Framingham Risk Research Articles

Triglyceride Glucose Index Is Associated With Arterial Stiffness and 10-Year Cardiovascular Disease Risk in a Chinese Population.

Background: Insulin resistance (IR) is a significant risk factor for cardiovascular disease (CVD). In this study, the association of the triglyceride glucose (TyG) index, a simple surrogate marker of IR, with arterial stiffness and 10-year CVD risk was evaluated.Methods: A total of 13,706 participants were enrolled. Anthropometric and cardiovascular risk factors were determined in all participants, while serum insulin levels were only measured in 955 participants. Arterial stiffness was measured through brachial-ankle pulse wave velocity (baPWV), and 10-year CVD risk was evaluated using the Framingham risk score.Results: All participants were classified into four groups according to the quartile of the TyG index. BaPWV and the percentage of participants in the 10-year CVD risk categories significantly increased with increasing quartiles of the TyG index. Logistic regression analysis showed that the TyG index was independently associated with a high baPWV and 10-year CVD risk after adjusting for traditional CVD risk factors. The area under the receiver operating characteristics curve (AUROC) of the TyG index for predicting a high baPWV was 0.708 (95%CI 0.693–0.722, P < 0.001) in women, higher than that in men. However, the association of the homeostatic model assessment of IR (HOMA-IR) with a high baPWV and the 10-year CVD risk was absent when adjusting for multiple risk factors in 955 participants.Conclusions: The TyG index is independently associated with arterial stiffness and 10-year CVD risk.

The Role of Garcinia Mangostana Pericarp Extract as Antioxidant to Inhibit Atherosclerosis Process in High Risk Framingham Score Patient; Original Article

Atherosclerosis is the pivotal role of cardiovascular disease (CVD) involving oxidative stress dan inflammation. Garcinia has anti-oxidant property for years. This study was performed to explore the role of α-Mangostin of Garcia Mangostana Pericarp Extract as an antioxidant in inhibiting atherosclerotic process in patients with high-risk Framingham score. Methods: This prospective cohort design was led in 90 grown-ups with high hazard cardiovascular score which were resolved dependent on Framingham criteria, age 50–70 years of age. The patients were divided into two groups. One group was administered 2520 mg/day Garcinia mangostana Linn extracts (GMLE) in 3 divided doses for 90 days and the other group was administered a placebo. Parameters were Nitric Oxide (NO), Superoxide Dismutase (SOD) and Malondialdehyde (MDA), measured at baseline and after 90 days of treatment. An Independent T-test was performed for normally distributed data and the Mann-Whitney test was performed for abnormally distributed data with a significance level of p≤0.05. Results: Among the 77 subjects, we found that the plasma, MDA, concentration was significantly decreased compared with placebo 0,29±0.5 vs -0.04±0.25, respectively p = 0.011). SOD level significantly decreased in GMLE patients compared with placebo patients (0,17±0.79 vs -0.27±0.67, respectively, p=0.010) and we found that there was slightly increased in nitric oxide (NO), but no significantly compared with placebo 4.34±10.01 and 2.35±7.39, respectively, p = 0.37). Conclusion: Garcinia mangostana pericarp extract has an antioxidant effect that significantly inhibit atherosclerosis process in high-risk Framingham score patients

