Modified Framingham Risk Score Research Articles

Coronary Artery Calcification Progression in Patients With Systemic Lupus Erythematosus.

To evaluate the progression of coronary artery calcification (CAC) and associated risk factors in a systemic lupus erythematosus (SLE) cohort. We reassessed the presence of CAC in patients with SLE who were screened 9 years before, using multidetector computed tomography. Clinical variables (cumulated disease activity and damage accrual), antiphospholipid syndrome and SLE serology, and cardiovascular (CV) risk factors (hypertension, BMI [kg/m2], modified Framingham risk score, lipid profile, menopausal status) were assessed longitudinally. We included 104 patients from the parent study. Most of them were women (94.2%), with a mean age of 41.0 (SD 8.3) years and mean disease duration of 14.8 (SD 2.9) years. We documented CAC in 17 patients (16.3%). Seven cases were from the parent study and 10 were incident cases. The cumulative incidence of CAC was 9% and the incidence density was 1 per 100 person-years. CAC occurred more frequently in the age groups 30-39 years and 40-44 years. All patients with previous CAC had worsening of their calcium indexes, and none developed clinical CV events. When comparing prevalent CAC cases (n = 17) vs patients without calcification (n = 87), both groups were similar in traditional CV risk factors, disease duration, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) area under the curve (AUC), and Systemic Lupus International Collaborating Clinics (SLICC) score, but were more likely to be postmenopausal and have higher apolipoprotein B (apoB) levels. Patients with previous CAC had higher apoB levels, SLEDAI-2K AUC scores, and anticardiolipin IgG antibodies than incident cases. CAC in patients with SLE progressed over time but was not associated with adverse CV events during the first 9 years of follow-up. ApoB levels and postmenopausal status might be associated with this progression.

Vascular Disease Is Associated With Differences in Brain Structure and Lower Cognitive Functioning in Inflammatory Bowel Disease: A Cross-Sectional Study.

Vascular disease and cognitive impairment have been increasingly documented in inflammatory bowel disease (IBD), and both have been individually correlated with changes in brain structure. This study aimed to determine if both macro- and microstructural brain changes are prevalent in IBD and whether alterations in brain structure mediate the relationship between vascular disease and cognitive functioning. Eighty-four IBD participants underwent multimodal magnetic resonance imaging. Volumetric and mean diffusivity measures of the thalamus, hippocampus, normal-appearing white matter, and white matter lesions were converted to age- and sex-adjusted z scores. Vascular comorbidity was assessed using a modified Framingham Risk Score and cognition was assessed using a battery of neuropsychological tests. Test scores were standardized using local regression-based norms. We generated summary statistics for the magnetic resonance imaging metrics and cognitive tests, and these were examined using canonical correlation analysis and linear regression modeling. Greater vascular comorbidity was negatively correlated with thalamic, normal-appearing white matter, and white matter lesion volumes. Higher Framingham Risk Score were also correlated with lower processing speed, learning and memory, and verbal fluency. Increased vascular comorbidity was predictive of poorer cognitive functioning, and this effect was almost entirely mediated (94.76%) by differences in brain structure. Vascular comorbidity is associated with deleterious effects on brain structure and lower cognitive functioning in IBD. These findings suggest that proper identification and treatment of vascular disease is essential to the overall management of IBD, and that certain brain areas may serve as critical targets for predicting the response to therapeutic interventions.

Predictors of Non-Obstructive Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography.

