QRISK2 Score Research Articles

Compensatory increase in oxygen extraction fraction is associated with age-related cerebrovascular disease.

Cerebrovascular disease is an important contributor to dementia with reductions in cerebral blood flow (CBF) potentially compromising oxygen supply. In early stages, reduced CBF may be associated with a compensatory increase in oxygen extraction fraction (OEF) to maintain the cerebral metabolic rate of oxygen consumption (CMRO2). We used a simultaneous PET-MRI protocol to measure OEF, CBF, CMRO2, and arterial transit time (ATT) in elderly people (n=24, age 69.6 ± 5.3 years) with a range of vascular disease risk (QRisk 18.7±10.8%) and cognitive abilities (MoCA scores 26.7±3.4) to determine if a) vascular disease risk (parameterised with QRisk2 score) is associated with altered CBF, ATT, OEF and CMRO2, b) if impaired blood supply and increasing transit times are associated with elevated OEF and c) if these physiological measures are associated with impaired cognition. ATT rose by 132ms per 10 point increase in QRisk and there was a trend for reduced CBF. Compensatory increases in OEF occurred in association with modified ATT and CBF, preserving CMRO2. There was no regional variation to these relationships. Cognitive impairment was associated with prolonged ATT. These findings demonstrate the potential use of multi-delay time ASL and Quantitative Susceptibility Mapping for the early detection of cerebrovascular changes and provide evidence for compensatory increases in oxygen extraction in the presence of reduced blood flow.

Transmural collaborative care model for cardiovascular risk management and medication review in patients using antipsychotics in primary care (TACTIC): A study protocol of an incomplete stepped wedge cluster randomized trial.

It is well established that patients with severe mental illness and those treated with atypical antipsychotics (AAPs) are at an increased risk of cardiovascular disease. However, primary care currently lacks adequate monitoring of AAP usage, its effects, and the associated cardiovascular risk. We have developed TACTIC, a transmural collaborative care model for patients using AAPs prescribed by the general practitioner (GP) to address the issues of potential overtreatment with AAPs and undertreatment for cardiovascular risk. TACTIC comprises three steps: an informative video for patients, a multidisciplinary meeting, and a shared decision-making consultation with the GP. To evaluate TACTIC's effectiveness on cardiovascular risk and mental health and its cost-effectiveness. We will conduct an incomplete stepped wedge cluster randomized trial in the Netherlands.40GP-nurse clusters are randomized into four waves. Each cluster recruits adult patients (25-85 years), without prior diagnoses of dementia, delirium, or cardiovascular disease, for whom the GP prescribes AAPs. Every five months, a new wave starts with TACTIC. Measurements are taken before the intervention starts and every 5 months until the study concludes. Primary outcomes are cardiovascular risk and mental health as measured with the QRISK3 score and MHI5, respectively. The economic evaluation consists of two cost-utility analyses, one on the data collected alongside the trial and one based on a model extrapolating the trial data to a 10-year horizon. We will also evaluate the process of delivering TACTIC. This study will assess TACTIC's (cost)effectiveness and provide insights for successful delivery in general practice. clinicaltrials.gov NCT05647980.

A Machine Learning Model Using Cardiac CT and MRI Data Predicts Cardiovascular Events in Obstructive Coronary Artery Disease.

Background Multimodality imaging is essential for personalized prognostic stratification in suspected coronary artery disease (CAD). Machine learning (ML) methods can help address this complexity by incorporating a broader spectrum of variables. Purpose To investigate the performance of an ML model that uses both stress cardiac MRI and coronary CT angiography (CCTA) data to predict major adverse cardiovascular events (MACE) in patients with newly diagnosed CAD. Materials and Methods This retrospective study included consecutive symptomatic patients without known CAD referred for CCTA between December 2008 and January 2020. Patients with obstructive CAD (at least one ≥50% stenosis at CCTA) underwent stress cardiac MRI for functional assessment. Eighteen clinical, two electrocardiogram, nine CCTA, and 12 cardiac MRI parameters were evaluated as inputs for the ML model, which involved automated feature selection with the least absolute shrinkage and selection operator algorithm and model building with an XGBoost algorithm. The primary outcome was MACE, defined as a composite of cardiovascular death and nonfatal myocardial infarction. External testing was performed using two independent datasets. Performance was compared between the ML model and existing scores and other approaches using the area under the receiver operating characteristic curve (AUC). Results Of 2210 patients who completed cardiac MRI, 2038 (mean age, 70 years ± 12 [SD]; 1091 [53.5%] female participants) completed follow-up (median duration, 7 years [IQR, 6-9 years]); 281 experienced MACE (13.8%). The ML model exhibited a higher AUC (0.86) for MACE prediction than the European Society of Cardiology score (0.55), QRISK3 score (0.60), Framingham Risk Score (0.50), segment involvement score (0.71), CCTA data alone (0.76), or stress cardiac MRI data alone (0.83) (P value range, <.001 to .004). The ML model also exhibited good performance in the two external validation datasets (AUC, 0.84 and 0.92). Conclusion An ML model including both CCTA and stress cardiac MRI data demonstrated better performance in predicting MACE than traditional methods and existing scores in patients with newly diagnosed CAD. © RSNA, 2025 Supplemental material is available for this article.

