Risk Charts Research Articles

Cardiovascular Risk Assessment Using Updated WHO/International Society of Hypertension Risk Prediction Charts and Atherosclerotic Cardiovascular Disease Risk Score in Residents of Amreli District

Introduction: India is one of the countries the World Health Organization (WHO) has recognized as having the majority of lifestyle-related illnesses in the near future. The highest incidence of CVD are found on the Indian subcontinent. Objectives:To assess the cardiovascular risk among adults aged >40 years using the updated WHO/ISH risk prediction charts and ASCVD risk score and to compare baseline cardiovascular risk estimation by both risk scores. Method: This cross-sectional study was done among 228 individuals aged 40–74 years of urban and rural areas. A semi-structured interviewer administered questionnaire was developed. The data was collected in Epicollect 5 mobile application and analyzed using Jamovi software. Results:The mean age of the study participants was 56.54 ±0.73 years. CVD high risk was signiicantly higher in males as compared to females (P<0.05). The ASCVD risk score classiied (38.2%), of the participants as high-risk, whereas the lab-based and non lab-based versions of WHO/ISH risk prediction classiied less than 10% as high risk. There was moderate agreement between the lab-based and non lab-based versions of the WHO/ISH risk prediction (Kappa-0.724, p-0 .000), fair between ASCVD risk score and non lab-based versions of the WHO/ISH (Kappa-0.310, p-0.000). The agreement between, ASCVD risk score and lab-based version of WHO/ISH risk predictor was fair (Kappa-0.309, p-0 .000). Conclusion: In current study, it was observed that one-third of the participants had a high risk of CVD events based on the ASCVD risk score, and a smaller number of participants were found to be at high risk according to the WHO/ISH risk chart. So we need to implement this risk scores predictors of CVD events for identify the high risk individual and their further management. Keywords: Atherosclerotic Cardiovascular Disease Risk Score, Cardiovascular Disease, WHO/International Society of Hypertension

Increased Levels of VCAM-1 in Patients with High Cardiovascular Risk and Obstructive Sleep Apnea Syndrome.

(1) Background: Although obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity, the link between OSA and cardiovascular disease (CVD) is not completely elucidated. Thus, we aim to assess cardiovascular risk (CVR) using SCORE 2 and SCORE 2 for older persons (SCORE 2OP), and to evaluate the association between the endothelial biomarkers VCAM-1, ICAM-1, epicardial fat, and sleep study parameters in order to improve current clinical practices and better understand the short-and long-term CVRs in OSA patients. (2) Methods: 80 OSA patients and 37 healthy volunteers were enrolled in the study. SCORE2 and SCORE 2 OP regional risk charts (validated algorithms to predict the 10-year risk of first-onset CVD) were used for the analysis of CVR. Two-dimensional echocardiography was performed on all patients and epicardial fat thickness was measured. VCAM-1 and ICAM-1 serum levels were assessed in all patients. (3) Results: OSA patients were classified as being at high CVR, regardless of the type of score achieved. Increased EFT was observed in the OSA group. VCAM-1 was associated with a high CVR in OSA patients, but no significant correlation was observed between adhesion molecules and epicardial fat thickness. (4) Conclusions: OSA patients have a high CVR according to the SCORE 2 and SCORE 2OP risk scores. VCAM-1 may be associated with a high CVR in OSA patients. Extending conventional risk stratification scores by adding other potential biomarkers improves the risk stratification and guide treatment eligibility for CVD prevention in the OSA population.

Apolipoproteins as predictors of cardiovascular risk in patients with chronic pancreatitis.

