Systematic Coronary Risk Evaluation Scale Research Articles

Differences in cardiovascular risk and health-related quality of life in COPD patients according to clinical phenotype

Chronic obstructive pulmonary disease (COPD) has a high prevalence and a major impact on health-related quality of life (HRQL). COPD exacerbations are an important cause of morbidity and mortality, affecting cardiovascular risk, and are associated with poorer health status. The aim of this study was to assess the association between cardiovascular risk (CVR) and HRQL, according to exacerbator or non-exacerbator phenotype. We undertook a cross-sectional, observational, descriptive study of 107 patients with COPD. Patients with two or more moderate exacerbations or one severe exacerbation in the previous year were considered as exacerbators. The CVR was calculated with the Framingham scale and SCORE (Systematic Coronary Risk Evaluation) and the HRQL was assessed with the generic questionnaire Short Form-36 Health Survey (SF-36), the St George Respiratory Questionnaire (SGRQ) and the COPD Assessment Test (CAT). Statistical analysis was done with SPSS version 26.0 for Windows. The SF-36 and the SGRQ showed lower values for the exacerbator phenotype, indicating a poorer quality of life. The CAT questionnaire showed values above 10 for the exacerbator phenotype, and lower values in the non-exacerbator group. After categorizing the sample according to their median age (65 years), we found a greater deterioration in HRQL in patients under 65 years of age according to the SF-36, the SGRQ and the CAT. We also detected differences in HRQL between non-exacerbator patients with a high CVR according to the Framingham (≥ 20%) and SCORE (≥ 5%) scales compared to those without this risk. A tendency towards worse HRQL was observed in non-exacerbator patients with a high CVR, which was statistically significant for the SGRQ impact domain on the SCORE scale. The CAT also showed a worse quality of life in non-exacerbator patients with a high CVR, which was significant in the Framingham model (Framingham high risk 8.41 vs non-high risk 6.05, p < 0.01). These differences were not observed in exacerbator patients. Our findings confirm that a high CVR influences HRQL in patients with COPD, especially in non-exacerbator patients with a high CVR, measured according to the SGRQ and the CAT.

Qualitative and quantitative ultrasound parameters of carotid atherosclerotic plaques in patients with moderate cardiovascular risk according to the SCORE scale: 7-year prospective follow-up study

Aim. To assess asymptomatic carotid atherosclerosis in patients with moderate cardiovascular risk over a 7-year prospective follow-up using non-invasive ultrasound markers.Material and methods. Eighty patients (47 men and 33 women) aged 53,1±5,9 years with moderate Systematic Coronary Risk Evaluation (SCORE) level, low-density lipoprotein cholesterol (LDL-C) of 2,7-4,8 mmol/l and asymptomatic hemodynamically insignificant (stenosis &lt;50%) carotid atherosclerosis (CA). Patients underwent CA ultrasound (PHILIPS IU22) at baseline and after 7 years. Plaque number, maximum plaque height, total plaque height, total CA stenosis, visual plaque morphology, gray-scale median (GSM), and intima- media thickness of the right and left common CAs were assessed. All patients were prescribed atorvastatin therapy at a dose of 10-40 mg until a target LDL-С level &lt;2,6 mmol/l was achieved.Results. During the follow-up period, a significant increase was noted in the number of plaques, the maximum and total plaque height, total CA stenosis, and intima- media thickness of the right and left common CAs. An increase in GSM was detected in 79% of plaques on statin therapy. Plaque echoicity increased by 4,90 [0,51; 17,41] (p &lt;0,001) or 7,2% [0,7%; 29%] (p&lt;0,001) over seven years. Regression analysis adjusted for sex and age showed the dependence of GSM changes (ΔGSM) on changes in the LDL-C level (ΔLDL-C) (p=0,049). With a decrease in LDL-C by 1 mmol/l, an increase in average GSM was noted by 5,9 (0,03-11,78). The maximum plaque height increased significantly after 7-year follow-up from 1,80 [1,50; 2,20] to 2,00 [1,63; 2,68] mm (p=0,044). In patients who reached a LDL-C level of 1,8 mmol/l, the maximum plaque height decreased more than in patients who did not reach this level (-0,07 [-0,45; 0,14] mm and 0,20 [-0,05; 0,40] mm, respectively (p=0,028)). Regression analysis adjusted for sex and age did not reveal a relationship between the change of maximum plaque height with ΔLDL-C and Δhigh-density lipoprotein cholesterol, but with LDL-C level after 7 years.Conclusion. Statin therapy in patients with CA stenosis &lt;50% stabilizes the plaques due to echogenicity increase. LDL-C &lt;1,8 mmol/l can lead to a decrease in maximum plaque height.

