Framingham Risk Score Research Articles

Predicting Cardiovascular Risk in People With Diabetic Retinopathy : Study Using Framingham Risk Score

Introduction: People with type 2 diabetes have an increase risk of cardiovascular disease (CVD). Framingham risk score is used to determine 10 years the risk of CVD in asymptomatic patients for primary prevention. Up to now, there have been no similar studies regarding the risk of CVD in diabetic retinopathy (DR) patients in Indonesia. Therefore, we would like to investigate the corelation between DR and CVD risk through the population using Framingham risk score.
 Methods: This research is a Population-Based Cross-sectional Study. The data was taken from the villages in Malang Regency. Participant with diabetes aged > 40 was recruited. The available data was then processed according to the variables and assessed using Framingham Risk Score. The scores were classified as high, intermediate, and low risk.
 Results: From 953 samples there were 155 respondents with Diabetes Mellitus (DM), 23 of them experience DR. There were more female participants than men in DM group without DR (73.9%) and DR group (73.9%). A significant correlation between diabetic retinopathy and CVD risk was found (r=0.407, p=0.001). The risk of CVD in 10 years is low in diabetic patients without retinopathy ( p=0.001), but in patients with diabetic retinopathy, the risk of CVD in 10 years is intermediate-high (p=0.001).
 Conclusion: There is corelation between Diabetic Retinopathy and risk for cardiovascular disease in intermediate-high category using Framingham risk score.

Association of plasma proteomics with incident coronary heart disease in individuals with and without type 2 diabetes: results from the population-based KORA study.

Coronary heart disease (CHD) is a major global health concern, especially among individuals with type 2 diabetes (T2D). Given the crucial role of proteins in various biological processes, this study aimed to elucidate the aetiological role and predictive performance of protein biomarkers on incident CHD in individuals with and without T2D. The discovery cohort included 1492 participants from the Cooperative Health Research in the Region of Augsburg (KORA) S4 study with 147 incident CHD cases (45 vs. 102 cases in the group with T2D and without T2D, respectively) during 15.6 years of follow-up. The validation cohort included 888 participants from the KORA-Age1 study with 70 incident CHD cases (19 vs. 51 cases in the group with T2D and without T2D, respectively) during 6.9 years of follow-up. We measured 233 plasma proteins related to cardiovascular disease and inflammation using proximity extension assay technology. Associations of proteins with incident CHD were assessed using Cox regression and Mendelian randomization (MR) analysis. Predictive models were developed using priority-Lasso and were evaluated on top of Framingham risk score variables using the C-index, category-free net reclassification index (cfNRI), and relative integrated discrimination improvement (IDI). We identified two proteins associated with incident CHD in individuals with and 29 in those without baseline T2D, respectively. Six of these proteins are novel candidates for incident CHD. MR suggested a potential causal role for hepatocyte growth factor in CHD development. The developed four-protein-enriched model for individuals with baseline T2D (ΔC-index: 0.017; cfNRI: 0.253; IDI: 0.051) and the 12-protein-enriched model for individuals without baseline T2D (ΔC-index: 0.054; cfNRI: 0.462; IDI: 0.024) consistently improved CHD prediction in the discovery cohort, while in the validation cohort, significant improvements were only observed for selected performance measures (with T2D: cfNRI: 0.633; without T2D: ΔC-index: 0.038; cfNRI: 0.465). This study identified novel protein biomarkers associated with incident CHD in individuals with and without T2D and reaffirmed previously reported protein candidates. These findings enhance our understanding of CHD pathophysiology and provide potential targets for prevention and treatment.

Association between cardiovascular disease risk and incident type 2 diabetes mellitus in individuals with prediabetes: A retrospective cohort study

AimsIn this study, we aimed to evaluate the impact of overall cardiovascular disease (CVD) risk on the development of incident T2DM in patients with prediabetes. MethodsWe retrospectively enrolled 5,908 subjects with prediabetes who underwent health check-ups at the Asan Medical Center. CVD risk was estimated using the Framingham Risk Score (FRS). We compared moderate- to high-risk groups with low-risk controls based on the FRS. Cox proportional hazards regressions were conducted to estimate the time-to-develop incident T2DM. ResultsAmong the 5908 subjects with prediabetes, 3031 (51.8 %) were identified to have either moderate or high CVD risk scores. During a median follow-up of 5.2 years, 278 (9.2 %) patients from the moderate- to high-risk group and 171 (5.9 %) from the low-risk group were diagnosed with T2DM. The covariate-adjusted hazard ratio for the incident T2DM was 1.30 (95 % CI, 1.06–1.60, p = 0.011) in the moderate- to high-risk group compared to the low-risk controls. ConclusionAmong patients with prediabetes, those with high CVD risk were more likely to develop incident T2DM, as determined by the FRS. CVD risk factors should be properly evaluated and managed in individuals with prediabetes to reduce the risk of both incident T2DM and associated cardiovascular complications.