Appropriate patient selection for coronary angiography (CAG) is essential to minimize the unnecessary risk of morbidities and exposure to radiation and iodinated contrast. This becomes even more relevant in low-to-middle-income settings where most health expenditures are out-of-pocket due to lack of medical insurance. We determined predictors of non-obstructive coronaries (NOC) in patients undergoing elective CAG. CathPCI Registry®, single-center data was extracted for 25,472 patients who had CAG over an eight year period. After excluding patients for compelling conditions or known CAD, 2,984 (11.7%) patients were included in this study. Non-Obstructive Coronaries was defined as <50% left main coronary artery and major epicardial vessel stenosis. Multiple Cox proportional algorithm was employed to report prevalence ratios (PR) of predictors of NOC along with 95% confidence interval. Mean age of patients was 57.9 ± 9.7 years, 23.5% were women. Preprocedural non-invasive testing (NIT) was performed in 46% of the patients; of which 95.5% reported to be positive but only 67.3% were stratified as high risk. Of 2,984 patients undergoing elective CAG, 711 (24%) had NOC. Predictors of NOC included younger age <50 years (PR: 1.3, CI: 1.0-1.5), Women (1.8, 1.5-2.1), low (1.9, 1.5-2.5) and intermediate risk stratification (1.3, 1.0-1.6) on Modified Framingham Risk Score and inappropriate (2.7, 1.6-4.3) and uncertain (1.3, 1.1-1.6) classification of CAG on Appropriate Use Criteria. Patients with heart failure as an indication of CAG (1.7, 1.4-2.0) and No NIT or positive low risk NIT (1.8, 1.5-2.2) were more likely to have NOC. Approximately one out of four patients undergoing elective CAG had NOC. Yield of diagnostic catheterization can be improved by adjudicating NIT especially in younger patients, women, patients with heart failure as an indication of CAG, patients classified as inappropriate on Appropriate Use Criteria and patients categorized as low or intermediate risk on MFRS.

The effect of cardiovascular risk on disease progression in de novo Parkinson's disease patients: An observational analysis.

Currently available treatment options for Parkinson's disease are symptomatic and do not alter the course of the disease. Recent studies have raised the possibility that cardiovascular risk management may slow the progression of the disease. We estimated the effect of baseline cardiovascular risk factors on the progression of Parkinson's disease, using measures for PD-specific motor signs and cognitive functions. We used data from 424 de novo Parkinson's disease patients and 199 age-matched controls from the observational, multicenter Parkinson's Progression Markers Initiative (PPMI) study, which included follow-up of up to 9 years. The primary outcome was the severity of PD-specific motor signs, assessed with the MDS-UPDRS part III in the "OFF"-state. The secondary outcome was cognitive function, measured with the Montreal Cognitive Assessment, Symbol Digit Modalities Test, and Letter-Number Sequencing task. Exposures of interest were diabetes mellitus, hypertension, body mass index, cardiovascular event history and hypercholesterolemia, and a modified Framingham risk score, measured at baseline. The effect of each of these exposures on disease progression was modeled using linear mixed models, including adjustment for identified confounders. A secondary analysis on the Tracking Parkinson's cohort including 1,841 patients was performed to validate our findings in an independent patient cohort. Mean age was 61.4 years, and the average follow-up was 5.5 years. We found no statistically significant effect of any individual cardiovascular risk factor on the MDS-UPDRS part III progression (all 95% confidence intervals (CIs) included zero), with one exception: in the PD group, the estimated effect of a one-point increase in body mass index was 0.059 points on the MDS-UPDRS part III per year (95% CI: 0.017 to 0.102). We found no evidence for an effect of any of the exposures on the rate of change in cognitive functioning in the PD group. Similar results were observed for the Tracking Parkinson's cohort (all 95% CIs overlapped with PPMI), but the 95% CI of the effect of body mass index on the MDS-UPDRS part III progression included zero. Based on this analysis of two large cohorts of de novo PD patients, we found no evidence to support clinically relevant effects of cardiovascular risk factors on the clinical progression of Parkinson's disease.

Correlation Between Jakarta Cardiovascular Score and Coronary Artery Calcium Score in High-Risk Women at Siloam Hospital Surabaya, Indonesia, 2020-2021

Background: Coronary Artery Calcium Score (CAC) is an indicator of atherosclerosis and could be used as a reliable noninvasive assessment of coronary artery disease. The Jakarta Cardiovascular Assessment (JAKVAS) is a modified Framingham risk score based on the Indonesian population targeted for developing countries. This study was aimed todetermine the correlation between Jakarta Cardiovascular Score and Coronary Artery Calcium Score in High-Risk Women in Surabaya, Indonesia, in 2020-2021. Method: This study was a retrospective study looking for a correlation between JAKVAS and CAC, with data taken from the medical records of Siloam Hospital Surabaya from 2020-2021. Result: The association between JAKVAS and CAC risk stratification was significant (P &lt; 0.05). Conclusion: Theabsence of CAC is related to a lower risk of cardiovascular events (JAKVAS) than CAC &gt; 0 in high-risk women.