RADT-03. CONTRAST-ENHANCING LESIONS INDUCED BY CNS-DIRECTED INTENSITY MODULATED PROTON THERAPY: DEMOGRAPHIC AND CARDIOVASCULAR RISK FACTORS ANALYSIS

Abstract INTRODUCTION Lesions exhibiting radiation-induced contrast enhancement (RICE) may develop following cranial intensity modulated proton therapy (IMPT). The mechanisms underlying their development may be shared or amplified by existing patient comorbidities. The objective of this study was to assess a potential relationship between individual or composite cardiovascular risk criteria and RICE development, independent of dosimetric considerations. METHODS Data were reviewed for patients treated at a single tertiary care institution between 2017-2023. Time to RICE development was assessed using Kaplan-Meier. Cox regression analysis was used to determine hazard ratios (HRs) with 95% confidence intervals (CIs). Host-related risk factors for RICE development were assessed in a univariable analysis (UVA). A binary logistic regression model was built to ascertain the effects of age and cardiovascular risk factors on the likelihood of developing RICE (expressed as QRISK3 relative risk). RESULTS The study cohort included 137 patients; the median age was 40 years (range: 1-85), 51% female, and 53% Hispanic. Cardiovascular risk factors included smoking (18% past, 6% current), diabetes (7%), hypertension (22%), dyslipidemia (15%) and high body mass index (BMI, 50% were obese with BMI&amp;gt;25). At a median follow-up of 3 years, RICE developed in 36 (26%) patients. On UVA, RICE development was only associated with age ≥18 compared to &amp;lt;18 (HR 3.3, 95% CI: 1.2-9.4, p=0.024). None of the other evaluated risk factors were significantly associated with RICE (p&amp;gt;0.05). Additionally, logistic regression analysis showed increasing age was associated with likelihood of developing RICE (χ2=6.95, p=0.031), while QRISK3 score was not. CONCLUSIONS In this contemporary series of patients treated with IMPT, age was the only host factor associated with RICE, while other cardiovascular risk factors, evaluated individually or using established composite risk scores (QRISK3) were not associated with RICE. Additional research is needed to identify potential patient characteristics associated with RICE.

A service evaluation of the uptake and effectiveness of a digital delivery of the NHS health check service

ObjectivesTo compare the uptake, effectiveness and costs of a digital version of the National Health Service (NHS) Health Check (DHC) to the standard face-to-face NHS Health Check (F2F).Participants and settingA...

Increased Cardiometabolic Risk in Men with Hypoprolactinemia: A Pilot Study

Low prolactin levels in men predispose them to mood disturbances, sexual dysfunction, and diabetes. The purpose of the current study was to assess cardiometabolic risk in males with hypoprolactinemia. This prospective study included three age-matched groups of young and middle-aged men: individuals with cabergoline-induced hypoprolactinemia (n = 15), cabergoline-treated subjects with prolactin levels within the reference range (n = 20), and untreated men with normal prolactin levels (n = 31). In men with hypoprolactinemia, the cabergoline dose was reduced in order to normalize prolactin concentration. Anthropometric parameters, blood pressure, QRISK3 score; plasma concentrations of prolactin, glucose, insulin, lipids, uric acid, high-sensitivity C-reactive protein (hsCRP), fibrinogen, homocysteine, and testosterone; whole-blood levels of glycated hemoglobin (HbA1C); urinary albumin-to-creatinine ratio (UACR); and carotid intima–media thickness were assessed at baseline and six months later. Men with hypoprolactinemia were characterized by higher body mass index, fat content, waist circumference, systolic blood pressure, fasting and 2 h post-load glucose, HbA1C, HOMA1-IR, uric acid, hsCRP, fibrinogen, homocysteine, and UACR; by lower HDL cholesterol and testosterone; by greater intima–media thickness; and by a higher QRISK3 score than their peers with normal prolactin levels. There were no statistically significant differences in the measured parameters between both groups of men with normal prolactin levels. Normalization of prolactin concentration was accompanied by normalization of biochemical variables, systolic blood pressure, and QRISK3 score. Although cabergoline dose reduction did not cause statistically significant changes in the remaining anthropometric parameters and intima–media thickness, six months later, they did not differ from those observed in the remaining study groups. Our findings suggest that iatrogenic hypoprolactinemia is associated with increased cardiometabolic risk, which is reversible and resolves after the normalization of prolactin levels.