Abstract WMP24: Association of the Mediterranean Diet With White Matter Integrity Among Hispanics/Latinos. Results From the Study of Latinos-Investigation of Neurocognitive Aging-MRI Ancillary Study

Objective: Investigate the association between adherence to the Mediterranean Diet (MeDi) and white matter (WM) integrity among Hispanic/Latino adults. Background: High adherence to a MeDi was associated with better cognitive performance and decreased memory decline among Hispanic or Latino adults. Methods: We included 2,342 participants from the Study of Latinos-Investigation of Neurocognitive Aging-MRI Ancillary Study. Participants completed 24-hour dietary recalls at baseline (2008-2011) which were used to calculate a MeDi score (MeDiS). Brain MRI and diffusion tensor images were collected between 2018 and 2022 on a 3T MRI scanner using a standardized protocol. WM integrity was ascertained using WM hyperintensity (WMH) volume, fractional anisotropy (FA), and peak skeletonized mean diffusivity (PSMD). WMH volumes were residualized for total cranial volume and Ln-transformed prior to analysis. The association of MRI outcomes with MeDiS was investigated using weighted linear regression analysis with complex survey design adjusting for age, sex, sociodemographic characteristics, and Framingham Risk Score. Results: Mean age (95% CI) at MRI scan was 64.03 (63.1 - 64.9) and 44% were males. Mean MeDiS was 5.05 (4.92 - 5.17). In our fully adjusted model, increasing MeDiS was associated with decreased LnWMH volume (β=-0.07, 95% CI -0.10 to -0.03) and PSMD (β=-0.004, 95% CI -0.006 to -0.002), and increasing FA (β=0.002, 95% CI 0.001 to 0.003). When participants were grouped by background, the results were retained for all the groups except for Puerto Ricans and Mexicans. Conclusions: Among diverse Hispanic/Latino adults, high MeDi adherence was associated with preserved WM integrity. Since our preliminary results were retained after adjustment for Framingham Risk Score, this suggests that vascular mechanisms do not fully account for the observed associations. In addition, our results highlight that the results obtained in selected cohorts may not be generalizable to other Hispanic/Latino heritages. A culturally tailored MeDi may preserve brain health among Hispanic/Latino adults.

Sex differences in the applicability of Western cardiovascular disease risk prediction equations in the Asian population.

Cardiovascular diseases (CVDs) are the most common cause of death, but they can be effectively managed through appropriate prevention and treatment. An important aspect in preventing CVDs is assessing each individual's comprehensive risk profile, for which various risk engines have been developed. The important keys to CVD risk engines are high reliability and accuracy, which show differences in predictability depending on disease status or race. Framingham risk score (FRS) and the atherosclerotic cardiovascular disease risk equations (ASCVD) were applied to the Korean population to assess their suitability. A retrospective cohort study was conducted using National Health Insurance Corporation sample cohort from 2003 to 2015. The enrolled participants over 30 years of age and without CVD followed-up for 10 years. We compared the prediction performance of FRS and ASCVD and calculated the relative importance of each covariate. The AUCs of FRS (men: 0.750; women: 0.748) were higher than those of ASCVD (men: 0.718; women: 0.727) for both sexes (Delong test P <0.01). Goodness of fits (GOF) were poor for all models (Chi-square P < 0.001), especially, underestimation of the risk was pronounced in women. When the men's coefficients were applied to women's data, AUC (0.748; Delong test P<0.01) and the GOF (chi-square P = 0.746) were notably improved in FRS. Hypertension was found to be the most influential variable for CVD, and this is one of the reasons why FRS, having the highest relative weight to blood pressure, showed better performance. When applying existing tools to Korean women, there was a noticeable underestimation. To accurately predict the risk of CVD, it was more appropriate to use FRS with men's coefficient in women. Moreover, hypertension was found to be a main risk factor for CVD.