Statin Use, Heart Radiation Dose, and Survival in Locally Advanced Lung Cancer

PurposePatients with locally advanced non-small cell lung cancer (LA-NSCLC) have a high prevalence of pre-existing coronary heart disease and face excess cardiac risk after thoracic radiation therapy. We sought to assess whether statin therapy is a predictor of overall survival (OS) after thoracic radiation therapy. Methods and MaterialsWe performed a retrospective analysis of 748 patients with LA-NSCLC treated with thoracic radiation therapy, using Kaplan-Meier OS estimates and Cox regression. ResultsStatin use among high cardiac risk patients (Framingham risk ≥20% or pre-existing coronary heart disease; n = 496) was 51.2%. After adjustment for baseline cardiac risk and other prognostic factors, statin therapy was associated with a significantly increased risk of all-cause mortality (adjusted hazard ratio, 1.39; 95% confidence interval [CI], 1.00-1.91; P = .048) but not major adverse cardiac events (adjusted hazard ratio, 1.18; 95% CI, 0.52-2.68; P = .69). Among statin-naïve patients, mean heart dose ≥10 Gy versus <10 Gy was associated with a significantly increased risk of all-cause mortality (hazard ratio, 1.32; 95% CI, 1.04-1.68; P = .022), with 2-year OS estimates of 46.9% versus 60.0%, respectively. However, OS did not differ by heart dose among patients on statin therapy (hazard ratio, 1.00; 95% CI, 0.76-1.32; P = 1.00; P-interaction = .031), with 2-year OS estimates of 46.9% versus 50.3%, respectively. ConclusionsAmong patients with LA-NSCLC, only half of statin-eligible high cardiac risk patients were on statin therapy, reflecting the highest cardiac risk level of our cohort. Statin use was an independent predictor of all-cause mortality but not major adverse cardiac events. Elevated mean heart dose (≥10 Gy) was associated with increased risk of all-cause mortality in statin-naïve patients but not among those on statin therapy, identifying a group of patients in which early intervention with statins may mitigate the deleterious effects of high heart radiation therapy dose. This warrants evaluation in prospective trials.

CCL20 in psoriasis: A potential biomarker of disease severity, inflammation, and impaired vascular health

Psoriasis is associated with increased cardiovascular risk that is not captured by traditional proinflammatory biomarkers. To investigate the relationship between Psoriasis Area and Severity Index, circulating proinflammatory biomarkers, and vascular health in psoriasis. In patients with psoriasis and in age and sex-matched controls, 273 proteins were analyzed with the Proseek Multiplex Cardiovascular disease reagents kit and Inflammatory reagents kit (Olink Bioscience), whereas vascular endothelial inflammation and health were measured via direct transcriptomic analysis of brachial vein endothelial cells. In psoriasis, chemokine ligand 20 (CCL20), interleukin (IL) 6, and IL-17A were the top 3 circulating proinflammatory cytokines. Vascular endothelial inflammation correlated with CCL20 (r=0.55; P<.001) and less so with IL-6 (r=0.36; P=.04) and IL-17A (r=0.29; P=.12). After adjustment for potential confounders, the association between CCL20 and vascular endothelial inflammation remained significant (β=1.71; P=.02). In nested models, CCL20 added value (χ2=79.22; P<.001) to a model already incorporating the Psoriasis Area and Severity Index, Framingham risk, high-sensitivity C-reactive protein, Il-17A, and IL-6 (χ2=48.18; P<.001) in predicting vascular endothelial inflammation. Our study was observational and did not allow for causal inference in the relationship between CCL20 and cardiovascular risk. We demonstrate that CCL20 expression has a strong association with vascular endothelial inflammation, reflects systemic inflammation, and may serve as a potential biomarker of impaired vascular health in psoriasis.

Abstract 17042: CCL20 in Psoriasis: A Potential Biomarker of Disease Severity, Inflammation, and Impaired Vascular Health

Introduction: CV risk calculators that incorporate traditional risk factors underestimate CV risk in psoriasis and guidelines now suggest incorporating psoriasis into clinical decision making. Therefore, the purpose of this study is to use high throughput targeted proteomic panels to investigate the relationship between skin disease activity, inflammatory biomarkers, and vascular health. Methods: A targeted proteomics approach of 280 inflammatory proteins was performed in 23 psoriasis patients (age, mean [SD], 42 [14] years; 48% male, psoriasis area and severity index [PASI] 5 [3 - 11]) and 15 controls (41 [14], years; 53% male) recruited into an on-going clinical trial to assess vascular health in psoriasis (NCT03228017). Vascular health was assessed ex vivo through direct transcriptomic analysis of brachial vein endothelial cells. Serum samples were analyzed using the OLINK Proseek multiplex assay Inflammation I, Cardiovascular II/III profiles. Results: Targeted proteomics identified CCL20, IL6 and IL7A as the three highest circulating pro-inflammatory cytokines. CCL20 was 80% higher in psoriasis compared to controls ( p =0.004 ) and revealed a strong association with PASI ( r= 0.57; p =0.009). Additionally, CCL20 was positively associated with IL6, IL17A and hsCRP ( p &lt;0.01 for all). CCL20 positively associated with the mean composite transcriptome of endothelial inflammation (meanEC) (r=0.55, p&lt;0.01), which remained significant even after adjustment for traditional CV risk factors (adjusted [adj]β=0.63, p =0.001). Interestingly, CCL20 had a stronger correlation with meanEC than other established pro-inflammatory makers, including IL6 (adj β=0.48, p =0.04), IL17a (adj β=0.54, p =0.05), TNFα (adj β=0.06, p =0.78), and hsCRP (adj β=0.08, p =0.79). In nested models CCL20 added value (χ 2 = 79.22, p&lt;0.001) to a model already incorporating PASI, Framingham Risk, hs-CRP, IL-17A and IL-6 (χ 2 = 48.18, p&lt;0.001). Conclusions: We demonstrate that CCL20 expression has a strong correlation with PASI score and endothelial inflammation and reflects systemic inflammation better than well-established markers of inflammation in psoriasis including IL-6, IL-17A, and hs-CRP. CCL20 may serve as a potential biomarker of vascular health in this population.