Patients with pancreatic diseases are at increased risk of cardiovascular events. Investigating various apolipoprotein forms as important atherogenesis components may improve cardiovascular risk (CVR) prediction. This study aimed to investigate CVR factors in patients with chronic pancreatitis. The study enrolled 70 patients (40 males and 30 females, mean age 55.2 years) with chronic pancreatitis and treated pancreatic exocrine insufficiency. We assessed CVR by apolipoproteins A-I, A-II, B, and C-III, lipid profile; score systems [SCORE risk chart and Framingham Risk Score (FRS)], diabetes mellitus; chronic pancreatitis by M-ANNHEIM classification. Statistics were performed via SPSS v. 22. Low apolipoprotein A-I and high apolipoprotein B levels with increased atherogenic potential were observed in 37 and 26 patients. 45.71% demonstrated a high risk of myocardial infarction with high apolipoprotein B/apolipoprotein A-I ratio. Men are at higher CVR risk. Apolipoproteins A-I and A-II correlated with the cardioprotective high-density lipoprotein (HDL) in contrast to apolipoproteins B and C-III, which correlated strongly with low-density lipoprotein (LDL), total cholesterol (TC), and triglycerides (TG). Increased CVR assessed by FRS correlated with significantly lower apolipoprotein A-I and higher apolipoprotein B and apolipoprotein B/apolipoprotein A-I ratio. With the increase in chronic pancreatitis severity, we observed decreased apolipoproteins and increased apolipoprotein B/apolipoprotein A-I ratio. Apolipoproteins are valuable CVR indicators. Further studies are required to establish a CVR screening panel in this population.

Individualised prognostic models using plasma biomarkers for clinical progression to Alzheimer’s disease dementia in non‐demented elderly

AbstractBackgroundBlood‐based biomarkers can provide a low‐invasive and accessible way to identify neurodegenerative diseases before the clinical onset of dementia. We aimed to construct prognostic models for personalized risk of developing Alzheimer’s disease (AD) dementia in a memory clinic population of individuals with either subjective cognitive decline (SCD) or mild cognitive impairment (MCI), using plasma phosphorylated‐tau‐181 (pTau181), amyloid beta1‐42/1‐40 (Aβ42/40), glial fibrillary acidic protein (GFAP) and/or neurofilament light (NfL).MethodFrom the Amsterdam Dementia Cohort and SCIENCe project we included 303 individuals with SCD (age 61±9 years, n = 126(42%) female, MMSE 28±1) and 250 with MCI (age 65±7 years, n = 89(36%) female, MMSE 27±2), who had annual follow‐up visits for re‐evaluation of diagnosis (average follow‐up duration: 2.7±1.7 years.) Our outcome measure was progression to AD dementia. Plasma biomarkers were measured at baseline using SiMoa. Concentrations were then Z‐transformed for the statistical analysis and split into tertiles for risk chart visualisation. We evaluated adding the biomarkers individually, or as a panel, to a basic prognostic model including age, sex and baseline diagnosis. We selected a final model by its discrimination (Harrell’s C‐index, a value above 0.7 indicates a good model) and accuracy (Brier score, a value below 0.2 indicates a good model) and used it to calculate 5‐year risk scores for progression to AD dementia.ResultDuring follow‐up, 86 individuals developed AD dementia (8 with SCD, 78 with MCI at baseline, average time to progression: 2.8±1.7 years). Adding any of the biomarkers to the basic model improved the model discrimination (Table 1). The prognostic model with all four plasma biomarkers had the best discrimination and accuracy, followed by the model with GFAP only, and the model with pTau181 only (Table 1). Using the model with all four biomarkers, 5‐year individual progression risks to AD dementia varied from 1.9% (lowest tertiles for GFAP, pTau181 and NfL, highest tertile for Aβ42/40 ratio) to 40.6% (highest tertiles for GFAP, pTau181 and NfL, lowest tertile for Aβ42/40 ratio) (Figure 1).ConclusionPlasma biomarkers, particularly plasma GFAP, can be utilized to provide prognostic risk information about progression to AD dementia for individuals presenting at a memory clinic.

Comparison of Laboratory and Non-Laboratory-Based 2019 World Health Organization Cardiovascular Risk Charts in the Bhutanese Population.

The World Health Organization (WHO) recommends the use of color-coded cardiovascular disease (CVD) risk charts for CVD management. This study evaluated the agreement between the laboratory and non-laboratory 10-year CVD risks based on 2019 WHO CVD risk-prediction charts. The agreement of CVD risk scores among 40- to 69-year-old Bhutanese population stratified by gender and age groups (<60 and ≥60 years) was determined via weighted kappa statistics. In the general population, there was substantial agreement between the two CVD risk score charts for all ages and <60 years but a moderate agreement for participants aged ≥60 years. In males, substantial agreement was observed in all ages and in <60 years and moderate agreement in ≥60 years. In females, both the predictions showed substantial agreement in all ages and <60, but a moderate agreement for ≥60 years. The non-laboratory-based risk charts can be used interchangeably with laboratory-based charts for predicting 10-year CVD risk in resource-constrained countries like Bhutan.