Networks of gut bacteria relate to cardiovascular disease in a multi-ethnic population: the HELIUS study.

Gut microbiota have been linked to blood lipid levels and cardiovascular diseases (CVDs). The composition and abundance of gut microbiota trophic networks differ between ethnicities. We aim to evaluate the relationship between gut microbiotal trophic networks and CVD phenotypes. We included cross-sectional data from 3860 individuals without CVD history from 6 ethnicities living in the Amsterdam region participating in the prospective Healthy Life in Urban Setting (HELIUS) study. Genetic variants were genotyped, faecal gut microbiota were profiled, and blood and anthropometric parameters were measured. A machine learning approach was used to assess the relationship between CVD risk (Framingham score) and gut microbiota stratified by ethnicity. Potential causal relationships between gut microbiota composition and CVD were inferred by performing two-sample Mendelian randomization with hard CVD events from the Pan-UK Biobank and microbiome genome-wide association studies summary data from a subset of the HELIUS cohort (n = 4117). Microbial taxa identified to be associated with CVD by machine learning and Mendelian randomization were often ethnic-specific, but some concordance across ethnicities was found. The microbes Akkermansia muciniphila and Ruminococcaceae UCG-002 were protective against ischaemic heart disease in African-Surinamese and Moroccans, respectively. We identified a strong inverse association between blood lipids, CVD risk, and the combined abundance of the correlated microbes Christensenellaceae-Methanobrevibacter-Ruminococcaceae (CMR). The CMR cluster was also identified in two independent cohorts and the association with triglycerides was replicated. Certain gut microbes can have a potentially causal relationship with CVD events, with possible ethnic-specific effects. We identified a trophic network centred around Christensenellaceae, Methanobrevibacter, and various Ruminococcaceae, frequently lacking in South-Asian Surinamese, to be protective against CVD risk and associated with low triglyceride levels.

Child Marriage and Cardiovascular Risk: An Application of the Non-laboratory Framingham Risk Score.

Child marriage, defined as marriage before the age of 18 years, is a precocious transition from adolescence to adulthood, which may take a long-term toll on health. This study aims to assess whether child marriage was associated with added risk of adverse cardiovascular outcomes in a nationally representative sample of Indian adults. Applying the non-laboratory-based Framingham algorithm to data on 336,953 women aged 30-49 years and 49,617 men aged 30-54 years, we estimated individual's predicted heart age (PHA). Comparing the PHA with chronological age (CA), we categorized individuals in four groups: (i) low PHA: PHA < CA, (ii) equal PHA: PHA = CA (reference category), (iii) high PHA: PHA > CA by at most 4 years, and (iv) very high PHA: PHA > CA by 5 + years. We estimated multivariable multinomial logistic regressions to obtain relative risks of respective categories for the child marriage indicator. We found that women who were married in childhood had 1.06 (95% CI 1.01-1.10) and 1.22 (95% CI 1.16-1.27) times higher adjusted risks of having high and very high PHA, respectively, compared to women who were married as adults. For men, no differential risks were found between those who were married as children and as adults. These results were generally robust across various socioeconomic sub-groups. These findings add to the relatively new and evolving strand of literature that examines the role of child marriage on later life chronic health outcomes and provide important insights for public health policies aimed at improving women's health and wellbeing.

Prediction of Coronary Artery Disease Risk Using Genetic and Phenotypic Variables.

Coronary artery disease (CAD) has the highest disease burden worldwide. To manage this burden, predictive models are required to screen patients for preventative treatment. A range of variables have been explored for their capacity to predict disease, including phenotypic (age, sex, BMI and smoking status), medical imaging (carotid artery thickness) and genotypic. We use a machine learning models and the UK Biobank cohort to measure the prediction capacity of these 3 variable categories, both in combination and isolation. We demonstrate that phenotypic variables from the Framingham risk score have the best prediction capacity, although a combination of phenotypic, medical imaging and genotypic variables deliver the most specific models. Furthermore, we demonstrate that Variant Spark, a random forest based GWAS platform, performs effective feature selection for SNP-based genotype variables, identifying 115 significantly associated SNPs to the CAD phenotype.