Comparability of cardiovascular risk assessment according to the SCORE and the coronary artery calcium score (Agatston score)

Aim. To determine whether the Systematic Coronary Risk Evaluation (SCORE) level corresponds to the coronary artery calcium (CAC) score (Agatston score).Material and methods. The study included 212 people aged 40-65 years (mean age, 56,5±7,9 years). The number of men and women was 54 (25,5%) and 158 (74,5%), respectively.Results. According to the SCORE, the groups were distributed as follows: 62 (29,2%) — low risk, 128 (60,4%) — moderate risk, 16 (7,5%) — high risk, 6 (2,8%) — very high risk. The average SCORE level for the general group was 2,5±2,4%. According to the Agatston score, the groups were distributed as follows: minimal risk (0-10) — 142 (67%) people, low risk (11-100) — 42 (19,8%) people, moderate risk (101-400) — 17 (8%) people, high risk (≥401) — 7 (3,3%) people. Inconsistencies for all categories of cardiovascular risk were revealed between SCORE and Agatston score.Conclusion. The identified inconsistencies in the distribution of risk groups in accordance with the SCORE and Agatston score indicate that the SCORE scale is insufficiently informative. Multislice computed tomography coronary angiography with CAC calculation is additionally recommended, which will allow determining patient management and deciding on therapy. A comparative analysis of CAC score and the SCORE scale can help optimize, first of all, drug therapy for patients with hypertension and lipid metabolism disorders.

Implementing an Artificial Intelligence System in the Work of General Practitioner in the Yamalo-Nenets Autonomous Okrug: Pilot Cross-sectional Screening Observational Study

Background. Early identification of risk factors (RF) associated with cardiovascular diseases (CVD) is essential for the prevention of CVDs and their complications. CVD risk factors can be identified using Artificial Intelligence (AI) systems, which are capable of learning, analyzing and drawing conclusions. The advantage of AI systems consists in their capacity to process large amounts of data over a short period of time and produce ready-made information. Objectives. Evaluation of the efficiency of implementing an AI software application by a general practitioner for identifying CVD risk factors.Methods. The study included data from 1778 electronic medical histories of patients aged over 18, assigned to an outpatient and polyclinic department of Muravlenkovskaya Gorodskaya Bolnitsa (Muravlenko municipal hospital), Yamalo-Nenets Autonomous Okrug (Russia). The study was conducted in four stages. The first stage involved a preliminary training of the Artificial Intelligence (AI) system under study using numerous CVD risk assessment scales. The Webiomed predictive analytics and risk management software by K-SkAI, Russia, was selected as a platform for this purpose. The second stage included an analysis of medical data to identify CVD risk factors according to the relative risk scale for patients under 40 and the SCORE scale for patients over 40. At the third stage, a specialist analyzed the previous and new information received about each patient. According to the results of the third stage, four risk groups for CVD (low, medium, high and very high) were formed. At the fourth stage, newly diagnosed patients with a high risk of CVD, who had not been previously subject to regular medical check-up, were directed for additional clinical, laboratory and instrumental follow-up examination and consultations of relevant specialists. Statistical data in absolute terms and as a percentage were obtained. Statistical processing of the results was carried out by a computer program aimed at medical decision support. Content visualization was performed in spreadsheets and charts.Results. Based on the data obtained, the AI system under study divided all patients into CVD risk groups and identified uncounted factors. The AI system confirmed a high and very high risk of CVD according to SCORE (Systematic COronary Risk Evaluation) in 623 people, who were already receiving appropriate cardiological assistance. The RFs that had not previously been taken into account in the diagnosis were recorded in 41 (11.5%) patients from the very highrisk group and in 37 (12.7%) high-risk patients. The AI system identified a high risk of CVD in 29 people who had not been previously under care of a general practitioner or other specialists due to their infrequent visits to health care facilities. These patients were detected by the AI system following periodic and preliminary medical check-ups (35%), full in-patient treatment for other diseases (31%), when seeking help of other specialists (17%), as well as when obtaining a medical certificate for a driving license (12%), admission to a swimming pool (3%) or possessing a weapon (2%). In a group with the newly diagnosed patients at a high risk of CVD, men dominated (24 persons, 82%) and women comprised only 8% (5 persons). All these people were of working age between 40 and 50. In order to confirm the information received, the supervising physician subsequently referred patients for a follow-up examination, as a result of which only 1 person (3%) was not diagnosed with a somatic pathology.Conclusion. The efficiency of the AI system under study comprised 97%. Permanent monitoring of all parameters of electronic medical histories and outpatient records is an efficient method for timely identification of RF at any visit of a person to a health care facility (preventive and periodic medical examinations, regular check-ups, specialist consultations, etc.) and their assignment to respective CVD risk groups. Such monitoring ensures an effective medical supervision of able-bodied populations.