Vascular risk factors, white matter lesions and cognitive impairment in Parkinson\u2019s disease: the PACOS longitudinal study

BackgroundVascular risk factors (VRFs) may be associated with cognitive decline in early Parkinson’s disease (PD) but results are inconclusive. The identification of modifiable risk factors is relevant for prevention and treatment.MethodsParkinson’s disease (PD) patients of the PACOS cohort who underwent a baseline and follow-up neuropsychological evaluation were enrolled in the study. PD with Mild Cognitive Impairment (MCI) and dementia (PDD) were diagnosed according to the MDS criteria. A Baseline 1.5 T brain MRI was used to calculate the white matter lesions (WMLs) burden using the Wahlund visual scale. Laboratory data, presence of hypertension, diabetes and use of anti-hypertensive drugs were collected and the Framingham Risk (FR) score was calculated. VRFs predicting PD-MCI and PDD were evaluated using Cox proportional hazard regression model.ResultsOut of 139 enrolled patients, 84 (60.4%) were classified as normal cognition (NC) and 55 (39.6%) as MCI at baseline. At follow-up 28 (33.3%) PD-NC developed MCI and 4 (4.8%) PDD (follow-up time 23.5 ± 10.3 months). Out of 55 PD-MCI patients at baseline, 14 (25.4%) converted to PDD. At multivariate analysis among PD-NC a systolic blood pressure (SBP) > 140 mmHg was the stronger predictor of MCI (adjHR 4.04; 95% CI 1.41–11.3) while the presence of MCI at baseline (adj HR 7.55; 95% CI 1.76–32.3) and a severe WMLs burden (adj HR 2.80; 95% CI 0.86–9.04) were the strongest predictors of PDD, even if this latter association has a trend towards significance.ConclusionHypertension represents the most important modifiable risk factor for PD-MCI in the PACOS cohort, increasing the risk of about four times.

Association between Growth Differentiation Factor 15 and Cardiovascular Risk in Patients with Type 2 Diabetes Mellitus

Background: Growth Differentiation Factor 15 (GDF 15) is one of the transforming growth factor-β (TGF-β) family, which is released from different cells under conditions of stress. Increased levels of GDF-15 are associated with cardiovascular diseases and are related to the progression and prognosis of the disease. Aim: the aim of the present study was to determine the correlation between serum GDF15 level and cardiovascular risk in patients with type2 DM using Framingham risk score (FRS). Subjects and methods: this study included three groups: control group (n=20), prediabetic group (n=30) and diabetic group (n=30). The participants have been subjected to laboratory investigations including serum levels of GDF15, measured by enzyme linked immunosorbent assay (ELISA). FRS was calculated through using the 10-year CHD Risk Framingham Tables. Results: there was a statistically significant increase in serum GDF 15 in diabetic and prediabetic groups in comparison to the control group (p= 0.006, p= 0.025) sequentially and serum GDF15 was significantly positively correlated with FRS in both the diabetic and prediabetic groups (r= 0.44, p=0.015and r= 0.38, p=0.04) sequentially. Conclusion: Serum GDF15 level may be a useful clinical biomarker for predicting cardiovascular risk in patients with type2 DM.

