Cardiovascular Disease Risk Score Research Articles

Ten-Year Review of the Postpartum Maternal Health Clinic at the Kingston Health Sciences Centre

ObjectivesThe postpartum Maternal Health Clinic (MHC) sees patients who have experienced pregnancy complications identified as pregnancy-related cardiovascular disease (CVD) risk indicators (hypertensive disorders of pregnancy, gestational diabetes, placental abruption, idiopathic preterm delivery, and intrauterine growth restriction) at 6 months postpartum for CVD risk screening. This project aimed to summarise the past 10 years of the MHC and identify trends in patient characteristics, patient CVD risk assessments, and clinic attendance over time. MethodsPatients included in this study have experienced 1 or more pregnancy-related CVD risk indicator(s) and have delivered between April 2011 and April 2021. MHC patient data and the Better Outcomes Registry Network database were utilised to compare eligible and participating patient data during clinically significant time periods. ResultsThe clinic has seen 1030 patients in the last 10 years and their characteristics have remained largely consistent. However, there has been an increase in the proportion of patients seen because of a hypertensive disorder and an increase in the proportion of patients with obesity, abnormal total cholesterol, and elevated fasting glucose. Additionally, CVD risk scores and the prevalence of metabolic syndrome have remained consistent over the years. Regarding the clinic’s outreach, patient eligibility for the MHC has been increasing while attendance has been decreasing over time. ConclusionsOverall, there remains a need to screen these patients for CVD risk and counsel them on risk reduction. There is also an opportunity to increase patient recruitment to improve attendance and to address the increased need for CVD risk screening and counselling in the community.

Rare Clinically Significant Idiosyncratic Drug Induced Liver Injury Caused by Low Dose Atorvastatin: Time for a New Approach to Surveillance and Risk Identification

Background: Atorvastatin is a member of the class of cholesterol lowering drugs called statins, which works by inhibiting HMG-CoA reductase, an enzyme involved in cholesterol synthesis in the liver. Statins are used to reduce the risk of cardiovascular events in individuals who have risk factors or a history of cardiovascular disease. While atorvastatin is generally well-tolerated, like all statins, it can have some adverse effects, including Drug induced liver injury (DILI) which is rare and often dose related. However, there is scarcity of reports on symptomatic DILI occurring in patients on low dose statin and normal baseline liver function test. This case adds to the growing body of literature on the potential idiosyncratic, non-dose related adverse effects associated with atorvastatin therapy. Case report: A 69-year-old woman with history of Hypertension, Hyperlipidemia, Prediabetes, Non-Alcoholic Fatty Liver Disease (NAFLD) presented to her Primary care Physician (PCP) for regular follow up. Her Lipid panel in the last 1 year has been suboptimal with her Atherosclerotic Cardiovascular disease (ASCVD) risk score between 12.0-15.1% despite lifestyle modification. Patient was started on 10 mg of Atorvastatin daily after documenting normal baseline liver function test. Fifty-six days later, patient presented to the PCP’s office with symptoms of fatigue, nausea and, right upper abdominal pain for 3 days. She had right upper abdominal tenderness and was mildly icteric. Based on her PCPs suspicion for DILI, she was advised to discontinue atorvastatin and transferred to the emergency room for further evaluation. In the Emergency room her vitals remained stable. Liver Ultrasound showed normal sized liver with features of hepatic steatosis. Laboratory analysis showed elevated alanine aminotransferase (ALT) greater than 16 times Upper limit of normal (ULN), aspartate aminotransferase (AST) greater than 9 times ULN, while alkaline phosphatase (ALP) elevation was less than 2 times ULN suggesting hepatocellular pattern. She was seen by a hepatologist 1 week later and other etiologies of acute hepatitis were ruled out. Over the course of 4 weeks, her symptoms completely resolved and liver function tests continued to improve. Forty-six days after Atorvastatin was discontinued, her aminotransaminases returned to normal levels. Conclusion: Although DILI is usually dose dependent, this case emphasizes the need for constant monitoring of liver function test of patients on low dose statins including patients with normal baseline liver function test. Personalized medical approach involving validated predictive score for DILI may become increasingly important in tailoring statin therapy to minimize the risk of adverse effects.

