Prospective Cardiovascular Münster Research Articles

Cost Effectiveness of Endovascular Ultrasound Renal Denervation in Patients with Resistant Hypertension.

Resistant hypertension (rHTN) is defined as blood pressure (BP) of ≥ 140/90mmHg despite treatment with at least three antihypertensive medications, including a diuretic. Endovascular ultrasound renal denervation (uRDN) aims to control BP alongside conventional BP treatment with antihypertensive medication. This analysis assesses the cost effectiveness of the addition of the Paradise uRDN System compared with standard of care alone in patients with rHTN from the perspective of the United Kingdom (UK) health care system. Using RADIANCE-HTN TRIO trial data, we developed a state-transition model. Baseline risk was calculated using Framingham and Prospective Cardiovascular Münster (PROCAM) risk equations to estimate the long-term cardiovascular risks in patients treated with the Paradise uRDN System, based on the observed systolic BP (SBP) reduction following uRDN. Relative risks sourced from a meta-analysis of randomised controlled trials were then used to project cardiovascular events in patients with baseline SBP ('control' patients); utility and mortality inputs and costs were derived from UK data. Costs and outcomes were discounted at 3.5% per annum. Modelled outcomes were validated against trial meta-analyses and the QRISK3 algorithm and real-world evidence of RDN effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty surrounding the model inputs and sensitivity of the model results to changes in parameter inputs. Results were reported as incremental cost-effectiveness ratios (ICERs). A mean reduction in office SBP of 8.5mmHg with uRDN resulted in an average improvement in both absolute life-years (LYs) and quality-adjusted life-years (QALYs) gained compared with standard of care alone (0.73 LYs and 0.67 QALYs). The overall base-case ICER with uRDN was estimated at £5600 (€6500) per QALY gained (95% confidence interval £5463-£5739 [€6341-€6661]); modelling demonstrated > 99% probability that the ICER is below the £20,000-£30,000 (€23,214-€34,821) per QALYs gained willingness-to-pay threshold in the UK. Results were consistent across sensitivity analyses and validation checks. Endovascular ultrasound RDN with the Paradise system offers patients with rHTN, clinicians, and healthcare systems a cost-effective treatment option alongside antihypertensive medication.

ГИПЕРТРИГЛИЦЕРИДЕМИЯ И АТЕРОСКЛЕРОТИЧЕСКИЕ СЕРДЕЧНО- СОСУДИСТЫЕ ЗАБОЛЕВАНИЯ

Introduction. Elevated triglyceride levels are associated with an increased risk of cardiovascular disease. An increase in the concentration of triglycerides indicates an elevated level of atherogenic lipoproteins, such as very low density lipoproteins, very low density lipoproteins residues and chylomicron residues. Lipoproteins rich in triglycerides increase the formation of foam cells, which is one of the key stages of the pathogenesis of atherosclerosis. Aim. To analyze the results of modern studies on elevated triglycerides and cardiovascular diseases. Material and methods. A review of medical literature and current research for the period from 1965 to 2022, published in the databases eLibrary, Google Scholar, PubMed, devoted to the analysis of hypertriglyceridemia and its effect on atherosclerotic cardiovascular diseases by the keywords «hypertriglyceridemia», «cardiovascular diseases», «atherosclerosis». Results and discussion. According to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation study, an elevated level of triglyceride was found in 30.2±0.52% of men in the entire sample, which is significantly higher than in women (20.1±0.34%; p<0.0001). According to the largest epidemiological study (Framingham Study), a TG level of more than 1.7 mmol/l means a significantly higher risk of developing cardiovascular complications. A prospective study by The Prospective Cardiovascular Munster (PROCAM) showed that an increase in the concentration of triglycerides from 2.3 mmol/l to 9.00 mmol/l increases the risk of cardiovascular diseases., even after correction of other risk factors. Conclusion. Triglycerides play an important role in the development of atherosclerotic diseases of the cardiovascular system, regardless of the etiology of hypertriglyceridemia. And effective lipid-lowering therapy prescribed in time can increase the life expectancy of such patients

Cardiovascular risk profiles in German Air Force pilots

IntroductionCardiovascular disease (CVD) is the leading cause of death in western industrial countries and one of the most frequent causes of sudden incapacitation in flight for pilots. There are limited...