Postsystolic shortening by speckle tracking echocardiography predicts cardiovascular events and death in the general population

Abstract Background Postsystolic shortening (PSS) have demonstrated to be a valuable predictor of contractile dysfunction in the myocardium. Our objective was to investigate the prognostic value of PSS, assessed by two-dimensional speckle tracking echocardiography (2DSTE), in relation to cardiovascular morbidity and mortality in a large general population study. Methods This prospective longitudinal study consisted of 4466 participants of the general population. The postsystolic index (PSI) was defined as follows: [(maximum strain in cardiac cycle–peak systolic strain)/(maximum strain in cardiac cycle)]×100. The endpoints were heart failure, major adverse cardiovascular events (MACEs), and all-cause mortality. Results During a median follow-up of 3,5 years, 148 participants (3.8 %) experienced MACE, 85 participants (2.2 %) were diagnosed with heart failure, and 192 (4.9 %) died. In unadjusted models, PSS was significantly associated with both MACE, heart failure and all-cause mortality. Following multivariable adjustments, PSS remained significantly associated with MACE (HR: 1.54; [95% CI, 1.04 – 2.3]; P=0.033) and heart failure (HR: 1.28; [95% CI, 1.11 – 1.49]; P &amp;lt; 0.001). PSI provided incremental prognostic value in relation to MACE (SCORE risk chart with the addition of PSI: 0.86 (0.83-0.89), P &amp;lt; 0.001) and heart failure (SCORE risk chart with the addition of PSI: 0.86 (0.83-0.89), P = 0.014. Conclusions In the general population, PSS as assessed by two-dimensional speckle tracking echocardiography independently predict the occurrence of both MACE and heart failure.Postsystolic index cubic spline curves

Performance of survival neural networks in predicting 10-year cardiovascular disease risk in UK and Chinese populations

Abstract Background Accurate risk assessment is essential for the primary prevention of cardiovascular disease (CVD). The commonly used models (e.g., WHO CVD risk charts and SCORE2) have been recalibrated using country-specific incidence to reduce the impact of population disparity. While some state-of-art machine learning algorithms have been developed to improve predictive accuracy, it is still unclear if they could accurately predict CVD risk in diverse populations. How to recalibrate these models for CVD risk prediction remains unknown. Purpose To adapt the recalibration method for survival neural network and assess its capability to predict 10-year CVD risk in UK and Chinese populations. Methods We selected adults aged 40-74 years without prior CVD from UK Biobank cohort and CHERRY cohort, an electronic health records-based Chinese cohort. 80% of participants of UKB cohort were used for model derivation, the rest were for internal validation, and the CHERRY cohort was for external validation. We used two different models of survival neural networks: ⑴ deepsurv which models the hazard function using Cox regression; ⑵ deephit which directly learns the distribution of survival time. Our models were based on predictors such as sex, age, smoking status, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol and history of diabetes. Model performance was evaluated in discrimination, calibration and reclassification compared with a Cox regression model. We recalibrated neural network models using the population-based incidence rate estimated from the CHERRY cohort. Results 347,206 participants from the UKB cohort (median[p25-p75] age:58[50-63]; women:54.7%) and 177,756 participants from the CHERRY cohort (median[p25-p75] age:55[48-62]; women:53.6%) were included for analyses. The 10-year Kaplan-Meier CVD rate was higher in CHERRY than in UKB (8.03%vs.3.66%). Using the same traditional CVD risk factors, compared to Cox regression, neural network models had higher C statistics in both UKB (0.732-0.734 vs. 0.731,P&amp;lt;0.001) and CHERRY cohorts (0.727-0.736 vs. 0.726,P&amp;lt;0.001). All models were well-calibrated in UKB, but underpredicted risk by around 60% (expected-observed ratio: 0.41-0.42) in CHERRY. Population-based recalibration yields substantial improvement (expected-observed ratio: 0.87-0.93). Moreover, recalibrated neural network models showed improved reclassification compared to Cox regression (the net reclassification improvements:1.89%-7.52% in UKB, 4.31%-5.17% in CHERRY), with a more distinct distribution of predicted risk. Conclusion Survival neural networks showed good discrimination in CVD risk prediction and consistently ranked low- and high-risk individuals across diverse populations. Like traditional regression, these models also need to be rescaled to adapt to the risk characteristics of the target population, and recalibration using population-based data could be a feasible method.Discrimination and calibrationRisk distribution and reclassification