Predicting cardiovascular disease risk using photoplethysmography and deep learning.

Cardiovascular diseases (CVDs) are responsible for a large proportion of premature deaths in low- and middle-income countries. Early CVD detection and intervention is critical in these populations, yet many existing CVD risk scores require a physical examination or lab measurements, which can be challenging in such health systems due to limited accessibility. We investigated the potential to use photoplethysmography (PPG), a sensing technology available on most smartphones that can potentially enable large-scale screening at low cost, for CVD risk prediction. We developed a deep learning PPG-based CVD risk score (DLS) to predict the probability of having major adverse cardiovascular events (MACE: non-fatal myocardial infarction, stroke, and cardiovascular death) within ten years, given only age, sex, smoking status and PPG as predictors. We compare the DLS with the office-based refit-WHO score, which adopts the shared predictors from WHO and Globorisk scores (age, sex, smoking status, height, weight and systolic blood pressure) but refitted on the UK Biobank (UKB) cohort. All models were trained on a development dataset (141,509 participants) and evaluated on a geographically separate test (54,856 participants) dataset, both from UKB. DLS's C-statistic (71.1%, 95% CI 69.9-72.4) is non-inferior to office-based refit-WHO score (70.9%, 95% CI 69.7-72.2; non-inferiority margin of 2.5%, p<0.01) in the test dataset. The calibration of the DLS is satisfactory, with a 1.8% mean absolute calibration error. Adding DLS features to the office-based score increases the C-statistic by 1.0% (95% CI 0.6-1.4). DLS predicts ten-year MACE risk comparable with the office-based refit-WHO score. Interpretability analyses suggest that the DLS-extracted features are related to PPG waveform morphology and are independent of heart rate. Our study provides a proof-of-concept and suggests the potential of a PPG-based approach strategies for community-based primary prevention in resource-limited regions.

Performance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study

AimsDespite notable population differences in high-income and low- and middle-income countries (LMICs), national guidelines in LMICs often recommend using US-based cardiovascular disease (CVD) risk scores for treatment decisions. We examined...

Antenatal Glycemic Management and Postpartum Cardiovascular Disease Risk Screening

ObjectivesThis study aims to evaluate the cardiovascular disease (CVD) risk profiles of patients referred to the Maternal Health Clinic (MHC) with a history of gestational diabetes mellitus (GDM). MethodsEligible patients had their MHC appointment at 6 months postpartum between November 2011 and May 2022 and experienced GDM in their most recent pregnancy. Included participants were then divided into subgroups comparing methods of glycemic control: diet-controlled GDM and insulin-controlled GDM. Additionally, the MHC recruited 47 patients who have not experienced a complication in pregnancy to act as a comparator group in research studies. Demographics, medical and pregnancy history, and CVD risk scores were compared between the 3 groups. ResultsIn total, 344 patients with GDM were included in the analysis; 165 were insulin-controlled and 179 diet-controlled. When measuring the median 30-year Framingham risk score based on both BMI and lipids, there was a significant stepwise increase seen from the unexposed group, the diet-controlled GDM, and the insulin-controlled groups, respectively (all P < 0.05). The presence of metabolic syndrome showed a stepwise increase in prevalence when comparing the unexposed group, diet-exposure group, and the insulin-exposure group, respectively (16.7%; 21.5%–44.8%, P < 0.05). ConclusionsOur findings reinforce the prevalence of maternal CVD risk among GDM-diagnosed patients in the postpartum period and the necessity for screening. More specifically, our findings show how CVD risk may differ based on required interventions for glycemic control throughout pregnancy. Future research should aim to compare a more diverse patient population to optimise the generalizability of glycemic control-specific CVD outcomes.