Prevalence of obesity, metabolic syndrome, diabetes and risk of cardiovascular disease in a psychiatric inpatient sample: results of the Metabolism in Psychiatry (MiP) Study.

The information on prevalence of obesity, diabetes, metabolic syndrome (MetS) and cardiovascular risk (CVR) and on sociodemographic variables available in patients with psychiatric diseases about to be treated with weight gain-associated medication (e.g., clozapine, mirtazapine, quetiapine) is limited. In a naturalistic study, psychiatric inpatients (age: 18-75) of all F diagnoses according to ICD-10, who were about to be treated with weight gain-associated medication, were included. Demographic variables were assessed as well as biological parameters to calculate the Body Mass Index (BMI), MetS, diabetes and CVR. A total of 163 inpatients were included (60.1% male; mean age: 39.8 (± 15.1, 18-75years). The three most common disorders were depression (46.0%), bipolar disorder (20.9%) and drug addiction (20.2%). The three most common pharmacotherapeutic agents prescribed were quetiapine (29.4%), mirtazapine (20.9%) and risperidone (12.9%). Of the included inpatients 30.1% were overweight, 17.2% obese, and 26.9% and 22.4% fulfilled the criteria for a MetS according to the International Diabetes Federation (IDF) and the National Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCEP ATP III), respectively, 3.8% had (pre)diabetes and 8.3% had a moderate and 1.9% a high CVR according to the Prospective Cardiovascular Münster (PROCAM) score. Detailed information is reported on all assessed parameters as well as on subgroup analyses concerning sociodemographic variables. The results suggest that psychiatric patients suffer from multiple metabolic disturbances in comparison to the general population. Monitoring weight, waist circumference, blood pressure and cholesterol regularly is, therefore, highly relevant.

The Predictive Value of Arteriogenic Erectile Dysfunction for Coronary Artery Disease in Men

BackgroundErectile dysfunction (ED) is assumed to be connected with vascular disease caused by endothelial dysfunction, and characterized by the incapability of the smooth muscle cells lining the arterioles to relax, therefore, inhibit vasodilatation. AimTo assess the predictive value of arteriogenic ED for coronary artery disease in men above the age of 40 years. Methods75 Patients reporting arteriogenic ED and 25 men with normal erectile function were enrolled in the study. Both patients and controls were subjected to the following investigations: lipid profile, fasting blood sugar, body mass index (BMI), waist circumference, penile duplex study, stress electrocardiography (ECG) test, International Index of Erectile Function (IIEF) Type 5 (Arabic version), and cardiovascular (CV) 10-year risk assessment using Framingham and Prospective Cardiovascular Münster (PROCAM) scoring systems. OutcomesWe compare between the study groups regarding the interpretation of exercise testing. ResultsWe observed significant increase in the mean value of age, systolic blood pressure, BMI, weight, height, and waist circumference in the cases; significant prevalence of obesity and overweight in the cases (P < .001); significant increase in the mean value of total cholesterol, triglycerides (TG), and low-density lipoprotein; and decrease in mean value of high-density lipoprotein in the cases (P < .001). Additionally, there was high incidence of positive stress ECG in the cases (25.3%) vs that in controls (12%), and significant difference between patients with positive stress ECG test and those with negative stress ECG test regarding their lipid profile, age, BMI, and waist circumference with higher values in positive stress ECG for total cholesterol, TG, and low-density lipoprotein, and lower value for high-density lipoprotein (P < .001). According to PROCAM and Framingham scoring systems 10-year risk assessment, there was a high significant difference between the cases and control groups with a higher score in cases than the control group with 30.7% of cases having ≥ 30% risk of developing coronary heart disease, and significant positive correlations between CV risk and BMI, and negative correlations with IIEF-5 cases (P < .001). Clinical TranslationIschemic heart disease events were higher in men with documented arteriogenic ED than those without ED. ConclusionsAll items of metabolic syndrome were investigated and analyzed and we evaluated our groups using both PROCAM and Framingham scoring system. An exercise ECG is suggested before starting treatment of vasculogenic ED at least in patients with CV risk factors.Azab SS, Hosni HED, El Far TA, et al. The Predictive Value of Arteriogenic Erectile Dysfunction for Coronary Artery Disease in Men. J Sex Med 2018;15:880–887.