1062 The Role of Sleep in Sex and Racial/Ethnic Differences in 10-Year CVD Risk in the Sleep Heart Health Study: The Use of Machine-Learnt and Precision Insights to Understand Racial/Ethnic and Sex Differences in Sleep-CVD Disparity

Abstract Introduction The current study investigated whether insufficient sleep (&amp;lt;7 hrs.) explains differences in 10-year CVD risk, using Framingham risk (FRS) and Reynolds risk (RRS) scores, between blacks and whites and characterized risk and protective CVD risk profiles. Methods Using the Sleep Heart Health Study (SHHS) (N=6,441) data, we investigated the independent role of insufficient sleep in explaining differences in 10-years CVD between blacks and whites via a proportional odds model of four 10-year CVD risk groups: low (&amp;lt;5%), low-medium (5% to &amp;lt;10%), medium-high (10% to &amp;lt;20%) and high (≥20%), adjusting for age, sex, and apnea-hypopnea index (AHI). We performed two levels of cluster analyses; via hierarchical cluster algorithm with entire sample (Level 1), and latent profiles in the low (protective profiles) and high (risk profiles) CVD risk groups (Level 2) to determine overall CVD risk, and risk and protective CVD profiles. Results Blacks had a higher prevalence of smoking behavior, diabetes, mean systolic blood pressure, body mass index, total cholesterol compared to whites. Conversely, whites had a higher mean HDL cholesterol, sleep hours, and sleep efficiency compared to blacks. Men had higher 10-year CVD risk than women. AHI and race/ethnicity-sleep interaction were positively associated, while sleep was negatively associated with FRS and RRS. Across all CVD risk groups, whites who slept less than 5.5 hrs. had a higher CVD risk and those who slept more than 6.5 hrs. had a lower CVD risk compared to blacks. In Level 1 cluster analyses, we found two clusters: Cluster 1 (n= 3233): 6.17 sleep hours, apnea-index 11.84, age 59, SBP 125.43, total cholesterol 209, HDL 51.39, BMI 29.03, and slightly more than 50% female; and Cluster 2 (n=1657): 5.61 sleep hours, apnea-index 13.41, age 74, SBP 131, total cholesterol 204, HDL 50.30, BMI 26.45, and slightly less than 50% female. In Level 2 cluster analyses, we found two profiles within the low and high CVD risk groups. Conclusion These findings suggest that blacks may not receive full protection from long-term CVD risk with longer sleep duration, as their white counterparts. Support K01HL135452, R01MD007716, R01HL142066, K07AG052685

Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis

Equations predicting the risk of occurrence of cardiovascular disease (CVD) are used in primary care to identify high-risk individuals among the general population. To improve the predictive performance of such equations, we updated the Framingham general CVD 1991 and 2008 equations and the Pooled Cohort equations for atherosclerotic CVD within five years in a contemporary cohort of individuals who participated in the Austrian health-screening program from 2009–2014. The cohort comprised 1.7 M individuals aged 30–79 without documented CVD history. CVD was defined by hospitalization or death from cardiovascular cause. Using baseline and follow-up data, we recalibrated and re-estimated the equations. We evaluated the gain in discrimination and calibration and assessed explained variation. A five-year general CVD risk of 4.61% was observed. As expected, discrimination c-statistics increased only slightly and ranged from 0.73–0.79. The two original Framingham equations overestimated the CVD risk, whereas the original Pooled Cohort equations underestimated it. Re-estimation improved calibration of all equations adequately, especially for high-risk individuals. Half of the individuals were reclassified into another risk category using the re-estimated equations. Predictors in the re-estimated Framingham equations explained 7.37% of the variation, whereas the Pooled Cohort equations explained 5.81%. Age was the most important predictor.

Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants.