The impact of an AI-driven personal health platform on cardiovascular disease risk

Cardiovascular disease (CVD) is a global health concern, particularly among older adults, linked to fat and sugar-rich diet, inactivity, tobacco smoking, as well as genetic factors. Regular exercise and a balanced diet are recommended to reduce CVD risk. Recently, the use of computer of mobile phone application platforms have become promenent tools for personal health interventions and guidance. Although research findings of the efficacy of mobile health apps has had mixed results, improved user health and lowered risk of CVD has been seen with regular engagement. Shae, an AI-driven mobile health platform, offers personalized lifestyle guidance based on an individual's phenotype. The aim of this study is to assess whether engagement with the online platform, Shae, decreases Framingham non-laboratory CVD risk score over time.The study collected data from 1684 participants who engaged with the Shae online platform for at least 3-months between May 2014 and March 2018. After applying exclusion criteria, 5225 complete assessment entries remained for analysis. The Shae platform assessed health, predicted future risks, and recommended personalized interventions. Data included anthropometric measurements and survey responses, converted for standardized analysis. Descriptive statistics were calculated for participants' characteristics and compared across gender and age groups, in alignment with established cardiovascular disease (CVD) risk factors. A linear mixed-effect regression model was employed to assess changes in CVD risk over time. This research aimed to evaluate the impact of personalized health interventions on CVD risk in diverse demographic groups.CVD risk score, when adjusted for age, decreased by 11.2% following 24 months of engagement with the Shae app, with men 45 years and older seeing the largest decrease (16.1%), and the lowest decrease seen in women under 55 years (10%). Use of the Shae app was primarily by women (85%).This study assessed the impact of engagement with the mHealth app, Shae, on reducing CVD risk. Results revealed a significant CVD risk reduction, notably in men over 45. mHealth apps like Shae provide personalized health assessments, activity tracking, nutrition advice, and medication reminders, enabling proactive cardiovascular health management. Increased physical activity and better blood pressure control were key factors in risk reduction. Tailored interventions for high-risk groups align with previous research. Given the importance of preventing CVD, mHealth apps hold promise. This 24-month study offers robust insights, and the focus on individual phenotypes enhances engagement and health outcomes.

Predicting cerebrovascular age and its clinical relevance: Modeling using 3D morphological features of brain vessels

Aging manifests as many phenotypes, among which age-related changes in brain vessels are important, but underexplored. Thus, in the present study, we constructed a model to predict age using cerebrovascular morphological features, further assessing their clinical relevance using a novel pipeline.Age prediction models were first developed using data from a normal cohort (n = 1181), after which their relevance was tested in two stroke cohorts (n = 564 and n = 455). Our novel pipeline adapted an existing framework to compute generic vessel features for brain vessels, resulting in 126 morphological features. We further built various machine learning models to predict age using only clinical factors, only brain vessel features, and a combination of both. We further assessed deviation from healthy aging using the age gap and explored its clinical relevance by correlating the predicted age and age gap with various risk factors.The models constructed using only brain vessel features and those combining clinical factors with vessel features were better predictors of age than the clinical factor-only model (r = 0.37, 0.48, and 0.26, respectively). Predicted age was associated with many known clinical factors, and the associations were stronger for the age gap in the normal cohort. The age gap was also associated with important factors in the pooled cohort atherosclerotic cardiovascular disease risk score and white matter hyperintensity measurements.Cerebrovascular age, computed using the morphological features of brain vessels, could serve as a potential individualized marker for the early detection of various cerebrovascular diseases.