A plasma proteomic signature for atherosclerotic cardiovascular disease risk prediction in the UK Biobank cohort.

While risk stratification for atherosclerotic cardiovascular disease (ASCVD) is essential for primary prevention, current clinical risk algorithms demonstrate variability and leave room for further improvement. The plasma proteome holds promise as a future diagnostic and prognostic tool that can accurately reflect complex human traits and disease processes. We assessed the ability of plasma proteins to predict ASCVD. Clinical, genetic, and high-throughput plasma proteomic data were analyzed for association with ASCVD in a cohort of 41,650 UK Biobank participants. Selected features for analysis included clinical variables such as a UK-based cardiovascular clinical risk score (QRISK3) and lipid levels, 36 polygenic risk scores (PRSs), and Olink protein expression data of 2,920 proteins. We used least absolute shrinkage and selection operator (LASSO) regression to select features and compared area under the curve (AUC) statistics between data types. Randomized LASSO regression with a stability selection algorithm identified a smaller set of more robustly associated proteins. The benefit of plasma proteins over standard clinical variables, the QRISK3 score, and PRSs was evaluated through the derivation of Δ AUC values. We also assessed the incremental gain in model performance using proteomic datasets with varying numbers of proteins. To identify potential causal proteins for ASCVD, we conducted a two-sample Mendelian randomization (MR) analysis. The mean age of our cohort was 56.0 years, 60.3% were female, and 9.8% developed incident ASCVD over a median follow-up of 6.9 years. A protein-only LASSO model selected 294 proteins and returned an AUC of 0.723 (95% CI 0.708-0.737). A clinical variable and PRS-only LASSO model selected 4 clinical variables and 20 PRSs and achieved an AUC of 0.726 (95% CI 0.712-0.741). The addition of the full proteomic dataset to clinical variables and PRSs resulted in a Δ AUC of 0.010 (95% CI 0.003-0.018). Fifteen proteins selected by a stability selection algorithm offered improvement in ASCVD prediction over the QRISK3 risk score [Δ AUC: 0.013 (95% CI 0.005-0.021)]. Filtered and clustered versions of the full proteomic dataset (consisting of 600-1,500 proteins) performed comparably to the full dataset for ASCVD prediction. Using MR, we identified 11 proteins as potentially causal for ASCVD. A plasma proteomic signature performs well for incident ASCVD prediction but only modestly improves prediction over clinical and genetic factors. Further studies are warranted to better elucidate the clinical utility of this signature in predicting the risk of ASCVD over the standard practice of using the QRISK3 score.

Optimizing Cardiovascular Health: A Comprehensive Review of Risk Assessment Strategies for Primary Prevention.

Cardiovascular disease (CVD) is a leading global health concern, and effective primary prevention strategies are essential to mitigate its impact. This comprehensive review examines current risk assessment strategies for primary prevention of CVD, emphasizing the importance of early identification and intervention to reduce disease incidence. Traditional risk factors such as hypertension, hyperlipidemia, smoking, and lifestyle choices are discussed alongside emerging factors, including genetic predispositions and biomarkers. The review evaluates various risk assessment tools and models, such as the Framingham risk score, atherosclerotic CVD risk calculator, QRISK, and Reynolds risk score, highlighting their methodologies, strengths, and limitations. Additionally, the review explores lifestyle modifications, including dietary changes, physical activity, weight management, smoking cessation, and pharmacological interventions like statins and antihypertensives. Special considerations for different populations, including the elderly, women, and those with a family history of CVD, are addressed. Future directions in cardiovascular risk assessment are also discussed, focusing on technological advancements and personalized medicine. This review aims to enhance the implementation of effective primary prevention measures and improve cardiovascular health outcomes by providing a thorough analysis of risk assessment strategies.