Standardized longitudinal strain curves stratified by age and sex in healthy individuals: The Copenhagen City Heart Study

Abstract Introduction Speckle-tracking echocardiography has gained widespread use, and strain parameters such as global longitudinal strain (GLS) and strain rates are strongly associated with risk of heart failure and cardiovascular death. Such strain measures, however, only represent limited features of the complete longitudinal strain (LS) curve. Thus, interpretation of entire curves might provide additional insight. Purpose To establish normal standardized LS curves over an entire heart cycle for healthy subjects stratified by age and sex. Furthermore, to assess how these curves vary with age and to compare this with conventional strain measures. Methods The study population consisted of 1790 healthy subjects free of cardiovascular disease and risk factors including diabetes mellitus and hypertension at baseline. Subjects were stratified by sex and further by age in groups as defined in the SCORE risk chart. Subjects underwent echocardiography, and LS curves from the apical four-chamber view were derived and standardized in length using linear interpolation. Terms to describe qualitative findings in the standardized strain curves were established (Figure 1). Early diastolic strain (EDS) was defined as the difference in strain from peak LS to maximal curvature after early diastolic filling, while late diastolic strain (LDS) was defined as the difference in strain from the plateau phase in late passive diastole to maximal curvature in active diastole. Conventional strain measures included GLS, systolic strain rate (SRS), early diastolic strain rate (SRE), and late diastolic strain rates (SRA). The association between these and age group were investigated using univariable linear regression for each sex. Results In the study population, 1101 (61.5%) subjects were female. The standardized strain curves (Figure 2) showed that aging primarily manifested in the diastolic part of the strain curve. Decreasing EDS was associated with increasing age group, while the opposite was true for LDS. In linear regression, both SRE (female: beta=-0.13; p&amp;lt;0.001, male: beta=-0.1; p&amp;lt;0.001) and SRA (female: beta=0.09; p&amp;lt;0.001, male: beta=0.09; p&amp;lt;0.001) were associated with age group for both sexes. Peak LS did not change notably with age, and in linear regression, GLS and SRS were only significantly associated with age for women (GLS: beta=0.12; p&amp;lt;0.001, SRS: beta=0.01; p&amp;lt;0.001). Conclusion We derived normal standardized LS curves for healthy individuals stratified by age and sex, which can serve as normal values in future studies. In addition, these showed that age was primarily associated with changes in the diastolic part of the strain curve in both sexes, which was consistent with conventional strain measures.Figure 1:Overview of termsFigure 2Standardized longitudinal strai

Ten-Year Risk for Developing Cardiovascular Disease Among Older Adults and Elderly in India: A Secondary Analysis of Wave-1 of Longitudinal Aging Study in India.

Background Cardiovascular disease (CVD) risk stratification is recommended by the World Health Organization (WHO) for effective CVD management in primary healthcare settings. Using the 2019 updated WHO CVD risk charts, we estimated the 10-year risk for developing fatal and non-fatal CVD among participants of the Longitudinal Aging Study in India (LASI). Methods We conducted secondary data analysis using the Wave-1 dataset of LASI. Analysis was performed in Stata software (version 14.1; StataCorp LLC, College Station, Texas) after applying sample weights. Ten-year CVD risk was estimated using a non-laboratory-based CVD risk chart. Logistic regression analysis was performed to determine the association between socio-demographic characteristics and 10% or more 10-year CVD risk. Results The weighted prevalence of 10% or more 10-year CVD risk was 24.70% (95% CI: 23.94%-25.47%). Participants who were currently working, living alone, and widowed had 3.63, 1.42, and 1.59 times increased odds of having a high 10-year CVD risk, respectively, after adjusting for other variables. Conclusion About a quarter of older adults and the elderly population in India have a 10-year risk for a fatal or non-fatal cardiovascular event of 10% or more, as estimated using a non-laboratory based chart.