Comparison of atherosclerotic cardiovascular disease (ASCVD) and Framingham risk scores (FRS) in an Iranian population

BackgroundFramingham risk score (FRS) and Atherosclerotic Cardiovascular Disease risk score (ASCVDrs) are widely used tools developed based on the American population. This study aimed to compare the ASCVDrs and FRS in an Iranian population. MethodThe participants of the Fasa Adult Cohort Study and the patients of the cardiovascular database of Vali-Asr Hospital of Fasa, aged 40–80 years, were involved in the present cross-sectional study. After excluding non-eligible participants, the individuals with a history of myocardial infarction or admission to the cardiology ward due to heart failure were considered high-risk, and the others were considered low-risk. The discriminative ability of FRS and ASCVDrs was evaluated and compared using receiver operating characteristic curve analysis. The correlation and agreement of ASCVDrs and FRS were tested using Cohen Kappa and Spearman. ResultsFinally, 8983 individuals (mean age:53.9 ± 9.5 y, 49.2 % male), including 1827 high-risk participants, entered the study. ASCVDrs detected a greater portion of participants as high-risk in comparison with FRS (28.7 % vs. 15.7 %). ASVD (AUC:0.794) had a higher discriminative ability than FRS (AUC:0.746), and both showed better discrimination in women. Optimal cut-off points for both ASCVDrs (4.36 %) and FRS (9.05 %) were lower than the original ones and in men. Compared to FRS, ASCVDrs had a higher sensitivity (79.3 % vs. 71.6 %) and lower specificity (64.5 % vs. 65.1 %). FRS and ASCVDrs had a moderate agreement (kappa:0.593,p-value<0.001) and were significantly correlated (Spearman:0.772,p-value<0.001). ConclusionsASCVDrs had a more accurate prediction of cardiovascular events and identified a larger number of people as high-risk in the Iranian population.

#3001 MtDNA copy number correlates to coronary artery calcium score and biological age in kidney failure patients

Abstract Background and Aims Chronic kidney disease (CKD) and kidney failure are connected to increased oxidative stress and vascular calcification, which are indicators for development of comorbidities and mortality outcome. Mitochondrial (mt)DNA copy number has been reported as independent predictor for frailty and mortality outcome of various cardiovascular diseases (CVD) and cancer. We aimed that mtDNA copy number in whole blood of kidney failure patients can be correlated to coronary artery media calcification score and coronary artery calcium (CAC) score and be used as an independent predictor for comorbidities and mortality outcome. Method Quantitative PCR (qPCR) with TaqMan® probes for three mtDNA genes (mtND1, mtND4 and mtCOX1) and two single locus genes on nuclear DNA (hemoglobin subunit beta and 18S), for normalization, is performed on DNA samples isolated from collected blood of 196 kidney transplant donors and 211 recipients at basal timepoint and 32 at 1-year-follow-up timepoint, included in the KaroKidney biobank. Resulting mtDNA copy number is investigated for correlation to CAC score, patient mortality outcome, biological age determined by skin autofluorescence and other clinical parameters. Results In our Swedish kidney transplant cohort we can see statistically significant difference in mtDNA copy number between kidney failure patients (recipients) and healthy controls (donors). No obvious difference between females and males was observed. mtDNA copy number correlates to biological age determined by skin autofluorescence, CAC score and Framingham CVD risk score. In the 32 1-year-follow-up samples we could see significant increase/recovery of mtDNA copy number for male patients compared to their baseline before receiving a transplant. Conclusion In this study we show that mtDNA copy number in kidney failure patients correlates to biological age and CAC score, affirming mtDNA copy number as an independent predictor of frailty in this Swedish cohort of CKD patients. Additionally, we can see that a kidney transplant can lead to a significant increase of mtDNA copy number in blood one year later, suggesting a general increase in health quality.

Association between gait video information and general cardiovascular diseases: a prospective cross-sectional study.