Cardiovascular disease risk assessment using a deep-learning-based retinal biomarker: a comparison with existing risk scores.

This study aims to evaluate the ability of a deep-learning-based cardiovascular disease (CVD) retinal biomarker, Reti-CVD, to identify individuals with intermediate- and high-risk for CVD. We defined the intermediate- and high-risk groups according to Pooled Cohort Equation (PCE), QRISK3, and modified Framingham Risk Score (FRS). Reti-CVD's prediction was compared to the number of individuals identified as intermediate- and high-risk according to standard CVD risk assessment tools, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the results. In the UK Biobank, among 48 260 participants, 20 643 (42.8%) and 7192 (14.9%) were classified into the intermediate- and high-risk groups according to PCE, and QRISK3, respectively. In the Singapore Epidemiology of Eye Diseases study, among 6810 participants, 3799 (55.8%) were classified as intermediate- and high-risk group according to modified FRS. Reti-CVD identified PCE-based intermediate- and high-risk groups with a sensitivity, specificity, PPV, and NPV of 82.7%, 87.6%, 86.5%, and 84.0%, respectively. Reti-CVD identified QRISK3-based intermediate- and high-risk groups with a sensitivity, specificity, PPV, and NPV of 82.6%, 85.5%, 49.9%, and 96.6%, respectively. Reti-CVD identified intermediate- and high-risk groups according to the modified FRS with a sensitivity, specificity, PPV, and NPV of 82.1%, 80.6%, 76.4%, and 85.5%, respectively. The retinal photograph biomarker (Reti-CVD) was able to identify individuals with intermediate and high-risk for CVD, in accordance with existing risk assessment tools.

Vascular comorbidity is associated with decreased cognitive functioning in inflammatory bowel disease

Reports of cognitive impairment in inflammatory bowel disease (IBD) have been mixed. IBD and cardiovascular disease are often co-morbid, yet it remains unknown whether vascular comorbidity confers a risk for decreased cognitive functioning, as observed in other populations. Participants with IBD were recruited from a longitudinal study of immune-mediated disease. Participants were administered a standardized neuropsychological test protocol, evaluating information processing speed, verbal learning and memory, visual learning and memory, and verbal fluency/executive function. Cognitive test scores were standardized using local regression-based norms, adjusting for age, sex, and education. Vascular risk was calculated using a modified Framingham Risk Score (FRS). We tested the association between FRS and cognitive test scores using a quantile regression model, adjusting for IBD type. Of 84 IBD participants, 54 had ulcerative colitis and 30 had Crohn’s disease; mean (SD) age was 53.36 (13.95) years, and a high proportion were females (n = 58). As the risk score (FRS) increased, participants demonstrated lower performance in information processing speed (β = − 0.12; 95% CI − 0.24, − 0.006) and verbal learning (β = − 0.14; 95% CI − 0.28, − 0.01) at the 50th percentile. After adjusting for IBD type and disease activity, higher FRS remained associated with lower information processing speed (β = − 0.14; 95% CI − 0.27, − 0.065). Vascular comorbidity is associated with lower cognitive functioning in persons with IBD, particularly in the area of information processing speed. These findings suggest that prevention, identification, and treatment of vascular comorbidity in IBD may play a critical role for improving functional outcomes in IBD.

Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE

ObjectiveStudies show that generic cardiovascular risk (CVR) prediction tools may underestimate CVR in SLE. We examined, for the first time to our knowledge, whether generic and disease-adapted CVR scores may...

Assessment of cardiovascular risk tools as predictors of cardiovascular disease events in systemic lupus erythematosus

BackgroundSLE is an independent risk factor for cardiovascular disease (CVD). This study aimed to determine which among QRISK2, QRISK3, Framingham Risk Score (FRS), modified Framingham Risk Score (mFRS) and SLE...

THU0147 CARDIOVASCULAR RISK IN RHEUMATOID ARTHRITIS: DO WE ALREADY HAVE A SENSITIVE AND SPECIFIC INSTRUMENT?