Estimation of 10-year cardiovascular risk among adult population in western Nepal using nonlaboratory-based WHO/ISH chart, 2023: A cross-sectional study.

Noncommunicable diseases have emerged as a major cause of morbidity and mortality worldwide among which the majority of the deaths are caused by cardiovascular diseases. Estimating the risk of cardiovascular diseases helps eliminate the risk factors and prevent developing cardiovascular diseases in the future. The World Health Organization in association with the International Society of Hypertension has developed risk charts for the estimation of 10-year risk for cardiovascular diseases. This study aimed to estimate 10-year cardiovascular risk in the Nepalese population using nonlaboratory-based charts. A hospital-based cross-sectional study was conducted among 314 adults aged 40-74 years visiting the outpatient departments of Shishuwa Hospital in western Nepal. Systematic random sampling was used to select the participants. Questionnaire-guided short interviews, physical examination, and anthropometric measurements were done. The χ 2 test was used to test the significance and a p < 0.05 was considered statistically significant. As per the risk estimation charts, high cardiovascular risk (20%-30%) was seen in 6.1% of total participants and moderate cardiovascular risk (10%-20%) was found in 29% of participants. The moderate-high risk was significantly higher among male participants compared to females (p < 0.01). Of all the participants, 22.0% were current smokers, 17.2% were alcohol users, 61.1% were hypertensive, and 35.7% were diabetics. Smoking tobacco, alcohol use, and hypertension were significantly more prevalent among the male participants. (p < 0.01) Adults in the 50-59 years age group had a significantly high prevalence of hypertension (p < 0.01), diabetes (p = 0.02), and alcohol abuse (p = 0.01). This study shows high cardiovascular risk among adult population in western Nepal. The 10-year cardiovascular risk score and risk factors were significantly higher among males than females. There seems to be a prompt necessity of health promotion interventions to reduce cardiovascular risk factors and prevent the burden of cardiovascular diseases in Nepal.

Coding Intensity Through Health Risk Assessments and Chart Reviews in Medicare Advantage: Does It Explain Resource Use?

Medicare Advantage (MA) plans increase their risk-adjusted payments through intensive coding in health risk assessments (HRAs) and chart reviews. Whether the additional diagnoses from HRAs and chart reviews are associated with increased resource use is not known. Using national MA encounter data (2016-2019), we examine the relative contributions of three health risk scores to MA resource use: the base risk score that excludes diagnoses from HRAs and chart reviews; the incremental score added to the base score from diagnoses in HRAs; and the incremental score added from diagnoses in chart reviews. We find that the incremental risk scores explain 53.5% to 64.5% of resource use relative to the base risk score effect-that is, 35.5% to 46.5% of the incremental risk scores are not accompanied by increased resource use. While HRAs and chart reviews contribute to more complete coding of diagnoses, they are sources of intensive coding not accompanied by resource use.

DIGITALESCAPE Project—Aerial Remote Sensing, HBIM, and Archaeology for the Preservation and Dissemination of the Cultural Heritage at Risk in the Sierra Sur and Sierra Morena Regions

The province of Jaén (Andalusia, Spain), despite being declared the European territory with the largest number of defensive constructions (castles, fortifications, etc.), has few conservation plans, with many remains included on the Red List of Spanish Heritage lying abandoned. This poses a challenge for landscape conservation and the optimal use of the province’s tourism potential. In this paper, we present the early implementation of an ongoing methodological approach designed to alleviate this situation. It takes advantage of data from the Sentinel 2A and 2B satellites, HBIM, RPAS, GIS, and fieldwork that will be applied across five archaeological case studies. It was tested for the first time in the village of Magaña. Three main objectives and phases of this methodological approach were designed: 1. Preparation of an environmental risk chart with which to answer such questions as “How have climate change, anthropic alterations and environmental characteristics affected the state of conservation of certain heritage sites?” 2. Preparation of HBIM models to foster monitorisation and conservation policies for the main archaeological remains and improving their protection based on digital and technological tools. 3. Building a smart tourism app for mobile devices aimed at promoting smart tourism by digitalising and virtualising tourist itineraries and archaeological remains. Finally, public administrations will be apprised of the need to implement a conservation policy for cultural assets and their surroundings in a simple, quick, and cost-effective manner.

