High 10-year Cardiovascular Disease Risk Research Articles

Adherence to cardiovascular prevention strategies in patients with rheumatoid arthritis

Objectives: Patients with rheumatoid arthritis (RA) have a high risk of cardiovascular disease (CVD). Recent national and international guidelines suggest strict treatment of CVD risk factors in RA. The aim of this study was to evaluate the self-reported adherence to CV prevention strategies in patients with RA.Method: RA patients visiting an outpatient clinic for strict CVD risk management received a validated questionnaire to evaluate adherence to CV prevention strategies. Strict treatment targets were defined and lifestyle recommendations were given following a prespecified protocol. CVD risk was assessed using the SCORE algorithm.Results: In total, 111 questionnaires were returned (response rate of 82%). A high 10-year CVD risk (≥ 20%) was present in 53%, but only 3% thought they had an increased CVD risk. A total of 53% of patients reported that they ‘follow the doctors’ suggestions exactly’ and 75% reported finding it ‘easy to follow the suggestions’. Of the 69% of patients who were prescribed lipid- and/or blood pressure-lowering drugs, 90% reported taking all prescribed tablets. The advice to follow a diet was given to 42%, of whom 68% said they followed the advised diet. Physical exercise was advised to 67%, of whom 62% said they performed specific physical exercise on at least 3 days a week. The adherence to lifestyle recommendations was not significantly different across the CVD risk groups.Conclusions: RA patients tend to underestimate their CVD risk. The self-reported adherence of RA patients to CVD risk management was high concerning pharmaceutical interventions and moderate in the case of lifestyle interventions.

Abstract 12229: Health Literacy, Adherence to Self-Care Behaviors, and Ten-Year Cardiovascular Disease Risk in Central Appalachian Residents

Background: Appalachian Kentucky has disproportionately higher rates of cardiovascular disease (CVD) and associated risk factors than the rest of the U.S. Health literacy and adherence to CVD risk reduction self-care behaviors are important predictors of health outcomes and may play a major role in modifying CVD risk. Objective: To examine the relationships among health literacy, adherence to self-care behaviors and 10-year CVD risk in Central Appalachian residents. Method: This was a sub-analysis of baseline data of a randomized control trial in 844 Central Appalachian residents (male 25%, age 51± 14, Caucasian 95%) without major CVD (e.g., coronary artery disease, stroke). Health literacy was assessed by the Newest Vital Sign (NVS), and adherence to self-care behaviors by the Medical Outcomes Study Specific Adherence Scale. Ten-year CVD risk points were calculated from the Framingham formula based on age, high density lipoprotein, total cholesterol, systolic blood pressure (treated & untreated), smoking status, and diagnosis of diabetes. Linear regressions were used to examine the relationships among health literacy, adherence to self-care behaviors, and 10-year CVD risk. Results: Based on the NVS, 12% of residents had limited health literacy. Residents who had limited health literacy were more likely to have higher 10-year CVD risk than those with adequate health literacy ( p = .014). Health literacy was not correlated with adherence to self-care behaviors. Unadjusted regressions revealed that both health literacy and adherence to self-care behaviors predicted 10-year CVD risk ( p = .002 and < .001, respectively). After adjustment for the covariates (age, gender, ethnicity, marital status, employed status), only adherence to self-care behaviors predicted 10-year CVD risk ( p = .012) Conclusion: Poor adherence to self-care behaviors predicts higher 10-year CVD risk. The lack of independent relationship between health literacy and self-care adherence, and health literacy and outcome suggests that adherence to effective self-care may be fostered despite low health literacy. It is important to design and implement effective interventions to enhance adherence to self-care behaviors to reduce 10-year CVD risks in Central Appalachian residents.

Prediction of cardiovascular risk using Framingham, ASSIGN and QRISK2: how well do they predict individual rather than population risk?

BackgroundThe objective of this study was to evaluate the performance of risk scores (Framingham, Assign and QRISK2) in predicting high cardiovascular disease (CVD) risk in individuals rather than populations.Methods and findingsThis study included 1.8 million persons without CVD and prior statin prescribing using the Clinical Practice Research Datalink. This contains electronic medical records of the general population registered with a UK general practice. Individual CVD risks were estimated using competing risk regression models. Individual differences in the 10-year CVD risks as predicted by risk scores and competing risk models were estimated; the population was divided into 20 subgroups based on predicted risk. CVD outcomes occurred in 69,870 persons. In the subgroup with lowest risks, risk predictions by QRISK2 were similar to individual risks predicted using our competing risk model (99.9% of people had differences of less than 2%); in the subgroup with highest risks, risk predictions varied greatly (only 13.3% of people had differences of less than 2%). Larger deviations between QRISK2 and our individual predicted risks occurred with calendar year, different ethnicities, diabetes mellitus and number of records for medical events in the electronic health records in the year before the index date. A QRISK2 estimate of low 10-year CVD risk (<15%) was confirmed by Framingham, ASSIGN and our individual predicted risks in 89.8% while an estimate of high 10-year CVD risk (≥20%) was confirmed in only 48.6% of people. The majority of cases occurred in people who had predicted 10-year CVD risk of less than 20%.ConclusionsApplication of existing CVD risk scores may result in considerable misclassification of high risk status. Current practice to use a constant threshold level for intervention for all patients, together with the use of different scoring methods, may inadvertently create an arbitrary classification of high CVD risk.