Comparison between a genetic risk score and the European SCORE in cardiovascular events prediction in a primary prevention population

Abstract Background The risk for Coronary Artery Disease (CAD) can be estimated using different scores, such as the European SCORE (Systematic Coronary Risk Evaluation) scale or genetic risk score (GRS). The addition of GRS to the European SCORE may increase the precision of predicting MACE (Major Adverse Cardiovascular Events). Purpose This study aims to compare the European SCORE and the multiplicative genetic risk score (mGRS) in predicting MACE. Methods and results The study included 1110 asymptomatic individuals without known CAD from GENEMACOR prospective registry. We defined the primary endpoint of all-cause cardiovascular events. The study population had mean age of 51.6 years, 74.1% male and had risk factors of diabetes (11.6%), dyslipidemia (67.5%), hypertension (48.1%) and smoking (22.9%). Using C-index methodology, mGRS score was superior to SCORE in predicting MACE (mGRS = 0.832 Vs SCORE = 0.615; p=0.014). Conclusions The mGRS score was superior to SCORE in predicting MACE in an asymptomatic and free of CAD population. Genetic information may improve cardiovascular risk stratification in primary prevention. Funding Acknowledgement Type of funding sources: None.

The Prevalence of Late-Onset Hypogonadism in Middle-Aged Men and Cardiovascular Risk Factors

Background: Life expectancy has increased dramatically worldwide, resulting in a sharp rise of age-associated diseases, including late-onset hypogonadism (LOH) in men. Aim: To assess the prevalence of LOH and to determine its relationships with cardiovascular risk factors in healthy middle-aged men. Material and Methods: A total of 200 men aged 44–55 (median 48.44, interquartile range 45.02–52.50) undergoing regular medical examinations were enrolled in a study. All participants were asked to complete the International Index of Erectile Dysfunction, Aging Male's Symptoms, and Beck Depression Inventory questionnaires. Sex and gonadotropin hormones were measured in all participants. Cardiovascular diseases (CVD) risk was assessed in all participants by using the Systematic Coronary Risk Evaluation scale, and additional risk factors were recommended in the 2019 European Society of Cardiology and European Atherosclerosis Society guidelines for the management of dyslipidemias: lipid modification to reduce cardiovascular risk. Results: Ninety-eight (49%) men suffered from LOH. Men with total testosterone (TT) of <12 nmol/L were considered testosterone-deficient. The mean TT level was 8.9 ± 2.4 nmol/L in the LOH group. Clinical signs and symptoms of LOH were associated with lower TT levels: 7.78 ± 2.49 and 10.15 ± 1.32 in the groups with and without LOH, respectively (p = 0.004). The prevalence of obesity, metabolic syndrome, and depression was significantly higher among men with LOH, compared with men without it. High cardiovascular risk was found only in those participants present with LOH (p = 0.003). After collecting other risk factors, we found that 94.9% of participants assigned to the LOH group had high cardiovascular risk. Conclusion: The prevalence of LOH is high among healthy middle-aged men. Moreover, it is associated with an increased cardiovascular risk. Early measurement of TT levels in this population group may predict the development of CVD and allow the introduction of timely primary prevention measures to reduce cardiovascular morbidity and mortality.