Incidental Coronary Arterial Calcification for Cardiovascular Risk Assessment in Men With Prostate Cancer Undergoing PET/CT Imaging

BackgroundCardiovascular (CV) disease is common among men with prostate cancer and the leading cause of death in this population. There is a need for CV risk assessment tools that can be easily implemented in the prostate cancer treatment setting. MethodsConsecutive patients who underwent positron emission tomography/computed tomography (PET/CT) for recurrent prostate cancer at a single institution from 2012 to 2017 were identified retrospectively. Clinical data and coronary calcification on nongated CT imaging were obtained. The primary outcome was major adverse CV event (MACE; myocardial infarction, coronary or peripheral revascularization, stroke, heart failure hospitalization, or all-cause mortality) occurring within 5 years of PET/CT. ResultsAmong 354 patients included in the study, there were 98 MACE events that occurred in 74 patients (21%). All-cause mortality was the most common MACE event (35%), followed by coronary revascularization/myocardial infarction (26%) and stroke (19%). Coronary calcification was predictive of MACE (HR = 1.9, 95% CI: 1.1-3.4, P = .03) using adjusted Kaplan-Meier analysis. As a comparator, the Framingham risk score was calculated for 198 patients (56%) with complete clinical and laboratory data available. In this subgroup, high baseline Framingham risk (corresponding to 10-year risk of CV disease > 20%) was not predictive of MACE. ConclusionsMACE was common (21%) in men with recurrent prostate cancer undergoing PET/CT over 5 years of follow-up. Incidental coronary calcification on PET/CT was associated with increased risk of MACE and may have utility as a CV risk predictor that is feasible to implement among all prostate cancer providers.

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

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

Liposomal-Associated Phospholipase A 2 Is More Effective in Predicting Cardiac Risk in Law Enforcement Than Framingham Risk Score and Coronary Artery Calcium Score Calculation.

To clarify the methods for identifying officers at high risk for cardiac events. This retrospective review included 3330 patient charts. Classic cardiovascular risk factors, coronary artery calcium (CAC) scores, and endothelial inflammatory biomarker levels were compared between civilians and law enforcement officers (LEOs). The Framingham Risk Score (FRS) was compared with risk assessment using inflammatory biomarkers. The FRS failed to identify more than 90% of LEOs at high risk of cardiovascular events. Similarly, the use of the CAC score was ineffective. Inflammatory biomarker analysis measuring the lipoprotein-associated phospholipase A 2 activity was the most reliable method for identifying LEOs at high risk of cardiovascular events. The use of the standard FRS and CAC scores is less effective than that of inflammatory biomarkers in identifying LEOs at high risk of cardiovascular events.

Influence of Repeated Plaque Visualization on Cardiovascular Risk Reduction after 3 years; a randomized controlled trial.

Helping people to understand their cardiovascular (CV) risk can influence the choices they make for risk reduction, including medication adherence and lifestyle modification. This study sought whether repeated visualization of coronary artery calcium (CAC) images was effective in sustaining long-term risk control in primary prevention, independent of a risk reduction program. Asymptomatic, statin-naïve participants, 40-70 years, with a family history of premature coronary artery disease and a CAC score from 1-400 were randomised to a nurse-led CV risk reduction program or standard care with bi-annual reviews. Only the intervention group (220 of 449 participants) visualised their CAC image (with repeat exposure in the first 3 months) and were initiated on statin therapy. The primary outcome was change in Framingham Risk Score (FRS) at 36 months, and the impact of CAC image recall on CV risk was assessed. The reduction in FRS (difference in differences (DID): -3.4% [95%CI: -4.4% to -2.4%], p=<0.001 and low-density-lipoprotein-cholesterol -1.2mmol/L [95%CI: -1.4 to -1.0], p=<0.001)) over 36 months was greater in the intervention than the control group. Within the intervention group, sustained recall of CAC images at 24 months was associated with lower systolic blood pressure (DID -4.3mmHg [95%CI: -7.7 to-0.9], p=0.01) and waist circumference (DID -2.0cm [95% CI: -3.9 to -0.1], p=0.03) at 36 months compared to unsustained recall. A nurse-led program, combining personalized patient visualization of CAC imaging with statin therapy, is beneficial for improving CV risk. Recalling the presentation of CAC images through repeated visual exposure may influence risk reduction.

Association of Periodic Limb Movements and Obstructive Sleep Apnea With Risk of Cardiovascular Disease and Mortality.