Prevalence and predictors of undiagnosed type 2 diabetes and pre-diabetes among adult Egyptians: a community-based survey

BackgroundThe global prevalence of abnormal glycemic level comprising diabetes mellitus (DM) and pre-diabetes (PDM) is rapidly increasing with special concern for the entity silent or undiagnosed diabetes; those unaware of their condition. Identification of people at risk became much easier with the use of risk charts than the traditional methods. The current study aimed to conduct a community-based screening for T2DM to estimate the prevalence of undiagnosed DM and to assess the AUSDRISK Arabic version as a predictive tool in an Egyptian context.MethodsA cross-sectional study was conducted among 719 Adults aging 18 years or more and not known to be diabetics through a population-based household survey. Each participant was interviewed to fill demographic and medical data as well as the AUSDRISK Arabic version risk score and undergo testing for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT).ResultsThe prevalence of DM and PDM were 5% and 21.7% respectively. The multivariate analysis revealed that age, being physically inactive, history of previous abnormal glycemic level and waist circumference were the predictors for having abnormal glycemic level among the studied participants. At cut off points ≥ 13 and ≥ 9, the AUSDRISK respectively discriminated DM [sensitivity (86.11%), specificity (73.35%), and area under the curve (AUC): 0.887, 95% CI: 0.824–0.950] and abnormal glycemic level [sensitivity (80.73%), specificity (58.06%), and AUC: 0.767, 95% CI: 0.727–0.807], p < 0.001.ConclusionsOvert DM just occupies the top of an iceberg, its unseen big population have undiagnosed DM, PDM or been at risk of T2DM because of sustained exposure to the influential risk factors. The AUSDRISK Arabic version was proved to be sensitive and specific tool to be used among Egyptians as a screening tool for the detection of DM or abnormal glycemic level. A prominent association has been demonstrated between AUSDRISK Arabic version score and the diabetic status.

Development and validation of a simple general population lung cancer risk model including AHRR-methylation

IntroductionScreening reduces lung cancer mortality of high-risk populations. Currently proposed screening eligibility criteria only identify half of those individuals, who later develop lung cancer. This study aimed to develop and validate a sensitive and simple model for predicting 10-year lung cancer risk. MethodsUsing the 1991–94 examination of The Copenhagen City Heart Study in Denmark, 6,820 former or current smokers from the general population were followed for lung cancer within 10 years after examination. Logistic regression of baseline variables (age, sex, education, chronic obstructive pulmonary disease, family history of lung cancer, smoking status and cumulative smoking, secondhand smoking, occupational exposures to dust and fume, body mass index, lung function, plasma C-reactive protein, and AHRR(cg05575921) methylation) identified the best predictive model. The model was validated among 3,740 former or current smokers from the 2001-03 examination, also followed for 10 years. A simple risk chart was developed with Poisson regression. ResultsAge, sex, education, smoking status, cumulative smoking, and AHRR(cg05575921) methylation identified 65 of 88 individuals who developed lung cancer in the validation cohort. The highest risk group, consisting of less educated men aged >65 with current smoking status and cumulative smoking >20 pack-years, had absolute 10-year risks varying from 4% to 16% by AHRR(cg05575921) methylation. ConclusionA simple risk chart including age, sex, education, smoking status, cumulative smoking, and AHRR(cg05575921) methylation, identifies individuals with 10-year lung cancer risk from below 1% to 16%. Including AHRR(cg05575921) methylation in the eligibility criteria for screening identifies smokers who would benefit the most from screening.

Estimating 10-year risk of lung and breast cancer by occupation in Switzerland.