Background:Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disorder with high cardiovascular (CV) risk due to both classic and specific disease risk factors. According to EULAR’s recommendations, all patients should carry out an assessment of their CV risk, however, there are no specific evaluation algorithm’s for RA.Objectives:To assess the efficacy to predict CV risk in RA patients using the Systematic Coronary Risk Evaluation model (SCORE), Modified SCORE (mSCORE), Framingham Risk Score (FRS), Modified Framingham Risk Score (mFRS) and the American College of Cardiology/American Heart Association algorithm (ACC/AHA).Methods:Cross-sectional observational study including patients fulfilling 2010 ACR/EULAR classification criteria for RA and followed in the Rheumatology Department at Guarda Local Health Unit. Clinical records were reviewed and sociodemographic, classic CV risk factors and disease related factors, previous history of CV events and current treatment were collected. Individual CV risk was calculated using aforementioned models. Patients were divided in two groups: group 1 (without CV event history) and group 2 (with a history of CV event). Discriminative capacity tests, sensitivity and specificity were asserted and the different models were compared.Results:A total of 107 patients were included in the study and 10 suffered a CV event. Of 107 patients, 78% are women, the average age is 55.97± 6,78 and the average body mass index is 26,44± 4,43 kg/m2(Table 1). Models evaluated revealed reasonable discriminative capacity with areas under the curve between 0.73 and 0.88 (Figure 1). Regarding sensitivity and specificity we found that SCORE calculator fail to identified high risk in all patients with a CV event, however it presented a specificity of 94%. Others CV risk calculators showed the following sensitivities and specificities: mSCORE 63%, 88%; ACC/AHA 88%, 84%; FRS 63%, 88%; mFRS 88%, 76%.Table 1.Patient characteristicsPatients with RA (N=107)Patients with RA without CVDPatients with RA with CVD (N=10)pAge (years), mean±SD56 ± 6,855,7 ± 6,958,5±5,60,240Female, n(%)83 (77,6)79 (81,4)4 (40)0,003Rheumatoid factor positivity, n(%)36 (37,5)33 (37,9)3 (33,3)0,787Anti-CCP positivity, n (%)34 (37)29 (34,9)5 (55,6)0,226Smoking, n (%)4 (3,7)3 (4,1)1 (10)0,031BMI (weight(Kg)/height(m)2), mean±SD26,4±4,426,2±4,429,7±4,10,040Treatment with statins (%)342890&lt;0,001Figure 1.Receiver operating characteristic curves of the different risk prediction algorithmsConclusion:The five models tested in this study have a relative discriminative capacity. SCORE did not identify any CV event, which may compromise its ability to assess the CV risk in this patients.The most sensitive and specific model was the ACC/AHA, a very restricted model. When applying the multiplication factor of 1.5 recommended by EULAR, there is an improvement in sensitivity, however the specificity decreases.This study proves the limitations of CV risk calculators designed for the general population when applied to patients with RA. In conclusion, CV risk assessment is extremely important and there is still no ideal calculator, which is both sensitive and specific, and easily applicable in a clinical context.

Potential Confounders and a Modified Framingham Risk Score for the Prediction of Pregnancy-related Medical Conditions Occurrence among Pregnant Women: A Retrospective Study from Baghdad, Iraq.

ABSTRACTBackground:The incidence of pregnancy-related medical conditions relied on a set of potential factors that could be available even before the term of pregnancy and may be associated with poor outcomes later in life. This study aimed to investigate the association between some potential predictive factors related to maternal, gestational, and clinical parameters and the incidence of pregnancy-related medical conditions in a sample of Iraqi pregnant women.Materials and Methods:A retrospective, observational, single-center study was carried out on 92 pregnant women during their routine visit to the obstetric clinic in a certain distinct of Baghdad province, Iraq. Demographic, gestational, and clinical records of the participants were collected and analyzed to detect the predictive factors for pregnancy-related medical conditions.Results:56.5% of the participants were at a gestational age of 25–37 weeks. 32.6% complained of pregnancy-related medical conditions, mainly gestational hypertension and diabetes mellitus. Pregnant women with pregnancy-related medical conditions were significantly correlated with a family history (P < 0.0001), previous gestational medical conditions (P < 0.001), diastolic blood pressure (P = 0.0011), different lipid panels (P = 0.0001), and maternal blood phenotype O (P = 0.0001).Conclusion:Some predictive factors related to maternal, gestational, and health characteristics are correlated with the incidence of pregnancy-related medical conditions. Interventions to adjust and recognize these confounders are essentials even before pregnancy which could improve maternal health and reduce the overall risk of pregnancy-related medical conditions.

