Individual 10-year Risk Research Articles

Relationship of Non-Invasive Arterial Stiffness Parameters with 10-Year Atherosclerotic Cardiovascular Disease Risk Score in Post-COVID-19 Patients-The Results of a Cross-Sectional Study.

This study evaluated the relationship of non-invasive arterial stiffness parameters with an individual 10-year risk of fatal and non-fatal atherosclerotic cardiovascular disease (ASCVD) events in the cohort post-coronavirus disease 2019 (COVID-19). The study group included 203 convalescents aged 60.0 (55.0-63.0) and 115 (56.7%) women. The ASCVD risk was assessed as low to moderate to very high based on medical history (for 62 participants with pre-existing ASCVD/diabetes/chronic kidney disease in the entire cohort) or calculated in percentages using the Systemic Coronary Risk Evaluation 2 (SCORE2) algorithm based on age, sex, smoking status, systolic blood pressure (BP), and non-high-density lipoprotein cholesterol (for 141 healthy participants). The stiffness index (SI) and reflection index (RI) measured by photoplethysmography, as well as pulse pressure (PP), calculated as the difference between systolic and diastolic BP, were markers of arterial stiffness. Stiffness parameters increased significantly with the increase in ASCVD risk in the entire cohort. In 30 (14.8%) patients in the low- to moderate-risk group, the median SI was 8.07 m/s (7.10-8.73), RI 51.40% (39.40-65.60), and PP 45.50 mmHg (40.00-57.00); in 111 (54.7%) patients in the high-risk group, the median SI was 8.70 m/s (7.40-10.03), RI 57.20% (43.65-68.40), and PP 54.00 mmHg (46.00-60.75); and in 62 (30.5%) patients in the very-high-risk group, the median was SI 9.27 m/s (7.57-10.44), RI 59.00% (50.40-72.40), and PP 60.00 mmHg (51.00-67.00). In healthy participants, the SI ≤ 9.0 m/s (sensitivity of 92.31%, area under the curve [AUC] 0.686, p < 0.001) based on the receiver operating characteristics was the most sensitive variable for discriminating low to moderate risk, and PP > 56.0 mmHg (sensitivity of 74.36%, AUC 0.736, p < 0.001) was used for discriminating very high risk. In multivariate logistic regression, younger age, female sex, PP ≤ 50 mmHg, SI ≤ 9.0 m/s, and triglycerides < 150 mg/dL had the best relationship with low to moderate SCORE2 risk. In turn, older age, currently smoking, PP > 56.0 mmHg, RI > 68.6%, and diastolic BP ≥ 90 mmHg were related to very high SCORE2 risk. In conclusion, arterial stiffness is significantly related to ASCVD risk in post-COVID-19 patients and can be helpful as a single risk marker in everyday practice. Cut-off points for arterial stiffness parameters determined based on SCORE2 may help make individual decisions about implementing lifestyle changes or pharmacological treatment of ASCVD risk factors.

(118) The Atherosclerotic Cardiovascular Disease Risk Score is a Reliable Tool to Identify Patients with Arteriogenic Erectile Dysfunction at Dynamic Penile Color Doppler Duplex Ultrasound – Findings From a Real-life Cross-sectional Study