Cardiovascular disease (CVD) may not be detected in time with conventional clinical approaches. Abnormal gait patterns have been associated with pathological conditions and can be monitored continuously by gait video. We aim to test the association between non-contact, video-based gait information and general CVD status. Individuals undergoing confirmatory CVD evaluation were included in a prospective, cross-sectional study. Gait videos were recorded with a Kinect camera. Gait features were extracted from gait videos to correlate with the composite and individual components of CVD, including coronary artery disease, peripheral artery disease, heart failure, and cerebrovascular events. The incremental value of incorporating gait information with traditional CVD clinical variables was also evaluated. Three hundred fifty-two participants were included in the final analysis [mean (standard deviation) age, 59.4 (9.8) years; 25.3% were female]. Compared with the baseline clinical variable model [area under the receiver operating curve (AUC) 0.717, (0.690-0.743)], the gait feature model demonstrated statistically better performance [AUC 0.753, (0.726-0.780)] in predicting the composite CVD, with further incremental value when incorporated with the clinical variables [AUC 0.764, (0.741-0.786)]. Notably, gait features exhibited varied association with different CVD component conditions, especially for peripheral artery disease [AUC 0.752, (0.728-0.775)] and heart failure [0.733, (0.707-0.758)]. Additional analyses also revealed association of gait information with CVD risk factors and the established CVD risk score. We demonstrated the association and predictive value of non-contact, video-based gait information for general CVD status. Further studies for gait video-based daily living CVD monitoring are promising.

Cardiovascular Risk Estimation Is Suboptimal in People With HIV.

Established cardiovascular disease (CVD) risk prediction functions may not accurately predict CVD risk in people with HIV. We assessed the performance of 3 CVD risk prediction functions in 2 HIV cohorts. CVD risk scores were calculated in the Mass General Brigham and Kaiser Permanente Northern California HIV cohorts, using the American College of Cardiology/American Heart Association atherosclerotic CVD function, the FHS (Framingham Heart Study) hard coronary heart disease function and the Framingham Heart Study hard CVD function. Outcomes were myocardial infarction or coronary death for FHS hard coronary heart disease function; and myocardial infarction, stroke, or coronary death for American College of Cardiology/American Heart Association and FHS hard CVD function. We calculated regression coefficients and assessed discrimination and calibration by sex; predicted to observed risk of outcome was also compared. In the combined cohort of 9412, 158 (1.7%) had a coronary heart disease event, and 309 (3.3%) had a CVD event. Among women, CVD risk was generally underestimated by all 3 risk functions. Among men, CVD risk was underestimated by the American College of Cardiology/American Heart Association and FHS hard CVD function, but overestimated by the FHS hard coronary heart disease function. Calibration was poor for women using the FHS hard CVD function and for men using all functions. Discrimination in all functions was good for women (c-statistics ranging from 0.78 to 0.90) and moderate for men (c-statistics ranging from 0.71 to 0.72). Established CVD risk prediction functions generally underestimate risk in people with HIV. Differences in model performance by sex underscore the need for both HIV-specific and sex-specific functions. Development of CVD risk prediction models tailored to HIV will enhance care for aging people with HIV.

Women with a history of gestational diabetes mellitus present an accumulation of cardiovascular risk factors at age 46-A birth cohort study.

The incidence of gestational diabetes mellitus (GDM) is globally increasing, and it has been associated with later type 2 diabetes, metabolic syndrome (MetS), and cardiovascular disease (CVD). However, long-term population-based studies investigating common CVD risk factors years after pregnancy are lacking. To evaluate the future mortality and morbidity in cardiovascular and metabolic diseases, we conducted a thorough investigation of midlife risk factors in women with and without previous GDM. A prospective population-based cohort study was conducted of 3173 parous women from the Northern Finland Birth Cohort, 1966. Study participants were obtained from the national register or patient records. Those with a GDM diagnosis formed the GDM cohort (n = 271), and those without a previous GDM diagnosis formed the control cohort (n = 2902). Clinical examinations were performed on participants at the age of 46 and included anthropometric measurements, oral glucose tolerance test (OGTT), biochemical measurements, and cardiovascular assessment. At the age of 46, women in the GDM cohort had a higher body mass index (BMI, 29.0 kg/m2 vs 26.3 kg/m2, p < 0.001) and greater waist circumference (94.1 cm vs 86.5 cm, p < 0.001) than the control cohort. In the GDM cohort, a higher incidence of impaired glucose tolerance (12.6% vs 7.3%, p = 0.002), more previously diagnosed and OGTT-detected type 2 diabetes (23.3% vs 3.9%, p < 0.001), lower high-density lipoprotein (1.53 mmol/L vs 1.67 mmol/L, p = 0.011), higher triglycerides (1.26 mmol/L vs 1.05 mmol/L, p = 0.002) and a higher fatty liver index (6.82 vs 2.47, p < 0.001), were observed even after adjusting for BMI, polycystic ovary syndrome, parity, level of education, physical activity, smoking, and alcohol consumption. The women in the GDM cohort also had more MetS (42.6% vs 21.9%, p < 0.001) and higher risk scores for CVD and fatal events (Framingham 4.95 vs 3.60, p < 0.001; FINRISK 1.71 vs 1.08, p < 0.001). Women with a previous diagnosis of GDM exhibit more risk factors for CVD in midlife and are at a higher risk for cardiovascular events later in life.