Cost-effectiveness of group medical visits and microfinance interventions versus usual care to manage hypertension in Kenya: a secondary modelling analysis of data from the Bridging Income Generation with Group Integrated Care (BIGPIC) trial

The Bridging Income Generation with Group Integrated Care (BIGPIC) trial in rural Kenya showed that integrating usual care with group medical visits or microfinance interventions reduced systolic blood pressure and cardiovascular risk in participants. We aimed to estimate the incremental cost-effectiveness of three BIGPIC interventions for a modelled cohort and by sex, as well as the cost of implementing these interventions. For this analysis, we used data collected during the BIGPIC trial, a four-group, cluster-randomised trial conducted in the western Kenyan catchment area of the Academic Model Providing Access to Healthcare. BIGPIC enrolled participants from 24 rural health facilities in rural western Kenya aged 35 years or older with either increased blood pressure or diabetes. Participants were assigned to receive either usual care, group medical visits, microfinance, or a combination of group medical visits and microfinance (GMV-MF). Our model estimated the incremental cost-effectiveness of the three BIGPIC interventions via seven health states (ie, a hypertensive state, five chronic cardiovascular-disease states, and a death state) by simulating transitions between health states for a hypothetical cohort of individuals with hypertension on the basis of QRISK3 scores. In every cycle, participants accrued costs and disability-adjusted life-years (DALYs) associated with their health state. Incremental cost-effectiveness ratios (ICERs) were calculated for the entire modelled cohort and by sex by dividing the incremental cost by the incremental effectiveness of the next most expensive intervention. The main outcome of this analysis was ICERs for each intervention evaluated. This analysis is registered at ClinicalTrials.gov (NCT02501746). Between Feb 6, 2017, and Dec 29, 2019, 2890 people were recruited to the BIGPIC trial. 2020 (69·9%) of 2890 participants were female and 870 (30·1%) were male. At baseline, mean QRISK3 score was 11·5 (95% CI 11·1-11·9) for the trial population, 11·9 (11·5-12·2) for male participants, and 11·3 (11·0-11·6) for female participants. For the population of Kenya, group medical visits were estimated to cost US$7 more per individual than usual care and result in 0·005 more DALYs averted (ICER $1455 per DALY averted). Microfinance was estimated to cost $19 more than group medical visits but was only estimated to avert 0·001 more DALYs. Relative to group medical visits, GMV-MF was estimated to cost $29 more and avert 0·009 more DALYs ($3235 per DALY averted). Relative to usual care, GMV-MF was estimated to cost $37 more and avert 0·014 more DALYs ($2601 per DALY averted). In the first year of the intervention, usual care was estimated to be the least expensive intervention to implement ($87 per participant; $10 238 per health-facility catchment area [HFCA]), then group medical visits ($99 per participant; $12 268 per HFCA), then microfinance ($120 per participant; $14 172 per HFCA), with GMV-MF estimated to be the most expensive intervention to implement ($139 per participant; $16 913 per HFCA). Group medical visits and GMV-MF were estimated to be cost-effective strategies to improve blood-pressure control in rural Kenya. However, which intervention to pursue depends on resource availability. Policy makers should consider these factors, in addition to sex differences in programme effectiveness, when selecting optimal implementation strategies. US National Institutes of Health.

To Evaluate Efficiency of Various Coronary Artery Disease Risk Scores With Traditional Risk Factors in Patients Undergoing Coronary Angiography.