ResumoFundamentos Afrodescendentes têm sido associados a uma maior gravidade da hipertensão arterial e maior incidência de complicações cardiovasculares. Características na apresentação da hipertensão resistente (HR) ou hipertensão refratária (HRf), especificamente nessa etnia, não têm sido devidamente estudadas.Objetivos O estudo compara características clínicas e epidemiológicas e prevalência de eventos cardiovasculares em afrodescendentes com diagnóstico de HR ou de HRf. Métodos: Estudo transversal realizado em ambulatório de referência para pacientes com Hipertensão Grave. O nível de significância foi de 5%.Resultados Avaliados 146 pacientes consecutivos, dos quais 68,7% eram do sexo feminino. A média de idade foi de 61,8 anos, sendo 88,4% afrodescendentes (pardos ou negros). 51% apresentavam HRf. Houve alta prevalência de fatores de risco cardiovascular: 34,2% tinham diabetes, 69,4% dislipidemia, 36,1% obesidade e 38,3% história de tabagismo. Função renal reduzida foi observada em 34,2%. Eventos cardiovasculares prévios ocorreram em 21,8% para infarto do miocárdio e em 19,9% para acidente vascular cerebral. O escore de risco de Framingham foi moderado/alto em 61%. Os pacientes com HRf eram mais jovens (média de idade de 59,38±11,69 anos versus 64,10±12,23 anos, p=0,02), tinham mais dislipidemia (83,8 versus 66,7%, p=0,021) e acidente vascular cerebral (30,4 versus 12,3%, p=0,011) quando comparados aos com HR. O uso de combinação de ACEi/BRA+CCB+Diurético, clortalidona e espironolactona também foi mais frequente em indivíduos com HRf.Conclusão Afrodescendentes com HR apresentaram alto risco cardiovascular, alta prevalência de HRf, maior frequência de dislipidemia e de acidente vascular cerebral, compatível com alta incidência de lesão a órgãos-alvo. (Arq Bras Cardiol. 2020; 115(1):31-39)

Inflammation and Coronary Heart Disease Risk in Patients with Depression in China Mainland: A Cross-Sectional Study.

ObjectiveThe risk of coronary heart disease (CHD) in patients with major depressive disorder (MDD) is higher than that in the general population. However, the mechanisms underlying the increased CHD risk in patients with MDD remain unclear. Inflammation plays an important role in the pathogenesis of MDD and CHD. Therefore, we explored the relationship between inflammatory biomarkers and CHD risk in patients with MDD.MethodsWe included 454 patients with acute MDD and 458 controls that matched the sample in age and gender. A readily available complete blood count was used to reflect inflammation, and the risk of CHD was assessed using the Framingham risk score.ResultsThe results showed that patients with MDD showed low-grade inflammation with an elevated platelet (p<0.001) and monocyte count (p<0.001), high platelet/lymphocyte (p=0.003) and monocyte/lymphocyte ratios (p<0.001), and a raised systemic immune-inflammation index (p=0.002). In addition, monocyte count was the only factor significantly associated with CHD risk in patients with MDD (B=7.521, 95% CI: 3.409–11.633, t=3.594, p<0.001).ConclusionCollectively, the results of this study support the hypothesis that MDD is systemic inflammation, and suggest that monocyte count predicts the risk of CHD in patients with MDD.

Brachial-ankle pulse wave velocity and SCORE in primary hypertension patients

Background: Hypertension is still an important health problem that cause many serious cardiovascular risks. So screening these risks is extremely essential for primary hypertension patients. Aim: This study was conducted to evaluate baPWV and SCORE risk score in primary hypertension patients, then determine the association between baPWV and SCORE as well as conventional atherosclerotic risk factors in screening cardiovascular risk in hypertension patients. Methods: baPWV and SCORE were measured in a descriptive cross-sectional study in total of 107 primary hypertension patients (43 males and 64 females, age 30 to 74 years). Results: Analysis demonstrated that baPWV was associated with both Framingham and SCORE risk scores, independently from conventional atherosclerotic risk factors. The receiver-operator characteristic curve demonstrated that a baPWV of 25.06 m/s is useful for discriminating primary hypertension patients with high risk stratification by SCORE. Logistic regression analysis demonstrated that a baPWV&gt;25,06 m/s is an independent variable for the risk stratification by SCORE. Conclusion: baPWV that was significantly correlated with SCORE, has potential as a marker of evaluating cardiovascular risk in primary hypertension patients. Key words: Hypertension, primary hypertension, baPWV and SCORE risk score

Association of lipoprotein subfractions and glycoprotein acetylation with coronary plaque burden in SLE

ObjectiveSubjects with SLE display an enhanced risk of atherosclerotic cardiovascular disease (CVD) that is not explained by Framingham risk. This study sought to investigate the utility of nuclear MR (NMR)...