Preliminary Study on Pulse Wave Changes in Patients with Inflammatory Arthropathies Treated with bDMARDs.

Background: Patients with inflammatory arthropathies exhibit an increased cardiovascular disease (CVD) risk as compared to the general population, which is not fully quantified by the conventional CVD risk scores. Biotechnological disease-modifying drugs (bDMARDs) have proved beneficial to reduce the overall CVD risk in these patients, although CVD remains a major cause of increased mortality. Since it has been shown that pulse wave parameters and in particular carotid-femoral pulse wave velocity (cfPWV) are predictors of CVD risk, the aim of this study was to evaluate their changes in patients with inflammatory arthropathies before and after bDMARD therapy. Methods: Pulse wave parameters were evaluated with applanation tonometry in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and rheumatoid arthritis (RA), before and after two years of bDMARD therapy. Results: At baseline, cfPWV was significantly associated with age (p < 0.001) and, among pulse wave parameters, the subendocardial viability ratio was negatively associated with C-reactive protein (CRP) (p = 0.04) and the HAQ-disability index (p = 0.03). At baseline, PsA patients showed a higher percentage of male subjects, higher CRP, and the highest cfPWV values (p = 0.048). After two years, pulse wave parameters improved in the AS and RA groups, but not in the PsA group. Conclusions: Our data confirm that pulse wave parameters are potentially reversible after bDMARD therapy, as they improved in AS and RA patients. In PsA patients, there were no changes, which may be due to the higher percentage of male subjects and higher baseline cfPWV values.

A parallel-arm randomised control trial to study the effects of risk communication methods for prevention of cardiovascular diseases: EFFRICO trial.

Cardiovascular diseases (CVDs) have many risk factors; few can be modified through health education. Traditional patient counselling methods fail to impact health behaviours to prevent or reduce the risk of CVDs. This study was conducted to estimate the effect of various risk communication methods on CVD risk reduction and medication adherence. An open-label superiority randomised control trial was conducted where 159 patients were randomised into three groups: Communication of 10-year Framingham CVD risk score, heart age, and routine care. Follow-up was done 3 months after recruitment. The primary outcome was a difference in excess 10-year Framingham CVD risk score in the end-line compared to baseline. The status of modifiable behavioural risk factors at baseline was expressed as 'yes' and 'no', and follow-up was defined as 'action', 'positive maintenance', 'negative maintenance', and 'defaulter'. The trial was registered with the Clinical Trials Registry India (CTRI NO. CTRI/2020/10/028614). The study setting was screening outpatient department (OPD), General Medicine OPD, and Cardiology OPD of a tertiary care hospital in Central India. Participants aged >30 years, residing in Bhopal for more than 6 months, diagnosed with hypertension or diabetes mellitus or both, and having any of the four CVD behavioural risk factors: tobacco use, alcohol use, physical inactivity, or unhealthy diet. Median excess 10-year Framingham CVD risk scores were 0.945% (CI: 1.275-4.297), -0.850% (-3.932-2.075), and -1.300% (-5.100-0.900) (10-year Framingham CVD risk score vs Heart age vs Routine care) and 0.000% (-3.125-5.925), -1.600% (-3.760-1.475), and -1.400% (-6.600-5.900) before and after intervention, respectively (P > 0.05). Positive maintenance was higher in both intervention groups concerning all modifiable behaviours, with a higher proportion reported in the 10-year Framingham risk score. The action phase was reported higher in intervention groups for medication adherence, addiction, and dietary changes. Systematic risk communication methods reduced the probability of contracting CVD in the future, though this finding was statistically insignificant.