Abstract Introduction The ASCVD (Atherosclerotic Cardiovascular Disease) risk score is a validated and standardised algorithm predicting the individual 10-year risk of developing acute cardiovascular events (CVs). Patients with erectile dysfunction (ED) are at greater risk of CVs; Objective we aimed to i) apply the ASCVD score at a homogenous cohort of men undergoing dynamic penile color doppler duplex ultrasound (CDDU) for ED, and ii) explore its predictive ability to identify patients with arteriogenic and venogenic ED at CDDU. Methods Complete data of 188 consecutive patients undergoing CDDU for ED were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. All patients completed the International Index of Erectile Function (IIEF) at baseline. Serum hormones (total testosterone (tT) and luteinising hormone (LH)) were dosed for every patient. The ASCVD score was applied to the entire cohort. According to the ASCVD, patients were segregated into low (≤7.5%) vs. intermediate/high risk (&amp;gt; 7.5%). Descriptive statistics was used to explore differences between the two groups. Logistic regression models tested the potential predictive role of ASCVD scores to predict pathological CDDU parameters (peak systolic velocity (PSV) &amp;lt; 35 cm/s and/or resistance index (RI) ≤ 0.70). Local polynomial smoothing models graphically displayed the probability of pathological CDDU parameters at different ASCVD scores. Results Overall, median (IQR) age was 54 (43-60) yr. Of all, 52 (27.7%) patients reported severe ED, as for IIEF-EF ≤ 11. Overall, 80 (42.6%) showed a pure arteriogenic ED and 15 (8%) pure venogenic ED at CDDU. Intermediate/high-risk patients (52.7%) were found to have lower IIEF-EF scores, higher BMI, higher CCI and presented with a greater rate of PDE5i non-responders compared to those with low-risk (47.3%) according to ASCVD (all p&amp;lt;0.005). Conversely, the two groups did not significantly differ in terms of CDDU parameters. At logistic regression analysis, the ASCVD risk score was identified as a strong predictor for arteriogenic ED at CDDU (OR: 1.07, 95% CI: 1.03-1.13, p = 0.007) after adjusting for BMI. Conversely, the ASCVD score was not identified as a predictor of pure venogenic ED (OR: 1.04, 95% CI: 0.98-1.1, p = 0.22). Figure 1 displays the probability of pathological findings at CDDU (PSV &amp;lt; 35 cm/sec vs. RI &amp;lt; 0.7) at different ASCVD scores. Conclusions The ASCVD risk score can be used as a valuable tool to identify patients with arteriogenic ED at CDDU in real-life settings. Since vasculogenic ED may anticipate CVs even by some years, the accurate identification of patients with deficient cavernosal arterial flow would certainly allow earlier and more effective cardiovascular prevention in this subset of patients. Disclosure No

Magnitude, Distribution and Contextual Risk Enhancing Predictors of High 10-Year Cardiovascular Risk Among Diabetic Patients in Tanzania.

Atherosclerotic Cardiovascular Disease (ASCVD) is the leading cause of death worldwide. In Diabetics, ASCVD is associated with poor prognosis and a higher case fatality rate compared with the general population. Sub-Saharan Africa is facing an epidemiological transition with ASCVD being prevalent among young adults. To date, over 20 million people have been living with DM in Africa, Tanzania being one of the five countries in the continent reported to have a higher prevalence. This study aimed to identify an individual's 10-year ASCVD absolute risk among a diabetic cohort in Tanzania and define contextual risk enhancing factors. A prospective observational study was conducted at the Aga Khan hospital, Mwanza, for a period of 8 months. The hospital is a 42-bed district-level hospital in Tanzania. Individuals 10-year risk was calculated based on the ASCVD 2013 risk calculator by ACC/AHA. Pearson's chi-square or Fischer's exact test was used to compare categorical and continuous variables. Multivariable analysis was applied to determine contextual factors for those who had a high 10-year risk of developing ASCVD. The overall cohort included 573 patients. Majority of the individuals were found to be hypertensive (n = 371, 64.7%) and obese (n = 331, 58%) having a high 10-year absolute risk (n = 343, 60%) of suffering ASCVD. The study identified duration of Diabetes Mellitus (>10 years) (OR 8.15, 95% CI 5.25-14.42), concomitant hypertension (OR 1.82 95% CI 1.06-3.06), Diabetic Dyslipidemia (OR 1.44, 95% CI 1.08-1.92) and deranged serum creatinine (OR 1.03, 95% CI 1.02-1.03) to be the risk enhancing factors amongst our population. The study confirms the majority of diabetic individuals in the lake region of Tanzania to have a high 10-year ASCVD risk. The high prevalence of obesity, hypertension and dyslipidemia augments ASCVD risk but provides interventional targets for health-care workers to decrease these alarming projections.