PTH-126 Assessment Of Cardiovascular Risk Of Patients On Home Parenteral Nutrition

IntroductionPrognostic factors in patients on home parenteral nutrition (HPN) are primarily thought to be related to the underlying disease. 1 To the best of our knowledge, there is no data...

SAT0114 Prevalence of Cardiovascular Comorbidities Already Increased at Onset of Arthritis and Axial Spondyloarthritis - Results from the ESPOIR and DESIR Cohorts

BackgroundRheumatoid arthritis (RA) and spondyloarthritis (SpA) are associated with increased cardiovascular (CV) morbidity and mortality, largely attributable to chronic inflammation. However, it has not yet been clarified if the increased...

Divergent Associations of Antecedent- and Response-Focused Emotion Regulation Strategies with Midlife Cardiovascular Disease Risk

It is not known whether various forms of emotion regulation are differentially related to cardiovascular disease risk. The purpose of this study is to assess whether antecedent and response-focused emotion regulation would have divergent associations with likelihood of developing cardiovascular disease. Two emotion regulation strategies were examined: reappraisal (antecedent-focused) and suppression (response-focused). Cardiovascular disease risk was assessed with a validated Framingham algorithm that estimates the likelihood of developing CVD in 10years. Associations were assessed among 373 adults via multiple linear regression. Pathways and gender-specific associations were also considered. One standard deviation increases in reappraisal and suppression were associated with 5.9% lower and 10.0% higher 10-year cardiovascular disease risk, respectively, in adjusted analyses. Divergent associations of antecedent and response-focused emotion regulation with cardiovascular disease risk were observed. Effective emotion regulation may promote cardiovascular health.

The efficiency of cardiovascular risk assessment: do the right patients get statin treatment?

ObjectiveTo evaluate targeting of statin prescribing for primary prevention to those with high cardiovascular disease (CVD) risk.DesignTwo cohort studies including the general population and initiators of statins aged 35–74 years.SettingUK...

The case for more intensive use of statins.

The case for more intensive use of statins.

Global cardiovascular disease risk assessment in United States adults with diabetes

Diabetes mellitus (DM) is often considered a risk equivalent for cardiovascular disease (CVD); however, the variation in CVD risk in adults with DM has not been described. We studied 1114 US adults aged ≥18 years with DM from national survey data and the proportion at low (<10%), intermediate (10-20%) and high (>20%) risk, or with CVD, by age, gender, ethnicity and diabetes type and treatment, and glycaemic and risk factor control by risk group. Overall, 22.9% were low, 17.5% intermediate, 31.4% high risk and 28.2% had pre-existing CVD (total 59.6% high risk/CVD). More Hispanics (32.4%) and Blacks (30.6%) versus Whites (18.8%) were at lower risk (p<0.0001). Among type 1 versus 2 DM, 35% vs. 65% (p<0.0001) and among insulin users 68.1% were high risk or with CVD. However, among low-intermediate risk, >50% have metabolic syndrome and 7% chronic kidney disease, increasing the high risk/CVD group to 86.8%. Simultaneous achievement of HbA1c, blood pressure and low density lipoprotein-cholesterol goals was low (<15%) regardless of risk group. Many DM patients are not at high 10-year CVD risk, but metabolic factors may place them at greater long-term risk. Risk assessment could help target the intensity of treatment.

P1-284 Variation in estimated ten-year cardiovascular risk across four risk scoring tools in both a general population sample and an occupational setting

IntroductionSeveral screening tools are now available to estimate 10-year risk of cardiovascular disease (CVD). This study aimed to quantify the differences in CVD risk estimates derived from four widely-used risk...

Obesity markers and estimated 10-year fatal cardiovascular risk in Switzerland

Background and aim There is an ongoing debate on which obesity marker better predicts cardiovascular disease (CVD). In this study, the relationships between obesity markers and high (>5%) 10-year risk of fatal CVD were assessed. Methods and results A cross-sectional study was conducted including 3047 women and 2689 men aged 35–75 years. Body fat percentage was assessed by tetrapolar bioimpedance. CVD risk was assessed using the SCORE risk function and gender- and age-specific cut points for body fat were derived. The diagnostic accuracy of each obesity marker was evaluated through receiver operating characteristics (ROC) analysis. In men, body fat presented a higher correlation ( r = 0.31) with 10-year CVD risk than waist/hip ratio (WHR, r = 0.22), waist ( r = 0.22) or BMI ( r = 0.19); the corresponding values in women were 0.18, 0.15, 0.11 and 0.05, respectively (all p < 0.05). In both genders, body fat showed the highest area under the ROC curve (AUC): in men, the AUC (95% confidence interval) were 76.0 (73.8–78.2), 67.3 (64.6–69.9), 65.8 (63.1–68.5) and 60.6 (57.9–63.5) for body fat, WHR, waist and BMI, respectively. In women, the corresponding values were 72.3 (69.2–75.3), 66.6 (63.1–70.2), 64.1 (60.6–67.6) and 58.8 (55.2–62.4). The use of the body fat percentage criterion enabled the capture of three times more subjects with high CVD risk than the BMI criterion, and almost twice as much as the WHR criterion. Conclusion Obesity defined by body fat percentage is more related with 10-year risk of fatal CVD than obesity markers based on WHR, waist or BMI.