Prevalence of major adverse cardiovascular events among Saudi patients with systemic lupus erythematosus compared with the general population: updates from the national SLE and PURE cohorts

ObjectiveThis study examined the prevalence of major adverse cardiovascular events (MACE) among Saudi patients with SLE and the general population and considered factors associated with such outcomes were taken into...

Community Health workers United to Reduce Colorectal cancer and cardiovascular disease among people at Higher risk (CHURCH): study protocol for a randomized controlled trial

BackgroundColorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polyps removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk.Design and methodsWe aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-month follow-up, and Life Simple7 (LS7)—a cardiovascular disease (CVD) risk score—at 6 months and 1 year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed-methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors.DiscussionChurch-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction.Trial registrationNCT05174286; clinicaltrials.gov; August 31st, 2023

Assessing, communicating and managing cardiovascular disease risk: a practical summary of the 2023 guideline.

The outdated cardiovascular disease risk calculator has been reported to overestimate cardiovascular disease risk for a contemporary Australian population, and does not include relevant variables, such as socioeconomic disadvantage, which has been shown to increase the incidence of both heart attack and stroke. The 2023 Australian Guideline for Assessing and Managing Cardiovascular Disease Risk marks a major milestone as the first update to Australia's cardiovascular disease prevention guideline in over a decade. The new guideline may help to refine and recategorise risk estimates, hence improving the discriminatory and predictive value of the new calculator. The new Australian Cardiovascular Disease Risk Calculator expresses risk scores as a percentage estimate of a person's probability of dying or being hospitalised due to cardiovascular disease within the next 5 years. The new calculator expresses risk scores as low (less than 5%), intermediate (5% to less than 10%), or high (10% or higher) risk over 5 years. Reclassification factors built into the new calculator are designed to help clinicians individualise risk estimates. These factors include ethnicity (e.g. First Nations status), family history of premature cardiovascular disease, severe mental illness, kidney disease and coronary artery calcium score. The new calculator also uses optional diabetes-specific variables (supporting a more granular cardiovascular disease risk assessment of people with type 2 diabetes). People who meet the clinically determined high-risk criteria (chronic kidney disease, familial hypercholesterolaemia) should not progress through the Australian Cardiovascular Disease risk calculator, but move straight to management. For a person with a cardiovascular disease risk score recorded from the outdated calculator, clinicians may want to reassess their risk using the new calculator the next time the person attends.

Trajectories of atherosclerotic cardiovascular disease risk scores as a predictor for incident chronic kidney disease

BackgroundThe relationship between atherosclerosis and renal function is well established. Atherosclerotic cardiovascular disease (ASCVD) risk scores reflect atherosclerotic burden, which changes over time. We investigated the association between ASCVD risk trajectories and incident chronic kidney disease (CKD) using data from a large community-based Korean cohort with up to 16 years of follow-up.MethodsWe analyzed data from 5032 participants without CKD from the baseline survey of the Korean Genome and Epidemiology Study Ansan-Ansung cohort. Participants were categorized into stable or increasing ASCVD risk groups based on the revised ASCVD risk pooled cohort equation over a median period of exposure of 5.8 years. Incident CKD was defined as two consecutive events of an estimated glomerular filtration rate < 60 mL/min/1.73 m2.ResultsDuring a median 9.9 years of event accrual period, 449 (8.92%) new-onset CKD cases were identified. Multiple Cox proportional regression analyses showed that the hazard ratio (95% confidence interval) for incident CKD in the increasing group, compared to the stable group, was 2.13 (1.74–2.62) in the unadjusted model and 1.35 (1.02–1.78) in the fully-adjusted model. Significant relationships were maintained in subgroups of individuals in their 50s, without diabetes mellitus or hypertension. The prevalence of proteinuria was consistently higher in the increasing group than that in the stable group.ConclusionsAn increasing trend in ASCVD risk scores independently predicted adverse renal outcomes in patients without diabetes mellitus or hypertension. Continuous monitoring of ASCVD risk is not only important for predicting cardiovascular disease but also for predicting CKD.