PD26-12 FLACCID PENILE ULTRASOUND: A NEW POTENTIAL TOOL TO PREDICT THE INDIVIDUAL 10-YEAR RISK OF CARDIOVASCULAR DISEASE

You have accessJournal of UrologyCME1 Apr 2023PD26-12 FLACCID PENILE ULTRASOUND: A NEW POTENTIAL TOOL TO PREDICT THE INDIVIDUAL 10-YEAR RISK OF CARDIOVASCULAR DISEASE Giovanni Cochetti, Giuseppe Maiolino, Michele Del Zingaro, Alessio Paladini, Graziano Felici, Giulia Manfredini, Angelica Tancredi, and Ettore Mearini Giovanni CochettiGiovanni Cochetti More articles by this author , Giuseppe MaiolinoGiuseppe Maiolino More articles by this author , Michele Del ZingaroMichele Del Zingaro More articles by this author , Alessio PaladiniAlessio Paladini More articles by this author , Graziano FeliciGraziano Felici More articles by this author , Giulia ManfrediniGiulia Manfredini More articles by this author , Angelica TancrediAngelica Tancredi More articles by this author , and Ettore MeariniEttore Mearini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003304.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cardiovascular risk has become a hot topic in evaluation of patients with vasculogenic erectile dysfunction (ED). Recently, European Society of Cardiology (ESC) designed a cardiovascular disease (CVD) Risk Calculation App to calculate individual 10-year risk of CVD for healthcare professionals based on specific population-target scores. Aim of our study is to evaluate the association between mean basal peak systolic velocity of cavernosal arteries and the 10-year risk in men with vasculogenic ED. METHODS: We prospectively evaluated all patients with vasculogenic ED who underwent penile ultrasound between September 2021 and July 2022. All patients were examined in the same setting: quiet and warm room, one expert operator, sampling of basal PSV in the first third of cavernosal artery with an angle of doppler between 40-50° and calculation of mean basal PSV (mbPSV) between right and left cavernosal artery. Exclusion criteria were: neurological disease or spinal injury, psychogenic (clinical suspicious and/or Beck Inventory Scale ≥14) erectile disfunction. For each patient we calculated 10-year risk of CVD disease using SCORE2 for patients between 40 and 69 years without history of cardiovascular disease and diabetes mellitus, SMART score for patients with a history of cardiovascular disease and ADVANCE score for patients with diabetes mellitus. All risk scores were calculated by CVD Risk Calculation App of ESC. Ethical Committee approval has been obtained. RESULTS: We enrolled 80 consecutive patients. Mean age and BMI were 57,9 years and 26,8 Kg/m2, respectively. Median IIF-5 was 13,7. Average mbPSV and 10-year risk of CVD disease resulted 13,6 cm/sec (range: 5,3 -32,4 cm/sec) and 10,8% (range: 1,9-34%), respectively. We found an inverse and significant correlation between mbPSV and 10-year risk of CVD disease (r: -0.29; p: 0,02). The correlation resulted significant in patients with a history of cardiovascular disease which were evaluated by SCORE2 (r: -0.34; p: 0,017) and a stronger significant inverse correlation was found between mbPSV and 10-year risk of CVD in patients with diabetes mellitus in which the cardiovascular risk was calculated by ADVANCE score (r: -0.61; p: 0,021). mbPSV resulted significantly correlated also with age (r: -0.28; p: 0,021). CONCLUSIONS: MbPSV is a useful screening tool in patients with vasculogenic ED to evaluate 10-year risk of cardiovascular (CVD) disease. A lower mbPSV is correlated with a higher cardiovascular risk, especially in patients with diabetes mellitus where risk is calculated by ADVANCE score. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e739 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Cochetti More articles by this author Giuseppe Maiolino More articles by this author Michele Del Zingaro More articles by this author Alessio Paladini More articles by this author Graziano Felici More articles by this author Giulia Manfredini More articles by this author Angelica Tancredi More articles by this author Ettore Mearini More articles by this author Expand All Advertisement PDF downloadLoading ...