The effects of preventive counseling followed by remote support via phone on physical activity in patients with high cardiovascular risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Education may increase physical activity (PA) in patients (pts) with high cardiovascular (CV) risk. Objectives To assess the effects of preventive counseling with focus on diet modification with remote support by phone on PA levels in high CV risk pts. Methods This is a randomized controlled study of pts aged 40 to 65 years with high/very high CV risk (Systematic Coronary Risk Evaluation scale [SCORE], ≥5%) and any 2 metabolic syndrome criteria. Pts were randomized into 2 groups in 1:1 ratio. Intervention group received comprehensive preventive counseling with focus on healthy diet followed by 3 months of biweekly remote counseling by phone (a total of 6 sessions). Control group received usual care including basic preventive counseling. PA was assessed by International Questionnaire on Physical Activity (IPAQ) at baseline, at 6 and 12 months. Results A total of 100 pts (women, 80%, aged 59.85 ± 4.47 years) were randomized. Demographics and clinical features were balanced across groups. Despite the study intervention not focusing on PA, total PA, moderate PA and walking significantly increased in the intervention group vs control at 6 and 12 months. Conclusion The study intervention provided a significant increase of PA in high CV risk pts. Intervention group, mean ± standard deviation Control group, mean ± standard deviation P for change from baseline Total physical activities, МЕТ-min/week Baseline 1317.94 ± 1455.4 2029.42 ± 2811.84 After 6 months 2217.58 ± 1813.95*** 1793.26 ± 1863.54 &amp;lt;0.001 After 12 months 2240.2 ± 1991.47*** 1629.48 ± 1629.02 &amp;lt;0.001 Vigorous physical activities, МЕТ-min/week Baseline 92.8 ± 407.72 220.8 ± 881.49 After 6 months 96 ± 557.08 0 ± 0 n/s After 12 months 132.8 ± 425.66 27.2 ± 109.15 n/s Moderate physical activities, МЕТ-min/week Baseline 268.8 ± 455.28 714 ± 1390.22 After 6 months 522.4 ± 570.54*** 518.8 ± 1075.79* &amp;lt;0.001 After 12 months 766.8 ± 1176.38** 481.6 ± 874.97* &amp;lt;0.001 Walking, МЕТ-min/week Baseline 956.34 ± 1071.49 1094.62 ± 1344.46 After 6 months 1599.18 ± 1404.88*** 1294.46 ± 1208.88 &amp;lt;0.05 After 12 months 1339.8 ± 1230.51** 1120.68 ± 1067.09 &amp;lt;0.05 *р&amp;lt;0,05;**р&amp;lt;0,01;***р&amp;lt;0,001 for within group comparisons vs baseline

The effects of preventive counseling followed by remote support via phone on the motivation to change lifestyle in patients with high cardiovascular risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Personal motivation for lifestyle change plays a fundamental role in modifying unhealthy habits. It can be improved, for example, through education. Objectives To assess the effects of preventive counseling with focus on diet modification followed by remote support via telephone on the motivation to change lifestyle in patients (pts) with high cardiovascular risk in a long-term follow-up. Methods This is a prospective randomized controlled study of pts aged 40 to 65 years with high/very high CV risk (≥5% according to the Systematic Coronary Risk Evaluation scale [SCORE]) and any 2 criteria of metabolic syndrome. Pts were randomized into 2 groups in 1:1 ratio. The intervention group received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group received usual care in Health centers which also included basic preventive counseling. A specially designed questionnaire was used to evaluate the motivation to change lifestyle at baseline and 12 months. Results A total of 100 pts (women - 80%, aged 59.85 ± 4.47 years) were randomized. At baseline 81% pts had high and 19% - very high CV risk. The groups were well balanced according to demographic and clinical features. At 1 year of follow-up the intervention group experienced significant improvement in motivation for lifestyle changes vs control. The proportion of pts achieving advanced stages of change process was 38% vs. 12% in the control group where 82% of pts only continued to think of lifestyle modification. Conclusion Preventive counseling followed by remote support via phone provided a significant improvement in motivation to change lifestyle. Intervention group Control group P for change from baseline Baseline After 12 months Baseline After 12 months Not ready yet, % 0 0 0 0 &amp;lt;0.05 Often think of lifestyle changes, % 62 46 86 82 Ready to do changes if provided specific advices, % 32 16 12 6 Are in process of successful changes, % 6 38 2 12

