Cholesterol Education Program Adult Treatment Panel III criterion was used to define the presence of metabolic syndrome. Results In multivariable models, metabolic syndrome was an independent determinant of CIMT in both sexes ( p ≤ 0.001 for both). When metabolic syndrome was included in the regression models along with its components, it was an independent determinant of CIMT in women but not in men. After dividing the population into risk categories according to FRS and the presence of metabolic syndrome, FRS predominantly determined CIMT regardless of the presence of metabolic syndrome in men. In women, however, CIMT was significantly higher in subjects with metabolic syndrome than in those without it, independently of the FRS. Conclusions Metabolic syndrome is an independent determinant of CIMT in both sexes. In women but not in men, metabolic syndrome is associated with CIMT independently of its components. Metabolic syndrome provides additional information on a person’s risk for early atherosclerosis beyond FRS in women but not in men.

INTER-GENERATION SOCIAL MOBILITY MODIFIES FRAMINGHAM RISK SCORE IN POLISH MIDDLE-AGED MEN, BUT NOT IN WOMEN

In modern societies, there are regular social gradients in most health parameters, and also in the structure of morbidity and mortality. However, the significance of inter-generation social mobility for general health status still remains equivocal. This study was therefore performed in order to compare the effect of social mobility on coronary heart disease (CHD) risk between middle-aged Polish men and women. A total of 342 men and 458 women, aged 40 and 50 and inhabitants of Wrocław, were examined. Risk of CHD was estimated using the Framingham Risk Score (FRS), calculated for each individual. Social mobility was defined as an inter-generation change in social status expressed as educational level between the examined individual and his/her father. Using two-variable regression models, it was demonstrated that FRS in men was determined by both their father's education level (beta=0.33, p<0.0001) and inter-generation change in educational status (beta=0.18, p=0.008). In contrast, FRS in women was related only to their father's education level (beta=0.35, p<0.0001), but not to inter-generation social mobility (beta=0.35, p=0.25). In particular, an incremental change in educational level among those men whose father had finished primary school at the very most or among those whose father had finished basic trade school was accompanied by a significant decrease in FRS (F=4.12, p=0.009 and F=3.25, p=0.04, respectively). It is concluded that inter-generation social mobility modifies CHD risk (as estimated using FRS) in middle-aged Polish men, but not in women. The precise mechanisms responsible for the observed sex difference in this phenomenon need to be established in further studies.