P1753Novel biomarker algorithmic panel measuring permutations of immune response to cardiac endothelial injury and global risk factors identifies patients at risk of acute coronary syndrome (ACS)

Abstract Background Global cardiovascular risk scores frequently underestimate risk in persons with underlying asymptomatic cardiac lesions who eventually experience cardiovascular events. The Get-With-The-Guidelines Initiative analysis revealed that over 70% of patients with a first cardiac event were well within guideline targets for lipid values. Most artery flow-disrupting events occur at locations with less than 50% lumen narrowing. From clinical studies published in the late 1990s using IVUS (in-the-artery-ultrasound) to visualize disease status, the typical heart attack occurs at locations with about 20% stenosis (narrowing), prior to sudden lumen closure and resulting ACS. This sudden lumen closure is caused by rupture of an unstable cardiac lesion causing a blood clot and occlusion in up to 75% of heart attacks. The role of multi-biomarker algorithms to identify vulnerable patients with these lesions at risk of short-term ACS events is of great interest. Methods We studied 725 adults (≥18 yrs) from Cardiology practices who received a 5-year modified Framingham Risk Score (mFRS), and a coronary artery disease predictive algorithm (CADPA) multi-biomarker score. CADPA incorporates 9 biomarkers (CTACK, Eotaxin, Fas Ligand, HGF, IL-16, MCP-3, sFas, HDL, and HbA1c) with age, sex, diabetes, and family history of myocardial infarction, previously shown to more accurately reclassify risk of cardiovascular events (cNRI=43%). Patients were classified into low (&lt;3.5%), intermediate (3.5% - &lt;7.5%), and high (≥7.5%) 5-year risk categories with both mFRS and CADPA. Patients low or intermediate risk by mFRS, but reclassified high by CADPA are reported and compared. Results Persons at low, intermediate, and high global risk categories were successively more likely to demonstrate high-risk scores with CADPA (Figure). However, 349 (65%) in the low mFRS risk group were reclassified into higher CADPA risk groups and 104 (70%) intermediate risk patients were reclassified into the high-risk group (p&lt;0.0001 for CADPA vs. mFRS). Analysis demonstrated that 89% (309) of the low or intermediate mFRS [125 females (99%); 184 males (83%); p&lt;0.0001] and, 86 below 65 years (93%) and 223 above 65 years (88%); p=0.26)] were classified as high-risk by CADPA, indicating that many persons who may be at high risk are not identified as such by global risk assessment. CADPA Risk Reclassification Conclusions We conclude that this novel multi-biomarker panel (CADPA) identifies many persons at increased risk of cardiac events due to asymptomatic cardiac lesions missed by traditional global risk methods. Further investigation of the value of such a test for prediction of near-term CVD events is required.

Prevalence of hypertension among office workers in a multi-national company in the Niger-Delta with the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines.

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines propose a new classification of blood pressure (BP).The objective was to compare the prevalence of hypertension among staff of a multinational oil/gas company in Niger-Delta, Nigeria using the 2017 ACC/AHA guidelines and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) guidelines.Cross-sectional analysis of 235 individuals who presented for their annual medical review between March 2017 and February 2018 was done. Demographic, medical and family history data were obtained with a questionnaire. Blood pressure was measured using the recommended procedure. Fasting blood samples were analysed for blood glucose and lipids. Ten-year cardiovascular risk was estimated with the 2008 modified Framingham risk score (FRS).The prevalence of hypertension using the JNC7 and the 2017 ACC/AHA guidelines was 25.9% and 53.9% respectively. With the former, family history of hypertension and increased BMI were independently significantly associated with hypertension. With the latter, male gender, family history of hypertension, BMI and physical inactivity were significant predictors of hypertension. 184 (78.3%) were categorised as low CVD risk, 38 (16.2%) intermediate risk and 13 (5.5%) high risk for CVD.The 2017 ACC/AHA guidelines doubled the prevalence of hypertension from 25.9% to 53.9%. Adoption of this guideline will necessitate careful consideration of the consequences of labeling individuals as hypertensive as well as an increment of the health care budget provided by companies for its staff to meet the increased burden of hypertension.