Atrial fibrillation (AF) in patients with CLL treated with ibrutinib: Assessing prediction models and clinical outcomes.

7522 Background: Ibrutinib therapy is associated with an increased risk (~15%) of AF. An accurate risk assessment model for the development of AF in pts starting ibrutinib is not established, and outcomes after AF are not well described. Methods: An IRB approved retrospective review of CLL pts treated with ibrutinib at Mayo Clinic between Oct 2012 and Nov 2018 was conducted. Results: 299 pts were identified with a total of 565 years of ibrutinib exposure (Table). After a median follow-up of 24 months (range 0–70 months), 51 pts developed treatment-emergent AF (13 [25%] CTCAE 3 or higher). Our study assessed 3 clinical prediction models, the Framingham (Schanbel:Lancet 2009), Italian (Visentin:Blood 2018;132:3118), and Shanafelt (Shanafelt:Leuk Lymp; 2017) risk scores. Based on a lower Akaike information criteria, the Italian score was best able to predict risk of treatment emergent AF (2-year risk of AF with score 0 6%; 1-2 8%; 3-4 26%; 5+ 47%). Thirty (61%) pts were treated with medical therapy for AF (27 rate control; 2 rhythm control; 1 both). 16 (31%) pts underwent interventional therapy (3 AV node ablation; 11 cardioversion; and 2 pacemaker). Twelve (23%) pts temporarily held ibrutinib and resumed their original dose, 22 (43%) pts continued reduced dose ibrutinib and 11 (22%) continued their initial ibrutinib dose. Six (12%) pts permanently discontinued ibrutinib. Of 51 pts with treatment-emergent AF, 41 (80%) had a CHA2DS2-VASc score of ≥2 (41% received anticoagulation alone; 12% received antiplatelet therapy alone; 10% received both). No pt developed a thrombotic stroke after treatment-emergent AF. Two major bleeds, (1 GI and 1 intracranial) occurred, one in a pt on concomitant antiplatelet and anticoagulation therapy, and one in a pt receiving neither. The development of AF was associated with shorter event-free survival (HR 2.5, 95%CI 1.5-4.2, p&lt;.001) and shorter overall survival (HR 3.5, 95%CI 2.0-6.3, p&lt;.001). Conclusions: The Italian score was the best predictor of AF development in this cohort of ibrutinib treated pts. Although the vast majority of pts who develop AF after ibrutinib are able to continue therapy, the occurrence of AF appears to be associated with shorter EFS and OS. [Table: see text]

Intensity and temporal patterns of physical activity and cardiovascular disease risk in midlife

Physical activity (PA) and sedentary time (SED) are associated with the risk of cardiovascular disease (CVD), but the temporal patterns of these behaviors most beneficial for cardiovascular health remain unknown. We aimed to identify the intensity and temporal patterns of PA and SED measured continuously by an accelerometer and their relationship with CVD risk.At the age of 46 years, 4582 members (1916 men; 2666 women) of the Northern Finland Birth Cohort 1966 study underwent continuous measurement of PA with Polar Active (Polar Electro, Finland) accelerometers for one week. X-means clustering was applied based on 10 min average MET (metabolic equivalent) values during the measurement period. Ten-year risk of CVD was estimated using the Framingham risk model.Most of the participants had low risk for CVD. Four distinct PA clusters were identified that were well differentiable by the intensity and temporal patterns of activity (inactive, evening active, moderately active, very active). A significant difference in 10-year CVD risk across the clusters was found in men (p = 0.028) and women (p < 0.001). Higher levels of HDL cholesterol were found in more active clusters compared to less active clusters (p < 0.001) in both genders. In women total cholesterol was lower in the moderately active cluster compared to the inactive and evening active clusters (p = 0.001).Four distinct PA clusters were recognized based on accelerometer data and X-means clustering. A significant difference in CVD risk across the clusters was found in both genders. These results can be used in developing and promoting CVD prevention strategies.

Cardiovascular risk prediction in India: Comparison of the original and recalibrated Framingham prognostic models in urban populations.