Распространенность субклинического атеросклероза при ревматоидном артрите

Objective. To study the parameters of the morpho-functional state of the vascular wall in patients with rheumatoid arthritis (RA) with different levels of total cardiovascular risk (CVR). Materials and methods. 181 patients with active RA (mean age 40.4 [31.8; 49.6] years) were examined, and 2 groups were formed: 1) patients with the seronegative subtype (n=87); 2) those with the seropositive subtype (n=94). CVR was determined using the modified Systematic COronary Risk Evaluation (SCORE) scale; the intima-media complex thickness (IMCT) and the stiffness index (SI) of common carotid arteries (CCA) were assessed with specific methods. Results. Low CVR was determined in 86 (48%), moderate risk - in 47%, and high risk - in 5% patients with RA. 176 (97%) patients with RA had signs of subclinical atherosclerosis, with simultaneous IMCT increase above the 75th percentile and SI increase over 10 m/s in 21% patients. Mean IMCT values and SI in the 2nd group were higher than in the 1st group (р=0.018 and р=0.048, respectively). The lower risk was more commonly accompanied by the IMCT increase; as the CVR increased, the proportion of RA patients with SI over 10 m/s increased (р&lt;0.01). A correlation was detected between the age and SI (r=0.58, p=0.035), IMCT parameters (r=0.64, p=0.002). SI correlated with the body mass index (BMI) (r=0.64, p=0.04), and IMTC correlated with the С-reactive protein level (r=0.61, p&lt;0.01). Direct correlation was detected between SI, IMTC, and the Disease Activity Score 28 (DAS28) (r=0.51, p=0.02; r=0.45, p=0.008), RA duration (r=0.42, p=0.04; r=0.58, p=0.04), rheumatoid factor (RF) (r=0.68, p=0.04; r=0.49, р=0.04) and anti-citrullinated peptide antibody (ACPA) levels (r=0.62, p=0.018; r=0.45, р=0.003), respectively. Conclusion. It is feasible to perform an advanced examination for the diagnosis of subclinical atherosclerosis along with the routine evaluation of total CVR using the SCORE scale in patients with active RA.

ОЦЕНКА ИНФОРМИРОВАННОСТИ ВРАЧЕЙ ПЕРВИЧНОГО ЗВЕНА О СУММАРНОМ СЕРДЕЧНО-СОСУДИТОМ РИСКЕ

In practical medicine, the assessment of total cardiovascular risk (CVR) plays an important role in identifying a high-risk group among “asymptomatic” patients, that is, individuals without clinical manifestations of atherosclerosis. Currently, the most famous are the American Framingham Total Coronary Risk Scale, as well as the European SCORE (Systematic Coronary Risk Evaluation) scale, which predicts the 10-year fatal risk of all CVDs for European countries with low and high risk. The survey involved 66 doctors from various regions of Uzbekistan

Cardiovascular risk factors in patients with calcium pyrophosphate crystal deposition disease