Lung and breast cancer are important in the working-age population both in terms of incidence and costs. The study aims were to estimate the 10-year risk of lung and breast cancer by occupation and smoking status and to create easy to use age-, and sex-specific 10-year risk charts. New lung and breast cancer cases between 2010 and 2014 from all 5 cancer registries of Western Switzerland, matched with the Swiss National Cohort were used. The 10-year risks of lung and breast cancer by occupational category were estimated. For lung cancer, estimates were additionally stratified by smoking status using data on smoking prevalence from the 2007 Swiss Health Survey. The risks of lung and breast cancer increased with age and were the highest for current smokers. Men in elementary professions had a higher 10-year risk of developing lung cancer compared to men in intermediate and managerial professions. Women in intermediate professions had a higher 10-year risk of developing lung cancer compared to elementary and managerial professions. However, women in managerial professions had the highest risk of developing breast cancer. The 10-year risk of lung and breast cancer differs substantially between occupational categories. Smoking creates greater changes in 10-year risk than occupation for both sexes. The 10-year risk is interesting for both patients and professionals to inform choices related to cancer risk, such as screening and health behaviors. The risk charts can also be used as public health indicators and to inform policies to protect workers.

Cardiovascular Risk Estimation Based on Country-of-Birth- and Country-of-Residence-Specific Scores among Migrants in the Netherlands: The HELIUS Study

Regional and country-specific cardiovascular risk algorithms have been developed to improve CVD risk prediction. But it is unclear whether migrants' country-of-residence or country-of-birth algorithms agree in stratifying the CVD risk of these populations. We evaluated the risk stratification by the different algorithms, by comparing migrant country-of-residence-specific scores to migrant country-of-birth-specific scores for ethnic minority populations in the Netherlands. data from the HELIUS study was used in estimating the CVD risk scores for participants using five laboratory-based (Framingham, Globorisk, Pool Cohort Equation II, SCORE II, and WHO II) and three nonlaboratory-based (Framingham, Globorisk, and WHO II) risk scores with the risk chart for the Netherlands. For the Globorisk, WHO II, and SCORE II risk scores, we also computed the risk scores using risk charts specified for the migrant home country. Risk categorization was first done according to the specification of the risk algorithm and then simplified to low (green), moderate (yellow and orange), and high risk (red). we observed differences in risk categorization for different risk algorithms ranging from 0% (Globorisk) to 13% (Framingham) for the high-risk category, as well as differences in the country-of-residence- and country-of-birth-specific scores. Agreement between different scores ranged from none to moderate. We observed a moderate agreement between the Netherlands-specific SCORE II and the country-of-birth SCORE II for the Turkish and a nonagreement for the Dutch Moroccan population. disparities exist in the use of the country-of-residence-specific, as compared to the country-of-birth, risk algorithms among ethnic minorities living in the Netherlands. Hence, there is a need for further validation of country-of-residence- and country-of-birth-adjusted scores to ascertain appropriateness and reliability.

A cost-effectiveness analysis of risk-based intervention for prevention of cardiovascular diseases in IraPEN program: A modeling study.

IraPEN, a program developed in Iran based on the World Health Organization (WHO) package of essential noncommunicable (PEN) disease interventions for primary healthcare, was launched in 2015. Preventive interventions for cardiovascular diseases (CVDs) are based on the level of risk calculated using the WHO CVD risk chart. The main objective of this study was to measure the potential cost-effectiveness (CE) of IraPEN preventive actions for CVD in comparison with the status quo. A CE analysis from a healthcare perspective was conducted. Markov models were employed for individuals with and without diabetes separately. Based on the WHO CVD risk chart, four index cohorts were constructed as low (<10%), moderate (10%-19%), high (20%-29%), and very high risk (≥30%). Life years (LY) gained and quality-adjusted life years (QALY) were used as the outcome measures. The intervention yields an incremental cost-effectiveness ratio (ICER) of $804, $551, and -$44 per QALY for moderate, high, and very high CVD risk in groups without diabetes, respectively. These groups gained 0.69, 0.96, and 1.45 LY, respectively, from the intervention. The results demonstrated an ICER of $711, $630, -$42, and -$71 for low, moderate, high, and very high-risk groups with diabetes, respectively, while they gained 0.46, 1.2, 2.04, and 2.29 years from the intervention. The IraPEN program was highly cost-effective for all CVD risk groups in the individuals without diabetes except the low-risk group. The intervention was cost-effective for all patients with diabetes regardless of their CVD risk. The results demonstrated that the IraPEN program can likely provide substantial health benefits to Iranian individuals and cost savings to the national healthcare provider.