Cardiovascular Risk Assessment and Follow-Up of Women After Hypertensive Disorders of Pregnancy:A Prospective Cohort Study.

Hypertensive disorders of pregnancy (HDP) comprise an independent, sex-specific risk factor for cardiovascular disease (CVD) in women. This study examined the utility of CVD risk models proposed in the 2016 Canadian Cardiovascular Society (CCS) lipid guidelines to identify women requiring further screening or lipid treatment following HDP. Using data collected from the postpartum Maternal Health Clinic (MHC) at Kingston General Hospital in Kingston, Ontario and the Preeclampsia New Emerging Team (PE-NET) cohort study, the study investigators used the models recommended by the CCS guidelines and the cardiometabolic model of life expectancy in each cohort to estimate CVD risk in women after HDP. (Canadian Task Force Classification II-2). Using the 10-Year Modified Framingham Risk Score, all women were classified by the 2016 CCS Guidelines as low risk, requiring no follow-up. The 30-Year and Lifetime Risk Scores resulted in significant reclassification of women at risk in the PE-NET control and HDP groups (P<0.001 and P<0.0001, respectively); 49.2% of women with HDP were classified as high risk, requiring follow-up, compared with 14.3% of control subjects. Using the cardiometabolic model, median life expectancy was significantly lower and expected onset of CVD was earlier in the HDP group compared with the control group (P<0.0001). The 2016 CCS lipid guidelines' risk classification recommendations significantly underestimated lifelong CVD risk in the HDP group compared with the control group. Women with HDP also had a significant decrease in cardiometabolic life expectancy and an earlier predicted age at onset of CVD. Early primary prevention in this at-risk population may improve CVD outcomes and reduce the future burden on the health care system.

Modified Framingham Risk Score predicted 10-y CAD better than the original score in patients with lupus.

Source Citation Urowitz MB, Ibanez D, Su J, Gladman DD. Modified Framingham Risk Factor Score for systemic lupus erythematosus. J Rheumatol. 2016;43:875-9. 26879352

Impact of Replacing the Pooled Cohort Equation With Other Cardiovascular Disease Risk Scores on Atherosclerotic Cardiovascular Disease Risk Assessment (from the Multi-Ethnic Study of Atherosclerosis [MESA

The increase in statin eligibility by the new cholesterol guidelines is mostly driven by the Pooled Cohort Equation (PCE) criterion (≥7.5% 10-year PCE). The impact of replacing the PCE with either the modified Framingham Risk Score (FRS) or the Systematic Coronary Risk Evaluation (SCORE) on assessment of atherosclerotic cardiovascular disease (ASCVD) risk assessment and statin eligibility remains unknown. We assessed the comparative benefits of using the PCE, FRS, and SCORE for ASCVD risk assessment in the Multi-Ethnic Study of Atherosclerosis. Of 6,815 participants, 654 (mean age 61.4 ± 10.3; 47.1% men; 37.1% whites; 27.2% blacks; 22.3% Hispanics; 12.0% Chinese-Americans) were included in analysis. Area under the curve (AUC) and decision curve analysis were used to compare the 3 risk scores. Decision curve analysis is the plot of net benefit versus probability thresholds; net benefit= true positive rate- (false positive rate× weighting factor). Weighting factor= Threshold probability/1- threshold probability. After a median of 8.6years, 342 (6.0%) ASCVD events (myocardial infarction, coronary heart disease death, fatal or nonfatal stroke) occurred. All 4 risk scores had acceptable discriminative ability for incident ASCVD events; (AUC [95% CI] PCE: 0.737 [0.713 to 0.762]; FRS: 0.717 [0.691 to 0.743], SCORE (high risk) 0.722 [0.696 to 0.747], and SCORE (low risk): 0.721 [0.696 to 0.746]. At the ASCVD risk threshold recommended for statin eligibility for primary prevention (≥7.5%), the PCE provides the best net benefit. Replacing the PCE with the SCORE (high), SCORE (low) and FRS results in a 2.9%, 8.9%, and 17.1% further increase in statin eligibility. The PCE has the best discrimination and net benefit for primary ASCVD risk assessment in a US-based multiethnic cohort compared with the SCORE or the FRS.