Calcium pyrophosphate crystal deposition disease (CPCDD) is among the most common inflammatory rheumatic diseases; however, studies of cardiovascular risks in CPCDD have not been conducted. Objective : to stratify a cardiovascular risk in patients with CPCDD according to the systematic coronary risk evaluation (SCORE) algorithm that allows determination of an individual 10-year risk of cardiovascular death. Subjects and methods . The one-stage, single-center study of a cardiovascular risk enrolled 118 patients (43 men and 75 women) with CPCDD. Laboratory studies included determination of fasting serum glucose, total cholesterol, uric acid, magnesium, phosphorus, and total calcium. The level of C-reactive protein (CRP) was measured by a highly sensitive method; CRP >5 mg/L was taken as a high level; parathyroid hormone was determined by chemiluminescence immunoassay. The SCORE table was used to assess the total cardiovascular risk in all the patients. Results and discussion . The patients' mean age was 60.7±12.4 years. According to the SCORE scale, very high and high risks of cardiovascular death were found in 59 (50%) and 6 (5%) patients, respectively; only in 10% of cases this risk was associated exclusively with age (> 65 years); 60 (50.8%) of the 118 patients did not have previous cardiovascular events or atherosclerosis risk factors. Coronary heart disease was detected in 28.8% of the 118 patients; hypertension was identified in 64%; diabetes mellitus (DM) was found in almost 15%. The mean SCORE values did not signif icantly differ in men and women. The level of CRP was higher in men than that in women (8.6±4.6 and 7.3±3.5 mg/dL, respectively; p = 0.04). Glomerular filtration rate (GFR) 100 ml/min: 61% (60/98) and 25% (5/20) of patients, respectively (p = 0.003). Hyperparathyroidism (HPT) was detected in 12 (10%) patients, and 7 of them were at a very high risk by the SCORE scale; however, hypercalcemia was diagnosed in only three cases. The results of the SCORE stratification of the whole group showed that 64 (54.2%) of the 118 patients with CPCDD were at a very high or high risk, the latter was very high in exactly half of the cases (n = 59. Conclusion . One-half of patients with CPCDD have a very high cardiovascular risk. In addition to the high detection rate of traditional cardiovascular risk factors (hypertension, smoking, hypercholesterolemia, and DM), the presence of chronic microcrystalline inflammation, concomitant metabolic disorders and diseases (hyperuricemia, HPT, decreased renal function) should be taken into account when determining the cardiovascular risk in patients with CPCDD.

Predictive validity of the risk SCORE model in a Mediterranean population with dyslipidemia

Background and aimsCholesterol treatment for the primary prevention of cardiovascular disease is based on cardiovascular risk, as assessed by the SCORE (Systematic COronary Risk Evaluation) scale. This study aimed to assess the predictive value and clinical utility of the SCORE scale for preventing cardiovascular events and all-cause mortality in people with dyslipidemia and no lipid-lowering treatment. MethodsPatients with dyslipidemia and no lipid-lowering treatment were included from the ESCARVAL-RISK cohort. Cardiovascular risk was calculated by means of the SCORE scale. All deaths and cardiovascular events were recorded for up to five years of follow-up. We calculated sensitivity, specificity and other predictive values for different cut-off points and assessed the effect of different risk factors on the diagnostic accuracy of the SCORE charts. ResultsIn the final cohort of 18,853 patients, there were 1565 cardiovascular events and 268 deaths. The risk value recommended to initiate pharmacological treatment (5%) presented a specificity of 86% for death and 90% for cardiovascular events, and a sensitivity of 53% for death and 32% for cardiovascular events. In addition, the scale classified as low risk 62.8% of the patients who suffered a cardiovascular event and 46.6% of those who died. Antithrombotic treatment, diabetes, hypertension, heart failure, peripheral artery disease and chronic kidney disease were associated with a reduction in the predictive capability of the SCORE scale, whereas metabolic syndrome was related to better risk prediction. ConclusionsThe predictive capability of the SCORE scale for cardiovascular disease and total mortality in patients with dyslipidemia is limited.

SCORE risk scale as a prognostic factor after sudden sensorineural hearing loss.

Sudden sensorineural hearing loss (SSHL) is an otologic urgency whose treatment is still controversial. Its etiology remains largely unknown in most cases and predicting its prognosis is still a challenge. Cardiovascular risk factors (CVRF) have been implicated in the etiopathogenesis of this entity. Application of the SCORE (Systematic Coronary Risk Evaluation) risk scale in patients with SSHL and evaluation of its potential prognostic value in recovery in patients with CVRF. Prospective analysis of patients with SSHL admitted for protocol treatment including intravenous corticosteroid therapy associated to weekly intratympanic injection in the event of therapeutic failure or severe hearing loss at admission. Demographic, audiometric, clinical and imaging data were assessed. The SCORE risk scale was applied and the audiometric recovery was compared among different risk groups. Our overall complete and partial recovery rates were 35.9% and 26%, respectively. More than a half of our patients had at least one CVRF. Of these, overweight/obesity, hyperlipidemia and hypertension were the most common. In our sample, patients with CVRF and higher SCORE risk presented higher PTA at admission and also worse hearing outcome, although these results were not statically significant. This preliminary study could not confirm the validity for SCORE scale for cardiovascular risk assessment in predicting audiometric recovery in patients with SSHL with multiple comorbidities. Further research with larger samples are needed to elucidate the etiology of SSHL and the exact role of cardiovascular risk factors in the pathophysiology of SSHL. 4.