Development and validation of a new algorithm for improved cardiovascular risk prediction

QRISK algorithms use data from millions of people to help clinicians identify individuals at high risk of cardiovascular disease (CVD). Here, we derive and externally validate a new algorithm, which we have named QR4, that incorporates novel risk factors to estimate 10-year CVD risk separately for men and women. Health data from 9.98 million and 6.79 million adults from the United Kingdom were used for derivation and validation of the algorithm, respectively. Cause-specific Cox models were used to develop models to predict CVD risk, and the performance of QR4 was compared with version 3 of QRISK, Systematic Coronary Risk Evaluation 2 (SCORE2) and atherosclerotic cardiovascular disease (ASCVD) risk scores. We identified seven novel risk factors in models for both men and women (brain cancer, lung cancer, Down syndrome, blood cancer, chronic obstructive pulmonary disease, oral cancer and learning disability) and two additional novel risk factors in women (pre-eclampsia and postnatal depression). On external validation, QR4 had a higher C statistic than QRISK3 in both women (0.835 (95% confidence interval (CI), 0.833–0.837) and 0.831 (95% CI, 0.829–0.832) for QR4 and QRISK3, respectively) and men (0.814 (95% CI, 0.812–0.816) and 0.812 (95% CI, 0.810–0.814) for QR4 and QRISK3, respectively). QR4 was also more accurate than the ASCVD and SCORE2 risk scores in both men and women. The QR4 risk score identifies new risk groups and provides superior CVD risk prediction in the United Kingdom compared with other international scoring systems for CVD risk.

Cost-Effectiveness of a Multicomponent Primary Care Intervention for Hypertension.

The SingHypertension primary care clinic intervention, which consisted of clinician training in hypertension management, subsidized single-pill combination medications, nurse-delivered motivational conversations and telephone follow-ups, improved blood pressure control and cardiovascular disease (CVD) risk scores relative to usual care among patients with uncontrolled hypertension in Singapore. This study quantified the incremental cost-effectiveness, in terms of incremental cost per unit reduction disability-adjusted life years, of SingHypertension relative to usual care for patients with hypertension from the health system perspective. We developed a Markov model to simulate CVD events and associated outcomes for a hypothetical cohort of patients over a 10-year period. Costs were measured in US dollars, and effectiveness was measured in disability-adjusted life years averted. We present base-case results and conducted deterministic and probabilistic sensitivity analyses. Based on a willingness-to-pay threshold of US $55 500 per DALY averted, SingHypertension was cost-effective for patients with hypertension (incremental cost-effectiveness ratio: US $24 765 per disability-adjusted life year averted) relative to usual care. This result held even if risk reduction was assumed to decline linearly to 0 over 10 years but not sooner than 7 years. Incremental cost-effectiveness ratios were most sensitive to the magnitude of the reduction in CVD risk; at least a 0.13% to 0.16% point reduction in 10-year CVD risk is required for cost-effectiveness. Probabilistic sensitivity analysis indicates that SingHypertension has a 78% chance of being cost-effective at the willingness-to-pay threshold. SingHypertension represents good value for the money for reducing CVD incidence, morbidity, and mortality and should be considered for wide-scale implementation in Singapore and possibly other countries. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02972619.