To analyze and compare various cardiovascular disease risk scores in Western Indian patients undergoing Coronary angiogram (CAG). In this prospective cross-sectional study, 1213 patients who underwent conventional coronary angiography; clinical risk profile and biochemical investigations were evaluated prior to undergoing CAG. Apart from the demographic information, 10-year absolute risk of having a major cardiovascular event (cardiovascular death, myocardial infarction or stroke) was calculated for each patient using various available Traditional Risk Scores (TRS). The population was divided in low, intermediate and high-risk categories for each of these scores. Traditional cardiovascular risk factors like hypertension (41.8%) and diabetes mellitus-II (26.9%) were the two most prevalent risk factors in our study population. A higher risk value for all these TRS was more likely to be associated with obstructive coronary artery disease (OCAD) on CAG. Patients with high risk (≥20% for 10-year) QRESEARCH (QRISK3) score category had higher number of patients with obstructive CAD (49.6%) as compared to high risk category of risk score for those with high Global Registry of Acute Coronary Events (GRACE) score (46.6%) or risk Framingham (FRS CHD) score (29.2%) and risk atherosclerotic cardiovascular disease (ASCVD) score (30.1%) (P < 0.0001). A higher TRS was more likely to be associated with obstructive CAD, with the highest predictability being with QRISK3 (QRISK3 score 60.9%, GRACE score 54.9%, FRS-CHD score 34% and ASCVD score 42.1% respectively; P < 0.0001). A substantial study population (27.4%) cannot be identified using any of these TRS and hence a need of indigenous or modified risk scores is proposed. QRISK3 score was most efficacious for predicting obstructive CAD in our Indian study population on CAG. A higher risk score also correlated with the number of vessels involved on coronary angiogram. A substantial obstructive CAD patient could not be identified using traditional risk scores hence need for an indigenous or modified score.

Exploring Vegetarian and Omnivorous Approaches to Cardiovascular Risk and Body Composition.

The role of nutrition in preventing non-communicable diseases has been widely studied in recent years, with indications that non-animal-based diets might improve body composition and therefore bring multiple health benefits. For all of these reasons, the main purpose was to compare body composition and metabolic status between vegetarian and omnivorous individuals and relate these values with cardiovascular risk. The present analysis included 176 participants (61 vegetarians and 115 omnivores). Body composition was assessed using a dual-energy X-ray absorptiometry, biochemical parameters obtained from capillary blood, and the 10-year cardiovascular risk (10RCVD) calculated by the QRISK3 score. No statistical differences were found between groups regarding body composition. Concerning metabolic markers, vegetarian individuals showed reduced values of total cholesterol, LDL cholesterol, and non-HDL cholesterol (p < 0.05). There were no differences in 10RCVD between groups. In both diets, moderate correlations between groups were found for cardiovascular risk and visceral adipose tissue. Our results suggest that the vegetarian regimen might be associated with better cardiometabolic biomarkers and better cardiovascular health, although controversial with the body composition trends observed. In conclusion, the results suggest that cardiovascular risk appears to be more influenced by body composition, mainly fat tissue, over dietary patterns itself.

Predicting cardiovascular events with fluoropyrimidine chemotherapy using a standard cardiovascular risk calculator.

Fluoropyrimidine chemotherapy is important for treatment of many solid tumours but is associated with cardiotoxicity. The relationship of fluoropyrimidine-associated cardiotoxicity (FAC) with conventional cardiovascular (CV) risk factors is poorly understood, and standard cardiovascular risk scores are not validated in this context. Single-centre retrospective study of patients treated with fluoropyrimidine chemotherapy using electronic health records for cardiovascular risk factors (and calculation of QRISK3 score), cancer treatment, and clinical outcomes. FAC was defined by cardiovascular events during or within 3months of fluoropyrimidine treatment, and Cox regression was used to assess associations of CV risk and cancer treatment with FAC. One thousand eight hundred ninety-eight patients were included (45% male; median age 64years), with median follow up 24.5 (11.5-48.3months); 52.7% of patients were at moderate or high baseline CV risk (QRISK3 score >10%) Cardiovascular events occurred in 3.1% (59/1898)-most commonly angina (64.4%, 38/59) and atrial fibrillation (13.6%, 8/59), with 39% events during cycle one of treatment. In univariable analysis, QRISK3 score >20% was significantly associated with incident FAC (HR 2.25, 95% CI 1.11-4.93, P=0.03). On multivariable analysis, beta-blocker use (HR 1.04, 95% CI 1.00-1.08, P=0.04) and higher BMI (HR 2.33, 95% CI 1.04-5.19, P=0.04) were independently associated with incident CV events. Thirty-two of the 59 patients with FAC were subsequently rechallenged with fluoropyrimidine chemotherapy, with repeat CV events in 6% (2/32). Incident FAC did not affect overall survival (P=0.50). High BMI and use of beta-blockers are associated with risk of CV events during fluoropyrimidine chemotherapy. QRISK3 score may also play a role in identifying patients at high risk of CV events during fluoropyrimidine chemotherapy. Re-challenge with further fluoropyrimidine chemotherapy can be considered in patients following CV events during prior treatment.