Obstructive sleep apnea is a well-established risk factor for cardiovascular disease (CVD). Recent studies have also linked periodic limb movements during sleep to CVD. We aimed to determine whether periodic limb movements during sleep and obstructive sleep apnea are independent or synergistic factors for CVD events or death. We examined data from 1049 US veterans with an apnea-hypopnea index (AHI) <30 events/hour. The primary outcome was incident CVD or death. Cox proportional hazards regression assessed the relationships between the AHI, periodic limb movement index (PLMI), and the AHI×PLMI interaction with the primary outcome. We then examined whether AHI and PLMI were associated with primary outcome after adjustment for age, sex, race and ethnicity, obesity, baseline risk of mortality, and Charlson Comorbidity Index. During a median follow-up of 5.1 years, 237 of 1049 participants developed incident CVD or died. Unadjusted analyses showed an increased risk of the primary outcome with every 10-event/hour increase in PLMI (hazard ratio [HR], 1.08 [95% CI, 1.05-1.13]) and AHI (HR, 1.17 [95% CI, 1.01- 1.37]). Assessment associations of AHI and PLMI and their interaction with the primary outcome revealed no significant interaction between PLMI and AHI. In fully adjusted analyses, PLMI, but not AHI, was associated with an increased risk of primary outcome: HR of 1.05 (95% CI, 1.00-1.09) per every 10 events/hour. Results were similar after adjusting with Framingham risk score. Our study revealed periodic limb movements during sleep as a risk factor for incident CVD or death among those who had AHI <30 events/hour, without synergistic association between periodic limb movements during sleep and obstructive sleep apnea.

Alterations in Th17 Cells and Non-Classical Monocytes as a Signature of Subclinical Coronary Artery Atherosclerosis during ART-Treated HIV-1 Infection.

Cardiovascular disease (CVD) remains an important comorbidity in people living with HIV-1 (PLWH) receiving antiretroviral therapy (ART). Our previous studies performed in the Canadian HIV/Aging Cohort Study (CHACS) (>40 years-old; Framingham Risk Score (FRS) > 5%) revealed a 2-3-fold increase in non-calcified coronary artery atherosclerosis (CAA) plaque burden, measured by computed tomography angiography scan (CTAScan) as the total (TPV) and low attenuated plaque volume (LAPV), in ART-treated PLWH (HIV+) versus uninfected controls (HIV-). In an effort to identify novel correlates of subclinical CAA, markers of intestinal damage (sCD14, LBP, FABP2); cell trafficking/inflammation (CCL20, CX3CL1, MIF, CCL25); subsets of Th17-polarized and regulatory (Tregs) CD4+ T-cells, classical/intermediate/non-classical monocytes, and myeloid/plasmacytoid dendritic cells were studied in relationship with HIV and TPV/LAPV status. The TPV detection/values coincided with higher plasma sCD14, FABP2, CCL20, MIF, CX3CL1, and triglyceride levels; lower Th17/Treg ratios; and classical monocyte expansion. Among HIV+, TPV+ versus TPV- exhibited lower Th17 frequencies, reduced Th17/Treg ratios, higher frequencies of non-classical CCR9lowHLADRhigh monocytes, and increased plasma fibrinogen levels. Finally, Th17/Treg ratios and non-classical CCR9lowHLADRhigh monocyte frequencies remained associated with TPV/LAPV after adjusting for FRS and HIV/ART duration in a logistic regression model. These findings point to Th17 paucity and non-classical monocyte abundance as novel immunological correlates of subclinical CAA that may fuel the CVD risk in ART-treated PLWH.

No Evidence for an Association of HIV and Antiviral Treatment With Changes in Framingham Cardiovascular Risk Score in the Ndlovu Cohort Study.