SC35 - Peak systolic velocity at basal penile ultrasound and individual 10-year risk of cardiovascular disease

SC35 - Peak systolic velocity at basal penile ultrasound and individual 10-year risk of cardiovascular disease

Cardiovascular risk factors in patients with calcium pyrophosphate crystal deposition disease

Calcium pyrophosphate crystal deposition disease (CPCDD) is among the most common inflammatory rheumatic diseases; however, studies of cardiovascular risks in CPCDD have not been conducted. Objective : to stratify a cardiovascular risk in patients with CPCDD according to the systematic coronary risk evaluation (SCORE) algorithm that allows determination of an individual 10-year risk of cardiovascular death. Subjects and methods . The one-stage, single-center study of a cardiovascular risk enrolled 118 patients (43 men and 75 women) with CPCDD. Laboratory studies included determination of fasting serum glucose, total cholesterol, uric acid, magnesium, phosphorus, and total calcium. The level of C-reactive protein (CRP) was measured by a highly sensitive method; CRP >5 mg/L was taken as a high level; parathyroid hormone was determined by chemiluminescence immunoassay. The SCORE table was used to assess the total cardiovascular risk in all the patients. Results and discussion . The patients' mean age was 60.7±12.4 years. According to the SCORE scale, very high and high risks of cardiovascular death were found in 59 (50%) and 6 (5%) patients, respectively; only in 10% of cases this risk was associated exclusively with age (> 65 years); 60 (50.8%) of the 118 patients did not have previous cardiovascular events or atherosclerosis risk factors. Coronary heart disease was detected in 28.8% of the 118 patients; hypertension was identified in 64%; diabetes mellitus (DM) was found in almost 15%. The mean SCORE values did not signif icantly differ in men and women. The level of CRP was higher in men than that in women (8.6±4.6 and 7.3±3.5 mg/dL, respectively; p = 0.04). Glomerular filtration rate (GFR) 100 ml/min: 61% (60/98) and 25% (5/20) of patients, respectively (p = 0.003). Hyperparathyroidism (HPT) was detected in 12 (10%) patients, and 7 of them were at a very high risk by the SCORE scale; however, hypercalcemia was diagnosed in only three cases. The results of the SCORE stratification of the whole group showed that 64 (54.2%) of the 118 patients with CPCDD were at a very high or high risk, the latter was very high in exactly half of the cases (n = 59. Conclusion . One-half of patients with CPCDD have a very high cardiovascular risk. In addition to the high detection rate of traditional cardiovascular risk factors (hypertension, smoking, hypercholesterolemia, and DM), the presence of chronic microcrystalline inflammation, concomitant metabolic disorders and diseases (hyperuricemia, HPT, decreased renal function) should be taken into account when determining the cardiovascular risk in patients with CPCDD.

Wiek naczyń — u kogo i jak go oceniać? Czy możemy „odmłodzić” naczynia naszych pacjentów?

Total cardiovascular risk assessment plays a key role in the prevention of cardiovascular disease (CVD). It facilitates identification of patients with increased CVD risk and allows to plan appropriate actions to reduce or eliminate risk factors. The SCORE chart is a practical tool for estimation of individual 10-year risk of fatal CVD. However, in young patients with risk factors, the absolute risk calculated with the SCORE chart may be low despite significantly elevated relative risk. In this group of patients, assessment of cardiovascular risk age (heart age, vascular age) may be useful for identification of individuals in whom intensive preventive measures should be implemented. These measures should focus on reducing existing risk factors, which in some patients might require the use of pharmacotherapy. Statins were proven to be effective in CVD risk reduction, including primary prevention. Statins significantly lower concentrations of low-density lipoproteins, which are crucial for the development of atherosclerosis. Moreover, beyond their cholesterol- -lowering properties, statins exert pleiotropic effects, leading to inhibition or even partial reversal of unfavorable changes within the vessel wall, and to a reduction of cardiovascular risk age.

Cardiovascular risk prediction: Can Systematic Coronary Risk Evaluation (SCORE) be improved by adding simple risk markers? Results from the Copenhagen City Heart Study.