Cardiovascular risk and physical activity in Syrians living in England compared with the population of North West England: a cross-sectional study

ObjectiveThis study aims to assess the 10-year cardiovascular risk and physical activity among Syrians residing in England and compare them with the North West England population.DesignCross-sectional study.SettingBilingual online questionnaire distributed...

Transmural collaborative care model for the review of antipsychotics: a feasibility study of a complex intervention

General practitioners (GPs) are often unaware of antipsychotic (AP)-induced cardiovascular risk (CVR) and therefore patients using atypical APs are not systematically monitored. We evaluated the feasibility of a complex intervention designed to review the use of APs and advise on CVR-lowering strategies in a transmural collaboration. A mixed methods prospective cohort study in three general practices in the Netherlands was conducted in 2021. The intervention comprised three steps: a digital information meeting, a multidisciplinary meeting, and a shared decision-making visit to the GP. We assessed patient recruitment and retention rates, advice given and adopted, and CVR with QRISK3 score and mental state with MHI-5 at baseline and three months post-intervention. GPs invited 57 of 146 eligible patients (39%), of whom 28 (19%) participated. The intervention was completed by 23 (82%) and follow-up by 18 participants (64%). At the multidisciplinary meeting, 22 (78%) patients were advised to change AP use. Other advice concerned medication (other than APs), lifestyle, monitoring, and psychotherapy. At 3-months post-intervention, 41% (28/68) of this advice was adopted. Our findings suggest that this complex intervention is feasible for evaluating health improvement in patients using AP in a trial.

Effects of the COVID-19 associated United Kingdom lockdown on physical activity in older adults at high risk of cardiovascular disease: a mixed methods perspective from the MedEx-UK multicenter trial.

Physical inactivity and sedentary behaviour are linked to increased risk of cardiovascular disease, infections and dementia, as well as placing a significant economic burden on healthcare systems. The implementation of COVID-19 pandemic lockdown measures aimed at reducing virus transmission posed challenges to the opportunity to be physically active. This study investigates how the first UK COVID-19 lockdown affected objectively measured physical activity in older adults at higher risk of cardiovascular disease. We studied 48 individuals aged 55-74 years (81.3% female) with self-reported PA levels < 90 min/week and a QRISK2 score ≥ 10 (indicative of a ≥ 10% risk of a major cardiovascular event in the next 10 years) without mild cognitive impairment or dementia. Physical activity data was collected using objective wrist-based activity monitors and analysed across three time periods, usual activity (pre-pandemic), the precautionary phase when the UK began advising on limiting social contact and finally during the first UK lockdown period was collected (27 January 2020 and 07 June 2020). Data was analysed using linear mixed effects model was used to investigate PA levels over the measured 12-week period. Effects of BMI, age, deprivation score and baseline PA levels on PA across the three measurement periods were also examined. Focus-group and individual interviews were conducted, and data were thematically analysed. Average daily step count (-34% lower, p < 0.001) and active energy expenditure (-26% lower, p < 0.001) were significantly lower during the precautionary period compared with the usual activity period. Physical activity remained low during the UK lockdown period. Participants with a lower BMI engaged in significantly more (+45% higher daily steps p < 0.001) physical activity and those over 70 years old were more physically active than those under 70 years across the 12-week period (+23% higher daily steps p < 0.007). The risk of COVID-19 infection and restrictions because of lockdown measures meant some individuals had to find alternative methods to staying physical active. Participants described a lack of access to facilities and concerns over health related to COVID-19 as barriers to engaging in physical activity during lockdown. For some, this resulted in a shift towards less structured activities such as gardening or going for a walk. The data presented shows that lockdown measures during the COVID-19 pandemic significantly reduced physical activity among older individuals at risk of cardiovascular disease, particularly those with a higher body mass index. To support this population group in staying active during future lockdowns, a multifaceted strategy is needed, emphasizing psychosocial benefits and home-based physical activity. The MedEx-UK study was pre-registered with ClinicalTrials.gov (NCT03673722).