Профилактическое консультирование с использованием дистанционных технологий – метод эффективного контроля метаболических факторов риска у пациентов с высоким и очень высоким риском развития сердечно-сосудистых заболеваний

to assess the impact of preventive counseling with focus on diet modification on lipid and metabolic parameters in patients with high / very high cardiovascular (CV) risk who visited Health centers. This was a prospective randomized controlled study of patients aged 40 to 65 years with high/very high CV risk (≥5% according to the Systematic Coronary Risk Evaluation scale [SCORE]) and any 2 criteria for metabolic syndrome. Patients were 1:1 randomized into 2 groups. The intervention group (n=50) received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group (n=50) received usual care in Health centers which also included basic preventive counseling. A total of 100 patients (women 82%, age 59.74±4.66 years) were randomized. At baseline 81% of patients had high and 19% - very high CV risk. The groups were well balanced according to demographic and clinical features. At 1 year of follow-up patients from the intervention group experienced significant improvement of metabolic parameters compared with controls: their diastolic blood pressure (BP) decreased by 5.62±7.7 mm Hg, total and low-density lipoprotein cholesterol (TC and LDL-C) - by 0.5±0.83 and 0.46±0.62 mmol/l, respectively. Both groups experienced statistically and clinically significant decreases in systolic BP (intervention, - 17.76±16.2 mm Hg, control, - 13.44±15.6 mm Hg; both groups p.

High Expression of STAT3 in Subcutaneous Adipose Tissue Associates with Cardiovascular Risk in Women with Rheumatoid Arthritis.

Despite the predominance of female patients and uncommon obesity, rheumatoid arthritis (RA) is tightly connected to increased cardiovascular morbidity. The aim of this study was to investigate transcriptional activity in the subcutaneous white adipose tissue (WAT) with respect to this disproportionate cardiovascular risk (CVR) in RA. CVR was estimated in 182 female patients, using the modified Systematic Coronary Risk Evaluation scale, and identified 93 patients with increased CVR. The overall transcriptional activity in WAT was significantly higher in patients with CVR and was presented by higher serum levels of WAT products leptin, resistin and IL-6 (all, p < 0.001). CVR was associated with high WAT-specific transcription of the signal transducer and activator of transcription 3 (STAT3) and the nuclear factor NF-kappa-B p65 subunit (RELA), and with high transcription of serine-threonine kinase B (AKT1) in leukocytes. These findings suggest Interleukin 6 (IL-6) and leptin take part in WAT-specific activation of STAT3. The binary logistic regression analysis confirmed an independent association of CVR with IL-6 in serum, and with STAT3 in WAT. The study shows an association of CVR with transcriptional activity in WAT in female RA patients. It also emphasizes the importance of STAT3 regulatory circuits for WAT-related CVR in RA.

TRADITIONAL RISK FACTORS FOR CARDIOVASCULAR DISEASES IN SYSTEMIC SCLEROSIS AND THEIR RELATIONSHIP TO STRUCTURAL CHANGES OF THE HEART