Midlife Cardiovascular Risk Factors and Late-Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND-MI, the AGES-Reykjavik Study.

BackgroundAssociations of atherosclerosis risk factors with unrecognized myocardial infarction (UMI) are unclear. We investigated associations of midlife risk factors with UMI and recognized MI (RMI) detected 31 years later by cardiac magnetic resonance.Methods and ResultsThe Reykjavik Study (1967–1991) collected serial risk factors in subjects, mean (SD) age 48 (7) years. In ICELAND‐MI (2004–2007), 936 survivors (76 (5) years) were evaluated by cardiac magnetic resonance. Analysis included logistic regression and random effects modeling. Comparisons are relative to subjects without MI. At baseline midlife evaluation, a modified Framingham risk score was significantly higher in RMI and in UMI versus no MI (7.4 (6.3)%; 7.1 (6.2)% versus 5.4 (5.8)%, P<0.001). RMI and UMI were more frequent in men (65%, 64% versus 43%; P<0.0001). Baseline systolic and diastolic blood pressure were significantly higher in UMI (138 (17) mm Hg versus 133 (17) mm Hg; P<0.006; 87 (10) mm Hg versus 84 (10) mm Hg; P<0.02). Diastolic BP was significantly higher in RMI (88 (10) mm Hg versus 84 (10) mm Hg; P<0.02). Cholesterol and triglycerides were significantly higher in RMI (6.7 (1.1) mmol/L versus 6.2 (1.1) mmol/L; P=0.0005; and 1.4 (0.7) mmol/L versus 1.1 (0.7) mmol/L; P<0.003). Cholesterol trended higher in UMI (P=0.08). Serial midlife systolic BP was significantly higher in UMI versus no MI (β [SE] = 2.69 [1.28] mm Hg, P=0.04). Serial systolic and diastolic BP were significantly higher in RMI versus no MI (4.12 [1.60] mm Hg, P=0.01 and 2.05 [0.91] mm Hg, P=0.03) as were cholesterol (0.43 [0.11] mmol/L, P=0.0001) and triglycerides (0.3 [0.06] mmol/L, P<0.0001).ConclusionsMidlife vascular risk factors are associated with UMI and RMI detected by cardiac magnetic resonance 31 years later. Systolic blood pressure was the most significant modifiable risk factor associated with later UMI.

Cognitive performance in depressed older persons: the impact of vascular burden and remission. A two-year follow-up study.

Depression is associated with an increased risk of cognitive decline. The present study compared two-year change in cognitive performance between depressed older persons and a non-depressed control group, between remitted and non-remitted patients, and evaluated whether vascular burden at baseline was associated with more cognitive decline in depressed older persons. Depressed patients (n = 378) aged ≥60 were recruited from mental healthcare institutes and general practices, and a non-depressed control group (n = 132) was recruited from general practices. A DSM-IV depressive episode was established with the Composite International Diagnostic Interview, and processing speed, working memory, verbal memory and interference control were evaluated with three neurocognitive tasks at baseline and 2 years later. A modified Framingham Risk Score, ankle-brachial index, and history of a vascular event defined vascular burden at baseline. After adjusting for baseline cognitive performance, age, sex, and education level, depressed older persons had worse processing speed and verbal memory scores at follow-up than controls (regression coefficients: -0.172; p = 0.042 and -0.309; p = 0.001, respectively) but did not differ in the other two-cognitive outcomes. In the sample of depressed patients, remission status at 2 years follow-up and baseline vascular burden did not predict cognitive performance at follow-up, after adjustment for baseline cognitive performance, age, sex and education level. Our findings suggest that cognitive deficits in depressed older persons are not just a manifestation of depression. In addition, vascular burden was not associated with worse cognitive decline in a sample of depressed older persons. Copyright © 2016 John Wiley & Sons, Ltd.