Abstract 1106: A Plasma Proteomic Signature For Atherosclerotic Cardiovascular Disease Risk Prediction In The UK Biobank

Background: The plasma proteome holds promise as a future diagnostic and prognostic tool that can accurately reflect complex human traits and disease processes. We assessed the ability of plasma proteins to predict incident atherosclerotic cardiovascular disease (ASCVD). Methods: We assessed the relative ability of clinical, genetic, and high-throughput proteomic data to associate with ASCVD in a cohort of 41650 UK Biobank participants (figure). Selected features for analysis included clinical variables such as a cardiovascular risk score (QRISK3) and lipid levels, Olink protein expression data, and 36 polygenic risk scores (PRS). We used LASSO to select features and compare AUC statistics between data types. Stability selection with randomized LASSO identified the most robustly associated proteins. The benefit of the selected proteomic signature over the QRISK3 score was evaluated through the derivation of a Δ AUC value. Results: In this cohort, the mean age was 56 years, 60.2% were female, and 9.6% developed incident ASCVD over a median follow-up of 9.33 years. A protein-only LASSO model selected 252 proteins and returned an AUC of 0.723 (95% CI 0.708, 0.737). A clinical and genetic LASSO model which selected 4 clinical variables and 20 PRS achieved an AUC of 0.726 (95% CI 0.712, 0.741). Fifteen proteins selected by a stability selection algorithm offered improvement in ASCVD prediction over the QRISK3 score [Δ AUC: 0.011 (95% CI 0.002, 0.019)]. Conclusion: A plasma proteomic signature modestly improves the prediction of incident ASCVD over clinical and genetic factors. Further studies are warranted to better elucidate the clinical utility of this signature in predicting the risk of ASCVD over the standard practice of using the QRISK3 score.

The value of neck adipose tissue as a predictor for metabolic risk in health and type 2 diabetes

Upper-body adiposity is adversely associated with metabolic health whereas the opposite is observed for the lower-body. The neck is a unique upper-body fat depot in adult humans, housing thermogenic brown adipose tissue (BAT), which is increasingly recognised to influence whole-body metabolic health. Loss of BAT, concurrent with replacement by white adipose tissue (WAT), may contribute to metabolic disease, and specific accumulation of neck fat is seen in certain conditions accompanied by adverse metabolic consequences. Yet, few studies have investigated the relationships between neck fat mass (NFM) and cardiometabolic risk, and the influence of sex and metabolic status. Typically, neck circumference (NC) is used as a proxy for neck fat, without considering other determinants of NC, including variability in neck lean mass. In this study we develop and validate novel methods to quantify NFM using dual x-ray absorptiometry (DEXA) imaging, and subsequently investigate the associations of NFM with metabolic biomarkers across approximately 7000 subjects from the Oxford BioBank. NFM correlated with systemic insulin resistance (Homeostatic Model Assessment for Insulin Resistance; HOMA-IR), low-grade inflammation (plasma high-sensitivity C-Reactive Protein; hsCRP), and metabolic markers of adipose tissue function (plasma triglycerides and non-esterified fatty acids; NEFA). NFM was higher in men than women, higher in type 2 diabetes mellitus compared with non-diabetes, after adjustment for total body fat, and also associated with overall cardiovascular disease risk (calculated QRISK3 score). This study describes the development of methods for accurate determination of NFM at scale and suggests a specific relationship between NFM and adverse metabolic health.

Comparing screening based on the NHS Health Check and Polypill Prevention Programmes in the primary prevention of heart attacks and strokes.

To compare the NHS Health Check Programme with the Polypill Prevention Programme in the primary prevention of heart attacks and strokes. Use of published data and methodology to produce flow charts of the two programmes to determine screening performance and heart attacks and strokes prevented. The UK population. The NHS Health Check Programme using a QRISK score on people aged 40-74 to select those eligible for a statin is compared with the Polypill Prevention Programme in people aged 50 or more to select people for a combination of a statin and three low-dose blood pressure lowering agents. In both programmes, people had no history of heart attack or stroke. In 1000 people, the number of heart attacks and strokes prevented in the two programmes. In the hypothetical perfect situation with 100% uptake and adherence to the screening protocol, in every 1000 persons, the NHS Health Check would prevent 287 cases of a heart attack or stroke in individuals who would gain on average about 4 years of life without a heart attack or stroke amounting to 1148 years in total, the precise gain depending on the extent of treatment for those with raised blood pressure, and 136 would be prescribed statins with no benefit. The corresponding figures for the Polypill Prevention Programme are 316 individuals who would, on average, gain 8 years of life without a heart attack or stroke, amounting to 2528 years in total, and 260 prescribed the polypill with no benefit. Based on published estimates of uptake and adherence in the NHS Health Check Programme, in practice only 24 cases per 1000 are currently benefitting instead of 287, amounting to 96 years gained without a heart attack or stroke. The Polypill Prevention Programme is by design simpler with the potential of preventing many more heart attacks and strokes than the NHS Health Check Programme.