30-Year-Old Man With Outside-of-Hospital Cardiac Arrest

30-Year-Old Man With Outside-of-Hospital Cardiac Arrest

Family physician-led, team-based, lifestyle intervention in patients with metabolic syndrome: results of a multicentre feasibility project.

Metabolic syndrome (MetS) is a medical condition with major complications and health care costs. Previous research has shown that diet and exercise can improve and reverse this condition. The goal of this study was to test the feasibility and effectiveness of implementing the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program into diverse family medicine practices to improve MetS. In this longitudinal before-after study, 305 adult patients with MetS were recruited from 3 diverse family medicine team-based organizations to the CHANGE personalized diet and exercise program. Participants were followed for 12 months. Primary outcomes included feasibility and reversal of MetS. Secondary outcomes included improvement in MetS components, changes in diet quality, aerobic fitness and cardiovascular risk. Participants attended 76% and 90% of the kinesiologist and dietitian visits, respectively. At 12 months, 19% of patients (95% confidence interval [CI] 14%-24%) showed reversal of MetS, VO2max increased by 16% (95% CI 13%-18%), and Healthy Eating Index and Mediterranean Diet Scores improved by 9.6% (95% CI 7.6%-11.6%) and 1.4% (1.1%-1.6%), respectively. In addition, the Prospective Cardiovascular Munster (PROCAM) 10-year risk of acute coronary event decreased by 1.4%, from a baseline of 8.6%. A team-based program led by the family physician that educates patients about the risks of MetS, and with a dietitian and kinesiologist, empowers them to undertake an individualized supervised program of diet modification and exercise, is feasible, improves aerobic capacity and diet quality, reverses MetS and improves MetS components at 12 months.

Time spent in sedentary posture is associated with waist circumference and cardiovascular risk.

The relationship between metabolic risk and time spent sitting, standing and stepping has not been well established. The present study aimed to determine associations of objectively measured time spent siting, standing and stepping, with coronary heart disease (CHD) risk. A cross-sectional study of healthy non-smoking Glasgow postal workers, n=111 (55 office workers, 5 women, and 56 walking/delivery workers, 10 women), who wore activPAL physical activity monitors for 7 days. Cardiovascular risks were assessed by metabolic syndrome categorisation and 10-year PROCAM (prospective cardiovascular Munster) risk. Mean (s.d.) age was 40 (8) years, body mass index 26.9 (3.9) kg m-2 and waist circumference 95.4 (11.9) cm. Mean (s.d.) high-density lipoprotein cholesterol (HDL cholesterol) 1.33 (0.31), low-density lipoprotein cholesterol 3.11 (0.87), triglycerides 1.23 (0.64) mmol l-1 and 10-year PROCAM risk 1.8 (1.7)%. The participants spent mean (s.d.) 9.1 (1.8) h per day sedentary, 7.6 (1.2) h per day sleeping, 3.9 (1.1) h per day standing and 3.3 (0.9) h per day stepping, accumulating 14 708 (4984) steps per day in 61 (25) sit-to-stand transitions per day. In univariate regressions-adjusting for age, sex, family history of CHD, shift worked, job type and socioeconomic status-waist circumference (P=0.005), fasting triglycerides (P=0.002), HDL cholesterol (P=0.001) and PROCAM risk (P=0.047) were detrimentally associated with sedentary time. These associations remained significant after further adjustment for sleep, standing and stepping in stepwise regression models. However, after further adjustment for waist circumference, the associations were not significant. Compared with those without the metabolic syndrome, participants with the metabolic syndrome were significantly less active-fewer steps, shorter stepping duration and longer time sitting. Those with no metabolic syndrome features walked >15 000 steps per day or spent >7 h per day upright. Longer time spent in sedentary posture is significantly associated with higher CHD risk and larger waist circumference.