Introduction: Cardiovascular diseases (CVDs) are the leading cause of death in India. The CVD risk approach is a cost-effective way to identify those at high risk, especially in a low resource setting. As there is no validated prognostic model for an Indian urban population, we have re-calibrated the original Framingham model using data from two urban Indian studies. Methods: We have estimated three risk score equations using three different models. The first model was based on Framingham original model; the second and third are the recalibrated models using risk factor prevalence from CARRS (Centre for cArdiometabolic Risk Reduction in South-Asia) and ICMR (Indian Council of Medical Research) studies, and estimated survival from WHO 2012 data for India. We applied these three risk scores to the CARRS and ICMR participants and estimated the proportion of those at high-risk (>30% 10 years CVD risk) who would be eligible to receive preventive treatment such as statins. Results: In the CARRS study, the proportion of men with 10 years CVD risk > 30% (and therefore eligible for statin treatment) was 13.3%, 21%, and 13.6% using Framingham, CARRS and ICMR risk models, respectively. The corresponding proportions of women were 3.5%, 16.4%, and 11.6%. In the ICMR study the corresponding proportions of men were 16.3%, 24.2%, and 16.5% and for women, these were 5.6%, 20.5%, and 15.3%. Conclusion: Although the recalibrated model based on local population can improve the validity of CVD risk scores our study exemplifies the variation between recalibrated models using different data from the same country. Considering the growing burden of cardiovascular diseases in India, and the impact that the risk approach has on influencing cardiovascular prevention treatment, such as statins, it is essential to develop high quality and well powered local cohorts (with outcome data) to develop local prognostic models.

Predicting for Cardiac Events Following Allogeneic Hematopoietic Stem Cell Transplantation in Adults

Introduction Cardiovascular (CV) complications occur after hematopoietic stem cell transplantation (HCT). Risk factors for events are unclear making it difficult to determine optimal pre-transplant screening. Solid organ transplants programs calculate pre-transplant risk to determine indication for further cardiac testing. Based on this, we investigated whether several commonly used CV risk calculators predicted for CV events after HCT. Methods This was a prospective case control study at a single academic institution. CV risk was estimated using the Framingham General CVD Risk Score (2008), ACC/AHA Pooled Cohort Hard CVD Risk (ASCVD; 2013) calculator, and JBS3 QRISK Lifetime calculator. Results Forty-eight patients transplanted between 2012 and 2016 were analyzed. 27 (56%) were female. Ages ranged from 53-74 with a median of 64. Diseases transplanted were: AML (38%), MDS (31%), Non-Hodgkin's lymphoma (15%), and others 47% had high risk for CVD (score>2) by Framingham score. 67% had high risk by ASCVD calculator (10 year risk >7.5%). 70% had high risk by QRISK Lifetime calculator. 9%were low risk by Framingham score, but high risk by QRISK Lifetime calculator. Cardiac events evaluated included atherosclerotic events (myocardial infarction and stroke), atrial fibrillation (a-fib), and others (other arrhythmia, CHF, drop in LVEF, and cardiac arrest). 40% had any cardiac event. 15% had an atherosclerotic event (MI or CVA). 21% had a-fib. Framingham Risk, ASCVD and QRISK calculators did not predict for either atherosclerotic events or any cardiac events after HCT [Table 1]. Risk factors for a-fib specifically, were also evaluated: history of MI, diastolic or systolic dysfunction, CHF, valvular disease, tobacco use, diabetes, and hypertension. Only CHF was a predictor for a-fib (p=0.08). Conclusion CVD risk calculators commonly used in the general population and by solid organ transplant programs did not predict for CV events post-HCT here. However, this analysis was limited by small study size. Study in a larger population is being planned to allow incorporation of transplant related variables to develop a HCT-specific multivariate risk calculator to accurately predict post-HCT CV events.

Potential Gains of Screening Family Members of Suspected Coronary Artery Disease: A Pilot Study.