HIV and antiretroviral therapy (ART) have been associated with increased cardiovascular disease (CVD) risk in high-income countries. The authors studied the longitudinal association between HIV and ART and nonlaboratory Framingham Risk Score (FRS) in a middle-income country. This longitudinal analysis of the NCS (Ndlovu Cohort Study), South Africa used baseline to 36-month follow-up data. Demographics, HIV, ART status, and cardiometabolic measures were obtained. FRS was used as a CVD risk measure. Through linear mixed models, FRS trends over time and the association with HIV were studied. Analysis included 1136 participants, with 609 (54%) having HIV, and 495 (81%) taking ART. At baseline, 9.8% of participants had a high FRS. People living with HIV (PLHIV) had a 3.2% lower FRS than HIV-negative participants (P<0.001). FRS increased similarly for both groups over time. Other factors associated with FRS were secondary and higher education (ß value: -0.075, P<0.001; ß value: -0.084, P<0.001) and alcohol consumption (ß value: 0.011, P<0.001). CVD risk increased for all participants over 36 months, suggesting classic risk factors rather than HIV status or ART to be drivers of CVD risk. People living with HIV had a significantly lower FRS than their HIV-negative counterparts, possibly related to HIV itself or a more frequent interaction with healthcare services. No association of HIV and ART with changes in FRS over 36 months was observed, suggesting the need for research using clinical endpoints to elucidate the effects of HIV and ART on CVD risk. Population-based prevention of CVD risk factors in sub-Saharan Africa is warranted, regardless of HIV status.

Comparison of arterial stiffness indices measured by pulse wave velocity and pulse wave analysis for predicting cardiovascular and all-cause mortality in a Chinese population.

Arterial stiffness measured by pulse wave velocity and pulse wave analysis has been widely studied in different populations in terms of its correlation with cardiovascular events and all-cause mortality. It remains unknown which arterial stiffness index is better for risk stratification in the general population. We included 4129 participants from Gaoyou County, Jiangsu Province, China, with a median follow-up of 11 years. The primary endpoint was cardiovascular mortality, and the secondary endpoint was all-cause mortality. Harrell's C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) based on the Cox proportional hazards regression model were evaluated to assess predictive discrimination and accuracy. The associations between the 4 indices and cardiovascular mortality remained significant after adjusting for the Framingham Risk Score (FRS) and/or associated risk factors. Considering reclassification based on the newly integrated models (FRS model combined with the 4 indices), NRI for cardiovascular mortality showed that haPWV and baPWV had more significant improvement in reclassification compared with C1 and C2 [NRI with 95% CI: haPWV 0.410 (0.293, 0.523); baPWV 0.447 (0.330, 0.553); C1 0.312 (0.182, 0.454); C2 0.328 (0.159, 0.463); all P < 0.05]. This study showed that pulse wave velocity (haPWV and baPWV) provides better discrimination of long-term risk than arterial elasticity indices (C1 and C2) in the general population.

The Probability of Stroke Based on Clinical Decision Support System (CDSS) using the Framingham Risk Score Method in Hospital

Stroke is the main cause of death in Indonesia. Identification of stroke risk factors can use the Clinical Decision Support System (CDSS). Researchers have designed and developed a CDSS using the Framingham Risk Score (FRS) method to identify stroke in patients. The study aims to identify stroke risk factors using CDSS with the Framingham Risk Score method in dr Soebandi Hospital.This research was an analytic observational study using secondary data from medical record documents of neurology patients. . The sampling technique used was incidental sampling that met the inclusion criteria and exclusion criteria. The inclusion criteria used in selecting medical records were medical records that had complete data regarding gender, age, systolic blood pressure, total cholesterol, HDL, smoking behavior, history of diabetes mellitus, and the patient's stroke incidence thus obtaining 14 patient medical records.. Data were analyzed using the FRS method. Based on the research results, it can be concluded that there were 8 patients with high risk and 6 patients with low risk. However, further research needs to be carried out on the relationship between variables so that they can contribute in more detail to efforts to reduce the prevalence of stroke in society.

Estimated pulse wave velocity added additional prognostic information in general population: Evidence from National Health and Nutrition Examination Survey (NHANES) 1999–2018