Estimates of 10-year risk of cardiovascular death and adherence to cardiovascular risk factor management in Danish patients investigated for obstructive sleep apnea

ObjectiveObstructive sleep apnea (OSA) increases the risk of cardiovascular disease (CVD) in both morbidity and mortality. We used the risk chart of Systemic Coronary Risk Evaluation (SCORE) from European Society of Cardiology (ESC) to determine the 10-year risk of cardiovascular death, and adherence to cardiovascular risk factor management in Danish patients investigated for obstructive sleep apnea. Research design and methodsIn a prospective cohort study, 303 patients with mild, moderate and severe OSA were investigated for cardiovascular risk factors before initiating CPAP therapy. Primary outcome was estimates of 10-year risk of cardiovascular death assessed from the ESC risk chart SCORE based on sex, age, smoking status, systolic blood pressure and s-total cholesterol. Furthermore we analyzed treatment indication with statins in patients with mild (apnea-hypopnea index, AHI <15), moderate (AHI 15–29.9) and severe OSA (AHI ≥30). ResultsPatients with mild OSA predominately had low or moderate 10-year risk of CVD (low risk 55.4%, moderate risk 30.8%) while patients with moderate and severe OSA were more likely to have high or very high risk of 10-year CVD (p = 0.001). The large majority of included OSA patients had dyslipidemia, 235 (77.6%) and of those, only 27.4% were treated with cholesterol lowering drugs while additional 27.7% were eligible for oral statin supplement as risk-estimated by the ESC SCORE. In multiple regression analysis among statin naive patients, AHI was positively associated with statin eligibility when adjusted for age and sex. ConclusionPatients with moderate and severe OSA had an elevated 10-year risk of fatal CVD and were undertreated with CVD risk lowering agents such as statins.

Stroke Risk Factor Profile in an Urban Population: A Community-Based Descriptive Study in Mojo Sub-District, Surabaya, Indonesia

Highlight: The stroke risk of the urban population in Mojo sub-district, Surabaya, was high (more than 10% risk for 36.3% of the population) . The risk factor for stroke is highly prevalent in Indonesia's urban communities, such as Surabaya. The Indonesian version of the Cardiovascular Disease Risk Index chart aids in determining stroke risk factors. The development of a stroke-spesific index chart has been done before but requires validation for the Indonesian population ABSTRACT Introduction: Stroke is still a major cardiovascular disease in Indonesia. Locally published data regarding stroke risk factors is still rarely reported. This condition complicates the regulation, policy-making, and community empowerment efforts to reduce modifiable stroke risk factors. Thus, a study is necessary to provide an overview of stroke risk factors and risks in cities in Indonesia, such as Surabaya. Objective: This study aimed to describe stroke risk factors in an urban Indonesian community, such as the Mojo sub-district in Surabaya. Methods: This was a descriptive study to describe stroke risk factors like age, gender, history of comorbidities, and history of cardiovascular disease, as well as patient clinical data like neurological symptoms, cardiovascular symptoms, anthropometry, vital signs, simple laboratory values, and cardiovascular risk categorization in the next ten years based on the Cardiovascular Disease Risk Index chart, Indonesian version. Results: In this study, 33 participants were included. Risk factors showed that many participants had histories of active smoking (18.2%), hypertension (45.5%), and diabetes (24.2%). One-third of the participants had a history of dyslipidemia. Based on the risk chart for cardiovascular disease, 36.3% of participants were at &gt;10% risk of developing cardiovascular disease in the next ten years. Conclusion: The risk index of cardiovascular disease in the Mojo sub-district, Surabaya, was still high. A combination of government policies, public awareness improvement, and community empowerment are urgently required to manage these risk factors epidemiologically.

Validation of the updated SCORE2, revised PCEs and WHO CVD risk charts in an Asian population

SCORE2, Revised PCEs and WHO CVD risk chart, have been developed to replace the outdated SCORE, 2013 PCEs and WHO/ISH risk chart, respectively. Before the revised risk models can be adapted in a local setting, they should be validated first.