Acetylsalicylic acid use in primary prevention in Canada: Insight from the Primary Care Audit of Global Risk Management (PARADIGM) study

Background: Acetylsalicylic acid (ASA) is of proven benefit in reducing cardiovascular (CV) events in both acute and chronic CV conditions. However, the role of ASA for the primary prevention of CV disease remains controversial, compounded by the risk of major hemorrhage with ASA therapy. Despite this, ASA remains frequently used in primary prevention. Methods: The PARADIGM study is an observational registry of 3015 healthy, middle-age Canadians, free of CV disease or diabetes, who underwent CV risk stratification. The present analysis assessed the use of ASA in this primary prevention cohort. Results: A total of 406 subjects (13.5%) were prescribed ASA by their primary care physician. Those prescribed ASA, compared with those who were not, were more likely to be older, of male sex, white Caucasian, past/current smokers, hypertensive and to have a family history of premature CV disease. Blood pressure, renal function, high-sensitivity C-reactive protein, waist circumference and body mass index were all discriminators of ASA use. The mean modified Framingham risk score was significantly higher for those prescribed ASA compared with those who were not. Importantly, only 44% of those prescribed ASA were at high risk according to Framingham risk score. Conclusions: The contemporary use of ASA in primary prevention remains high. Several clinical and laboratory factors influence the decision to prescribe ASA. However, the majority of ASA use was noted in individuals at low and intermediate risk (versus those at high risk).

Abstract 11917: Midlife Cardiovascular Risk Factors and Late-Life Unrecognized and Recognized Myocardial Infarction Detected by Cardiac Magnetic Resonance (ICELAND-MI, the AGES-Reykjavik Study)

Introduction: The association of midlife atherosclerosis risk factors (RF) with later unrecognized myocardial infarction (UMI) is unclear. We investigated associations of midlife RF with UMI and recognized MI (RMI) detected 31 years later by cardiac magnetic resonance (CMR). Methods: The Reykjavik Study (1967-91) collected serial measures of RF in subjects born 1907-35, mean (SD) age 48 ± 7 years. In ICELAND-MI (2004-07), 936 randomly selected survivors (76 ± 5 years) were evaluated by CMR. Analysis included logistic regression and random effects modeling adjusted for age, sex, and covariates. All comparisons are relative to the no MI group. Results: At baseline midlife evaluation, atherosclerotic risk assessed by a modified Framingham risk score was significantly higher in RMI and UMI than in no MI (7.4 ± 6.3%; 7.1 ± 6.2% vs 5.4 ± 5.8% respectively, p&lt;0.001). RMI and UMI were more common in men (65%, 64% vs 43%; p&lt;0.0001). Compared with no MI, baseline systolic BP was significantly higher in UMI (138 ± 17 mm Hg vs 133 ± 17 mm Hg; p=0.006), and trended higher in RMI (p=0.06). Likewise, baseline diastolic BP was significantly elevated in both RMI and UMI (88 ± 10 mm Hg and 87 ± 10 mm Hg vs 84 ± 10 mm Hg; p&lt;0.02). Serum cholesterol was significantly higher in RMI (6.7 ± 1.1 mmol/L vs 6.2 ± 1.1 mmol/L; p=0.005), as were serum triglycerides (1.4 ± 0.7 mmol/L vs 1.3 ± 0.7 mmol/L; p&lt;0.03). Serum cholesterol trended higher in UMI (p=0.08). Compared to no MI, serial midlife systolic and diastolic BP were significantly higher in RMI [beta=4.03 ± 1.64 (SE) mm Hg, p=0.014 and 2.05 ± 0.94 mm Hg, p=0.025, respectively] as were cholesterol and triglycerides [0.43 ± 0.11 mmol/L, p=0.001 and 0.31 ± 0.07 mmol/L, p&lt;0.0001, respectively]. Systolic BP was significantly higher in UMI [beta=2.76 ±1.31 mm Hg, p=0.036, figure]. Conclusions: Midlife vascular risk factors are associated with UMI and RMI detected by CMR 31 years later. Systolic BP was the most important individual risk factor associated with later UMI.