A study to compare and correlate the effect of a yogic lifestyle on Framingham, Q RISK 3, and WHO risk scores among high-risk cardiovascular subjects.

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. Yoga is a low-cost, easily accessible lifestyle modification program that holds as an approach to decreasing cardiometabolic risk factors and increasing exercise self-efficacy among high-risk subjects. This study aimed to assess the impact of the yogic lifestyle (including diet) on cardiovascular risk scores by using the Framingham (FRS), QRISK3 score, and World Health Organization (WHO) CVD risk prediction charts at baseline, three months, and six months. The present study compares and correlates FRS, QRISK3, and WHO cardiovascular risk scores. The experimental interventional study was conducted among the high-risk population at RUHS College of Medical Sciences and Associated Group of Hospitals, Jaipur. Framingham risk Score, QRISK3 score, and WHO CVD risk prediction charts were used as a method of measurement for the outcome of interest at baseline, three months, and six months in the study and control group. Randomization and allocation in yoga and control groups were performed using computer-generated random numbers. The statistical analysis was done using advanced SPSS-22 software at significant level tests as p≤0.05, ensuring the highest level of accuracy. Data were analyzed using a one-way variance ANOVA test analysis at baseline, three, and six months. Pearson correlation analysis was done to compare different risk scores. Participants had a mean age of 48.43 ± 6.4 years. Baseline values (mean±SD) of FRS, Qrisk3, WHO were 24.59±10.15,28.59±10.11,15.71±6.07. After six months of yogic lifestyle, these values decreased significantly to 15.1±7.05, 20.09±7.08, and 13.85±4.96. The decrease in cardiovascular scores was statistically significant (p<0.0001), providing strong evidence for the effectiveness of the yogic lifestyle. Pearson correlation analysis results depict that FRS and Q risk 3 (r=0.840, p<0.0001), FRS and WHO risk chart (r=0.768, p<0.0001), Q risk3 and WHO risk chart (r=0.778, p<0.0001) have a statistically significant strong positive correlation. This study's findings suggest that a 24-week yogic lifestyle intervention (including diet) significantly decreased FRS, Q RISK 3, and WHO CVD risk scores among high-risk subjects compared to the control group.

A polygenic risk score added to a QRISK®2 cardiovascular disease risk calculator demonstrated robust clinical acceptance and clinical utility in the primary care setting.

The aim of the study was to assess the real-world feasibility, acceptability, and impact of an integrated risk tool for cardiovascular disease (CVD IRT, combining the standard QRISK®2 risk algorithm with a polygenic risk score), implemented within routine primary practice in the UK National Health Service. The Healthcare Evaluation of Absolute Risk Testing Study (NCT05294419) evaluated participants undergoing primary care health checks. Both QRISK2 and CVD IRT scores were returned to the healthcare providers (HCPs), who then communicated the results to participants. The primary outcome of the study was feasibility of CVD IRT implementation. Secondary outcomes included changes in CVD risk (QRISK2 vs. CVD IRT) and impact of the CVD IRT on clinical decision-making. A total of 832 eligible participants (median age 55 years, 62% females, 97.5% White ethnicity) were enrolled across 12 UK primary care practices. Cardiovascular disease IRT scores were obtained on 100% of the blood samples. Healthcare providers stated that the CVD IRT could be incorporated into routine primary care in a straightforward manner in 90.7% of reports. Participants stated they were 'likely' or 'very likely' to recommend the use of this test to their family or friends in 86.9% of reports. Participants stated that the test was personally useful (98.8%) and that the results were easy to understand (94.6%). When CVD IRT exceeded QRISK2, HCPs planned changes in management for 108/388 (27.8%) of participants and 47% (62/132) of participants with absolute risk score changes of >2%. Amongst HCPs and participants who agreed to the trial of genetic data for refinement of clinical risk prediction in primary care, we observed that CVD IRT implementation was feasible and well accepted. The CVD IRT results were associated with planned changes in prevention strategies.