Concordancia entre las escalas de riesgo cardiovascular PROCAM y FRAMINGHAM en varones que reciben tratamiento antirretroviral en un hospital nacional de Lima, Perú 2013

The aim of the study is to determine the concordance between the PROCAM (Prospective Cardiovascular Münster) and Framingham scales in patients receiving highly active antiretroviral therapy (HAART). A cross sectional study was conducted in HIV-positive male population who use HAART in a national reference hospital located in Lima, Peru. To evaluate the concordance between the two scales the graphic method of Bland and Altman was used, for the evaluation of the correlation we used the Pearson coefficient and to measure the agreement we use the kappa coefficient. 111 patients were enrolled, with an average age of 47.0 years. The distribution of patients according to the risk was low, moderate and high, 81.2%, 13.6% and 5.4% respectively for PROCAM and 71.2%, 25.2% and 3.6% for Framingham. According to the graphic method of Bland and Altman, the concordance was adequate in low values and was lost as the risk score increased. Pearson’s test found a strong correlation (r=0.87 and p<0.05) and the kappa coefficient was 0.56 (p<0,001). The agreement we found at low risk decreases as the risk increases. Strong correlation was found between the two scales. We recommend further studies in order to know which scale of cardiovascular risk is the most optimal scale for clinical practice among HIV population who receive HAART.

Cardiovascular risk analysis by means of pulse morphology and clustering methodologies

The purpose of this study was the development of a clustering methodology to deal with arterial pressure waveform (APW) parameters to be used in the cardiovascular risk assessment. One hundred sixteen subjects were monitored and divided into two groups. The first one (23 hypertensive subjects) was analyzed using APW and biochemical parameters, while the remaining 93 healthy subjects were only evaluated through APW parameters. The expectation maximization (EM) and k-means algorithms were used in the cluster analysis, and the risk scores (the Framingham Risk Score (FRS), the Systematic COronary Risk Evaluation (SCORE) project, the Assessing cardiovascular risk using Scottish Intercollegiate Guidelines Network (ASSIGN) and the PROspective Cardiovascular Münster (PROCAM)), commonly used in clinical practice were selected to the cluster risk validation. The result from the clustering risk analysis showed a very significant correlation with ASSIGN (r=0.582, p<0.01) and a significant correlation with FRS (r=0.458, p<0.05). The results from the comparison of both groups also allowed to identify the cluster with higher cardiovascular risk in the healthy group. These results give new insights to explore this methodology in future scoring trials.

HIV Infection and Cardiovascular Disease

HIV Infection and Cardiovascular Disease

Cardiovascular risk scores for coronary atherosclerosis

Objective The objective of this study was to compare frequently used cardiovascular risk scores in predicting the presence of coronary artery disease (CAD) and 3-vessel disease.Methods and results In 350 consecutive patients (218 men and 132 women) who underwent coronary angiography, the cardiovascular risk level was determined using the Framingham Risk Score (FRS), the Modifi ed Framingham Risk Score (MFRS), the Prospective Cardiovascular Munster (PROCAM) score, and the Systematic Coronary Risk Evaluation (SCORE). The area under the curve for receiver operating characteristic curves showed that FRS had more predictive value than the other scores for CAD (area under curve, 0.76, P≤ 0.001), but all scores had good specifi city and positive predictive value. For 3-vessel disease, the FRS had better predictive value than the other scores (area under curve, 0.74, P≤ 0.001), but all scores had good specifi city and negative predictive value.Conclusion The risk scores (FRS, MFRS, PROCAM, and SCORE) may predict the presence and severity of coronary atherosclerosis. The FRS had better predictive value than the other scores.

Comparisons of established risk prediction models for cardiovascular disease: systematic review

Objective To evaluate the evidence on comparisons of established cardiovascular risk prediction models and to collect comparative information on their relative prognostic performance.Design Systematic review of comparative predictive model studies.Data...

Coronary Risk Assessment and Arterial Age Calculation Using Coronary Artery Calcium Scoring and the Framingham Risk Score

Accounting for one in five deaths, coronary artery disease (CAD) is the leading cause of death among Americans.1 Risk assessment for future coronary events is important in management of patients who have no symptoms of cardiovascular disease (primary prevention). The European Prospective Cardiovascular Munster (PROCAM) Study and Systemic Coronary Risk Evaluation (SCORE), along with the American Framingham Heart Study are used to assess risk clinically.2–4 These studies have made available methods for calculation of an individual’s risk for a future cardiovascular event.5–7

Correlation of cardiovascular risk scores with myocardial high-energy phosphate metabolism