Background:Early diagnosis of asymptomatic coronary artery disease (CAD) is presently targeted in preventive cardiology. A positive family history though not modifiable can provide a window of opportunity for intervening on modifiable risk factors. We assessed the prevalence of risk factors among the family members of suspected CAD patients and estimated their 10 years CAD risk.Methods:In a hospital-based cross-sectional study, socio-demographic, personal data and blood samples for total and HDL cholesterol were collected. The risk of having a heart attack in the next 10 years was calculated using Framingham Risk Score.Results:The mean age of participants (n = 60) was 40.55 ± 1.78 years. 85% were physically inactive. Smoking (13%), alcohol use (12%), history of CAD (2%), HTN (12%) and diabetes (22%) were the observed risk factors. A family history of CAD at <40 years of age was reported by 7% of subjects. Prevalence of overweight was 21% and 11% were obese. Increased waist-hip ratio (43%), diabetes (22%), hypercholesterolemia (28%), reduced HDL Cholesterol (48%) were other prevalent risk factors. Risk of CAD of >1% in the next 10 years was noted among 60% of subjects.Conclusions:Window of opportunity for secondary prevention exists among the family members of suspected CAD.

Maternal age and cardiovascular and metabolic disease outcomes: a retrospective cohort study using data from population-based electronic medical records

Objective: To evaluate whether a woman’s age at first birth is associated with cardiovascular risk and metabolic health outcomes (cardiometabolic outcomes) by age 45.Methods: This is a retrospective, population-based cohort study that uses electronic health record data from the largest health fund in Israel. Women aged 34–39 at baseline (2004–2006) free of chronic diseases were identified as nulliparous at baseline and were followed up to 10 years (through 2016). The cohort was divided into three groups based on their age at first birth: younger parturients (ages 35–39), older parturients (ages 40–44), and never had children. The percentage of adverse pregnancy events and cardiometabolic outcomes at age 45 were compared across these three groups as well as to women in the general population. Cardiovascular risk and metabolic health outcomes were defined as: Type 2 diabetes, obesity, hypertension, cardiovascular disease, and Framingham risk score.Methods and results: Out of a group of 126,121 women aged 34–39 at baseline, 9979 were nulliparous and free of comorbidities. Over the course of the follow-up, there were 952 younger parturients and 673 older parturients who had their first birth, and 8354 women who remained persistent nulliparous. While older parturients had more adverse pregnancy events, there was no difference in rates of cardiometabolic outcomes between the two parturient groups, and they both had lower rates than the persistent nulliparous and the general population.Conclusions: Parturients free of major chronic diseases who give birth at a later age do not have increased cardiometabolic outcomes in midlife as compared to a general population of women in a large retrospective cohort. Our results may support clinicians when counseling healthy women who are seeking advice regarding delaying their first pregnancy without a tradeoff on health outcomes.

Cardiovascular risk reduction over time in patients with diabetes or pre-diabetes undergoing bariatric surgery: data from a single-center retrospective observational study

BackgroundBariatric surgery is effective in remission of obesity comorbidities. This study was aimed at comparing CVD risk between morbidly obese patients with type 2 diabetes and pre-diabetes before and after bariatric surgery as well as assessing comorbidities.MethodsThis is a retrospective observational study with 105 patients with type 2 diabetes (DMbaseline) and prediabetes (preDMbaseline) who underwent Roux-en-Y gastric bypass. Data were collected preoperative and then at 3,6,12,18,24,36,48, and 60 months after surgery. Anthropometric, cardiovascular and glycemic parameters were assessed. CVD risk was calculated using the Framingham Risk Score.ResultsPrior to surgery, 48 patients had type 2 diabetes, while 57 had pre-diabetes. Mean age was 48 (9.2) and mean BMI was 52 (7.4). 26.1% of patients had a high CVD risk. CVD risk decreased in patients with type 2 diabetes and prediabetes at month 12 after surgery compared to the baseline risk (p < 0.001). BMI, body fat percentage, fasting plasma glucose, HbA1c, c-peptide, HOMA-IR, LDL-c, systolic blood pressure, and diastolic blood pressure decreased during the first year after surgery. From the 12th month until the 60th, they showed a flat trend, or a very mild increase in some cases. 3.2% of patients maintained high CVD risk at 60 months. Type 2 diabetes remission was 92%. No patient of the preDMbaseline group developed type 2 diabetes.ConclusionBariatric surgery reduces CVD risk in type 2 diabetes and pre-diabetes. Given that patients with type 2 diabetes benefit the most, more studies are necessary to consider pre-diabetes as a criterion for metabolic surgery in patients with BMI ≥ 35 kg/m2.