European society of cardiology (ESC) guidelines recommend that cardiovascular disease (CVD) risk stratification in asymptomatic individuals is based on the Systematic Coronary Risk Evaluation (SCORE) algorithm, which estimates individual 10-year risk of death from CVD. We assessed the potential improvement in CVD risk stratification of 19 easily available risk markers by adding them to the SCORE algorithm. We followed 8476 individuals without prior CVD or diabetes from the Copenhagen City Heart study. The 19 risk markers were: major and minor electrocardiographic (ECG) abnormalities, heart rate, family history (of ischaemic heart disease), body mass index (BMI), waist-hip ratio, walking duration and pace, leisure time physical activity, forced expiratory volume (FEV)1%pred, household income, education, vital exhaustion, high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), high-sensitive C-reactive protein (hsCRP) and fibrinogen. With the exception of family history, BMI, triglycerides and minor ECG changes, all risk markers remained significantly associated with CVD mortality after adjustment for SCORE variables. However, the addition of the remaining 15 risk markers resulted in only small changes in discrimination calculated by area under the curve (AUC) and integrated discrimination improvement (IDI) and no improvement in net reclassification improvement (NRI). HsCRP improved AUC by 0.006 (p = 0.015) and IDI by 0.012 (p = 0.002); FEV1%pred improved AUC by 0.006 (p = 0.032) and IDI by 0.006 (p = 0.029). In the intermediate risk group FEV1%pred, education, vital exhaustion and ApoA1 all improved NRI but FEV1%pred was the only risk marker to significantly improve both IDI, AUC and NRI. The SCORE algorithm predicted CVD mortality in a Danish cohort well. Despite strong association with CVD mortality, the individual addition of 19 easily available risk makers to the SCORE model resulted in small risk stratification improvements.

The measures of autonomic homeostasis as predictors of an individual risk of stroke and their dynamics during therapy with actovegin

To evaluate an individual 10-year risk of stroke in patients with chronic cerebral ischemia, identify predictors of this risk and assess its dynamics during therapy with actovegin. The measures of autonomic homeostasis were estimated in 54 patients with chronic brainstem ischemia. The dynamics of these indexes during therapy with actovegin was studied. Chronic cerebral ischemia, mostly vertebrobasilar ischemia, is correlated with an increasing individual 10-year risk of stroke. A high positive pharmacologic effect of actovegin on the central and peripheral structures of the autonomic nervous system in chronic cerebral ischemia has been shown. A mediated hypotensive effect of actovegin due to humoral, metabolic and neurogenic influences on a vessel wall has been demonstrated.

Outcome Prediction in Node-Negative Breast Cancer Based on ASCO-Recommended Biomarkers uPA/PAI-1 Using the Final 10-Year Analysis of the Randomized Multicenter Chemo N0 Trial Compared to Adjuvant Online™.

Abstract Background: Based on interim analysis of Chemo N0, the first prospective multicenter randomized clinical trial using biomarkers uPA/PAI-1 for risk stratification and chemotherapy selection in N0 breast cancer, uPA/PAI-1 are now recommended for routine use by ASCO and AGO guidelines. Final 10-year follow-up of Chemo N0 has validated the clinically relevant long-term prognostic and predictive impact of uPA/PAI-1 in N0 breast cancer. To quantify the clinical utility of this impact, outcomes in subgroups defined by these biomarkers were compared to predictions of Adjuvant Online™, the leading validated tool based on established clinical factors. Methods: In Chemo N0, patients (n=647, 1993-98) were prospectively stratified according to uPA/PAI-1: High-risk patients were randomized (6x CMF vs. observation), low-risk patients observed. Retrospectively, we divided recruited patients into two groups (chemotherapy vs. no adjuvant therapy) and stratified using uPA/PAI-1 (low vs. high). Individual 10-year OS was calculated by www.adjuvantonline.org (Version 7.0); these estimated values were compared to the observed Chemo N0 10-year OS. Results: 383/647 patients have complete 10-year follow-up data. Median 10-year OS estimated by Adjuvant Online™ was 80.5% taking into account administered adjuvant therapy; 10-year Chemo N0 follow-up revealed observed 10-year OS of 74.7% (97/383 died). 77.8% (298/383) did not receive chemotherapy: In high-risk, untreated patients (n=137), 10-year OS was 72.3% vs. estimated 81.1%. In CMF-treated patients (all high-risk, n=85), observed OS was 61.2% vs. estimated 76.4%. Conclusions: For the first time, risk assessment by novel biomarkers is compared to that by Adjuvant Online™ in final data from a randomized prospective clinical trial. In patients with high uPA/PAI-1, the individual 10-year risk calculated by Adjuvant Online™ seems to be underestimated compared to observed patient outcome. Tumor-biological information provided by validated biomarkers thus has the potential of enhancing epidemiology-based risk estimation using only established factors. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4038.