BackgroundAs an indicator of arterial stiffness, there is controversy over whether estimated pulse wave velocity (ePWV) add additional prognostic information other than cardiovascular risk factors or traditional risk estimation model in general population. MethodsData from National Health and Nutrition Examination Survey in 1999–2018 was analyzed. Cardiovascular risk factors were collected and Framingham Risk Score (FRS) was calculated. Using all-cause and cardiovascular mortality as outcomes, Cox and restricted cubic spline (RCS) analysis was performed. Receiver operator characteristic (ROC) curves, Harrell's C-statistic and net reclassification index (NRI) analysis were used to assess whether ePWV adds additional predictive value. ResultsThe association between ePWV and outcomes was independent of cardiovascular risk factors (HR = 1.23 [95%CI 1.23–1.50] per m/s for all-cause mortality, and 1.52 [1.30–1.78] for cardiovascular mortality) and FRS (1.22 [1.12–1.32] for all-cause mortality, and 1.32 [1.10–1.59] for cardiovascular mortality). Except for ePWV and all-cause mortality adjusted by FRS, a liner association was found between ePWV and outcomes. For predictive value, the area under ROC and C-index of the model added with ePWV was higher than the one with FRS or risk factors alone (P < 0.01). The elevated ePWV upgraded 1338456 subjects from high-intermediate to high FRS category, and NRI was 3.61 % and 2.62 % for all-cause and cardiovascular deaths, respectively (all P < 0.001). ConclusionsIn general population, the present study demonstrated the association between ePWV and all-cause, cardiovascular mortality is independent of cardiovascular risk factors and traditional risk estimated model. ePWV also added additional information to them in predicting clinical outcomes.

Characterisation of Symptom and Polysomnographic Profiles Associated with Cardiovascular Risk in a Sleep Clinic Population with Obstructive Sleep Apnoea.

Recent data have identified specific symptom and polysomnographic profiles associated with cardiovascular disease (CVD) in patients with obstructive sleep apnoea (OSA). Our aim was to determine whether these profiles were present at diagnosis of OSA in patients with established CVD and in those with high cardiovascular risk. Participants in the Sydney Sleep Biobank (SSB) database, aged 30-74 years, self-reported presence of CVD (coronary artery disease, cerebrovascular disease, or heart failure). In those without established CVD, the Framingham Risk Score (FRS) estimated 10-year absolute CVD risk, categorised as "low" (<6%), "intermediate" (6-20%), or "high" (>20%). Groups were compared on symptom and polysomnographic variables. 629 patients (68% male; mean age 54.3 years, SD 11.6; mean BMI 32.3 kg/m2, SD 8.2) were included. CVD was reported in 12.2%. A further 14.3% had a low risk FRS, 38.8% had an intermediate risk FRS, and 34.7% had a high risk FRS. Groups differed with respect to age, sex and BMI. OSA severity increased with established CVD and increasing FRS. The symptom of waking too early was more prevalent in the higher FRS groups (p=0.004). CVD and FRS groups differed on multiple polysomnographic variables; however, none of these differences remained significant after adjusting for age, sex, and BMI. Higher CVD risk was associated with waking too early in patients with OSA. Polysomnographic variations between groups were explained by demographic differences. Further work is required to explore the influence of OSA phenotypic characteristics on susceptibility to CVD.

Recalibration of Framingham Risk Score for predicting 10-year cardiovascular disease risk in a South Indian population

Abstract Background: Cardiovascular diseases (CVDs) are the leading cause of mortality in India. Guidelines recommend using tools, such as the Framingham Risk Score (FRS), to predict the 10-year CVD risk of adults for primary prevention of CVDs. However, FRS was developed based on data from a predominantly White population in the United States, limiting its applicability to other regions. Objectives: This study aimed to recalibrate the FRS equations among adults in Kerala, India. Materials and Methods: Baseline survey data from the Kerala Diabetes Prevention Program were analyzed: 921 males and 567 females for lipid-based FRS scores and 1042 males and 646 females for body mass index (BMI)-based FRS scores. Recalibration of the original FRS scores was performed using local data on CVD risk factors and CVD mortality. Results: Among males, the median 10-year CVD risk with the recalibrated lipid-based FRS score was 7.34 (interquartile ranges [IQR] 4.33–12.42), compared with the original score of 8.88 (5.23–14.87) (P &lt; 0.001). For BMI-based FRS scores, the median 10-year CVD risk was 7.40 (4.27–11.83) for the recalibrated score, compared with 9.32 (5.40–14.80) for the original score (P &lt; 0.001). In females, the median 10-year CVD risk was 4.83 (2.90–8.36) for the recalibrated score, compared with 2.85 (IQR 1.71–4.98) for the original score (P &lt; 0.001). Similarly, the median 10-year CVD risk was 4.66 (2.74–8.81) for the recalibrated BMI-based FRS score, compared for 2.95 (1.72–5.61) with the original score (P &lt; 0.001). Conclusion: Recalibrated FRS scores estimated a significantly lower 10-year CVD risk in males and a higher risk in females than the original FRS scores.