The aim of our current work was to prove the association of myocardial high-energy phosphate metabolism measured by MR spectroscopy with validated cardiovascular risk scores, such as the European Systematic COronary Risk Evaluation (SCORE) Project [1], the German PROspective CArdiovascular Munster (PROCAM) Study [2] and the US Framingham Heart and Offspring Studies [3]. We used the ratio of phosphocreatinine (PCr) to β-adenosine-triphosphate (β-ATP) as a surrogate for the energy metabolism of the myocardium [4,5]. PCr-β-ATP ratios are reduced in patients with coronary heart disease [4,5], hypertension [6], and our previous studies suggested cardiovascular risk factors such as hypercholesterolemia [7], diabetes [8] or age [9] to be involved in this process. Therefore we hypothesized a relationship between established primary-event risk scores [1–3] and myocardial high-energy phosphate metabolism. Fasting blood samples of ninety-nine healthy asymptomatic volunteers without history of coronary heart disease were obtained to evaluate cardiovascular risk factors. All of the volunteers underwent cycle ergometry and echocardiography to exclude a latent coronary insufficiency and/or a reduced left ventricular function. Tabulated cardiovascular risk factors and parameters are shown in Table 1. For each patient the cardiovascular risk was assessed by:

Coronary heart disease risk assessment in HIV-infected patients: a comparison of Framingham, PROCAM and SCORE risk assessment functions

The aim of this was to compare the performance of the Framingham, Systematic Coronary Risk Evaluation (SCORE) and Prospective Cardiovascular Munster (PROCAM) scoring systems in the risk assessment of HIV-infected patients with no overt vascular disease. A cross-sectional study of 220 HIV-infected patients was conducted at the outpatient clinic of a referral and training centre in infectious and parasitic diseases in Belo Horizonte, Brazil. The Framingham, SCORE and PROCAM equations were calculated. Patients were classified as having low, moderate or high risk, which according to the Framingham and PROCAM equations corresponded to < 10%, 10-20% and > 20% respectively, and according to SCORE corresponded to < 3%, 3-4% and > or = 5% respectively. Cohen's kappa coefficient was used to assess agreement between the methods. Of a total of 220 HIV-infected patients, 56 were antiretroviral (ARV)-naïve while 164 had already been treated with ARV. The prevalence of patients with a high 10-year cardiovascular risk was 3.7%, 2.5% and 1.9% according to the Framingham, PROCAM and SCORE equations respectively. The degree of agreement was moderate between the Framingham and PROCAM risk estimates (kappa = 0.433; p < 0.001), poor-to-fair between the Framingham and SCORE estimates (kappa = 0.220; p < 0.001) and moderate between the PROCAM and SCORE systems (kappa = 0.478; p < 0.001). There are differences in risk assessment and in the identification of high risk individuals between the three risk functions under evaluation and only a prospective study will be capable of assessing which offers the best current sensitivity, specificity and predictive values for the population under investigation.

Assessing and Managing Risk for Cardiovascular Disease: A Worldwide Perspective

Cardiovascular disease (CVD) has become increasingly recognized as a major cause of disability, premature death, and escalating health-care costs throughout the world. The purpose of the present report is to review the most widely used worldwide tools for assessment of the total (absolute, global, integrated) risk of developing CVD during the next 5 or 10 years and to review guidelines for the clinical management of dyslipidemia, hypertension, and dysglycemia that incorporate these tools. The World Health Organization (WHO) / International Society of Hypertension (ISH) risk charts, The Framingham system, Systematic Coronary Risk Evaluation (SCORE) charts, and the PROCAM (PROspective Cardiovascular Munster) Quick Check and Health Check systems are described. Since the use of clinical guidelines based on these tools has some limitations and challenges, alternative or modified approaches for the management of CVD risk factors have been proposed by several researchers recently. Future studies are needed to evaluate the effectiveness of these proposed strategies

COSEHC global vascular risk management quality improvement program: rationale and design

Background:The Consortium for Southeastern Hypertension Control (COSEHC) promotes global risk factor management in patients with metabolic syndrome. The COSEHC Global Vascular Risk Management Study (GVRM) intends to quantify these efforts on long-term patient outcomes. The objectives of this study were to present baseline demographics of patients enrolled in the GVRM, calculate a modified COSEHC risk score using 11 variables (COSEHC-11), and compare it with the original COSEHC-17 and Framingham, Prospective Cardiovascular Münster (PROCAM), and Systemic Coronary Risk Evaluation (SCORE) risk scores.Methods:Deidentified electronic medical records of enrolled patients were used to calculate the risk scores. The ability of the COSEHC-11 score to predict the COSEHC-17 score was assessed by regression analysis. Raw risk scores were converted to probability estimates of fatal coronary heart disease (CHD) and compared with predicted risks from other algorithms.Results:Of the 177,404 patients enrolled, 43,676 had data for all 11 variables. The COSEHC-11 score (mean ± standard deviation) of these 43,676 patients was 31.75 ± 11.66, implying a five-year fatal CHD risk of 1.4%. The COSEHC-11 score was highly predictive of the COSEHC-17 score (R2 = 0.93; P < 0.0001) and correlated well with the SCORE algorithm.Conclusion:The COSEHC-11 risk score is statistically similar to the COSEHC-17 risk score and should be a viable tool for evaluating its ability to predict five-year cardiovascular mortality in the coming years.

Effect of a plant stanol ester-containing spread, placebo spread, or Mediterranean diet on estimated cardiovascular risk and lipid, inflammatory and haemostatic factors

Background and aims Mediterranean diet is associated with a reduced risk for cardiovascular disease (CVD). Use of plant stanols decreases low density lipoprotein cholesterol (LDL-C) concentrations. We compared the effects of the Mediterranean diet and plant stanol esters on vascular risk factors and estimated CVD (eCVD) risk. Methods and results In this prospective, randomized, placebo-controlled study, 150 mildly hypercholesterolaemic subjects were randomized to Mediterranean diet, a spread containing plant stanol esters (2 g/day) or a placebo spread. Vascular risk factors were assessed every month for 4 months and the eCVD risk was calculated using the PROspective- Cardiovascular-Munster (PROCAM), Framingham, and Reynolds risk engines. Placebo had no significant effect on risk factors or eCVD risk. Mediterranean diet gradually induced a significant reduction in total cholesterol (TC), LDL-C, triglycerides, high sensitivity C-reactive protein (hsCRP), blood pressure and eCVD risk (24–32%). The plant stanol ester spread reduced (by 1 month) TC (−14%), LDL-C (−16%), hsCRP (−17%), and estimated CVD risk (26–30%). eCVD risk reduction was sustained at 4th months when the gradual Mediterranean diet eCVD risk reduction became comparable to that of the stanol group. Conclusions Plant stanol esters yielded an early, by 1st treatment month, reduction of eCVD risk that resulted from a TC, LDL-C, and hsCRP decrease. eCVD risk reduction on the Mediterranean diet resulted from a change in several CVD risk factors and equaled that of plant stanol at 4 months. The consumption of plant stanol esters by moderately hypercholesterolaemic patients may be a useful option to reduce CVD risk in those who do not adopt a Mediterranean diet.

Glucose intolerance and risk of cardiovascular disease in Iranian men and women: Results of the 7.6-year follow-up of the Tehran Lipid and Glucose Study (TLGS)

Despite the high prevalence of diabetes, limited information is available about the impact of impaired glucose regulation on the cardiovascular disease (CVD) risk among Middle East populations. To determine the risk of CVD in an urban Iranian population according to glucose tolerance status. The study population consisted of 1752 men and 2273 women, aged > or = 40 yr, free of CVD at baseline. Incident CVD was ascertained over a median of 7.6 yr of follow-up. A total of 340 CVD events occurred (197 in men and 143 in women). At baseline, there was no difference between newly diagnosed and known diabetes regarding the Prospective Cardiovascular Münster (PROCAM) risk score and prevalence of metabolic syndrome in both genders. Applying the 1997 American Diabetes Association (ADA) criteria, compared with those with normal glucose tolerance, after controlling traditional risk factors, hazard ratios (HR) and 95% confidence intervals (95% CI) for CVD in women with known and newly diagnosed diabetes were 3.30 (2.09-5.21) and 1.93 (1.16-3.21) and the corresponding values for men were 1.90 (1.11-3.25) and 1.69 (1.12-2.54), respectively. Impaired fasting glucose or impaired glucose tolerance was associated with 56% increased risk of CVD in women (HR 1.56, 95% CI 1.00 to 2.45), in the age-adjusted analysis, considering the 2003 ADA criteria. All diabetic subjects, whether newly diagnosed or known cases, should receive intensive primary prevention for CVD regardless of risk factors, in particular females with abnormal glucose regulation.