Objective: to determine the frequency of traditional risk factors (TRFs) for cardiovascular diseases (CVD) in patients with systemic sclerosis (SS) and to analyze their relationship to the clinical manifestations of SS, as well as to structural changes, as evidenced by echocardiography (EchoCG).Subjects and methods. The investigation enrolled 125 patients with SS and 50 sex- and age-matched, apparently healthy individuals included in a control group. Standard electrocardiography was performed in all and EchoCG – in 121 patients. The Systematic Coronary Risk Evaluation (SCORE) scale was used to assess the risk of fatal CVD in 100 patients with SS and in 47 control individuals within 10 years.Results and discussion. The frequency of TFRs in patients with SS was not significantly different from that in the control group, except for the occurrence of hypercholesterolemia and increased body mass index (BMI). In SS, BMI &gt;25 kg/m2 was observed significantly more often and the frequency of hypercholesterolemia was lower than in the controls (p &lt;0.018). Hypertension and diabetes mellitus were slightly more frequently encountered in SS patients than in the controls, but this difference was insignificant. Taking into account the Russian Society of Cardiology (RSC) guidelines, the cardiovascular risk (CVR) was assessed with the SCORE scale. A very high CVR was much more common in SS and a moderate CVR was much more frequently seen in the control group. There were no substantial differences in the frequency of low and high CVRs. SS is characterized by the increased frequency of high total CVD risk as compared to the controls. Hypertension, overweight, and over 50 years of age were associated with more obvious structural heart disease.Conclusion. TRFs make a substantial contribution to the formation of a high CVR in patients with SS, promoting the development of atherosclerosis and its complications. Assessment of TGFs in SS patients will facilitate identifying patients at high risk for cardiovascular death and timely prescribing therapy. Hypertension is an important TGF that in SS is associated with considerable structural changes in the heart; therefore adequate blood pressure control is of importance in improving SS prognosis especially in patients older than 50 years.

Primary prevention of cardiovascular disease: More patient gender-based differences in risk evaluation among male general practitioners.

Our objective was to analyse general practitioner (GP) cardiovascular risk assessment of patients for primary prevention while considering the gender of both the GP and the patient. This study consisted of an observational survey of GPs who were internship supervisors in the Paris metropolitan area. Each of 52 volunteer GPs completed a self-administered questionnaire regarding their own characteristics and randomly selected 70 patients from their patient list. Dependent variables from the patient files included the presence of information about risk factors necessary to assess the patient's cardiovascular risk according to the French scale and the Systematic COronary Risk Evaluation (SCORE) scale. Analyses used mixed logistic models with a random intercept and adjusted for patient and physician characteristics. Both cardiovascular risk scales could be assessed less frequently in women than in men (odds ratio (OR) = 0.64 (95% confidence interval (CI): 0.5-0.8) for the French scale and OR = 0.63 (95% CI: 0.5-0.8) for the SCORE scale). These gender differences were less substantial when the patients were seen by female (for the SCORE scale OR = 0.72 (95% CI: 0.5-1.01)) compared with male physicians (OR = 0.56 (95% CI: 0.4-0.7)). The patients who were least well assessed for cardiovascular risk were women seen by male physicians. Even before the onset of cardiovascular disease, women patients receive less satisfactory preventative management than men do, and these differences are even more marked when the physician is a man. More attention to the influence of gender stereotypes is needed in medical training in order to combat the inequalities that they cause.

Inclusion of hazardous drinking does not improve the SCORE performance in men from Central and Eastern Europe: the findings from the HAPIEE cohorts.

BackgroundThe SCORE (Systematic COronary Risk Evaluation) scale uses conventional risk factors for the prediction of the 10-year risk of fatal atherosclerotic cardiovascular disease (CVD). The high-risk version of SCORE is recommended by the European Society of Cardiology for use in the populations of Central and Eastern Europe and former Soviet Union (CEE/FSU). Given the role of hazardous alcohol consumption as an important determinant of CVD mortality in CEE/FSU men, this study investigated whether adding hazardous drinking characteristics to the high-risk SCORE improves its prognostic performance in contemporary population-based male CEE/FSU cohorts.MethodsThe HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study follows Czech (seven towns), Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002–2005. In HAPIEE men (n = 8,927), 264 atherosclerotic cardiovascular deaths were registered over the median follow-up time of 6.2-8.1 years.ResultsIn HAPIEE men, the baseline levels of the high-risk SCORE ≥5% significantly predicted fatal CVD. After controlling for the high-risk SCORE, binge drinking (drinking ≥100 g of ethanol at least once a month) and problem drinking (≥2 positive answers to CAGE questionnaire) were inconsistently associated with fatal CVD. No marked improvement in calibration and discrimination was observed for the high-risk SCORE extended by these hazardous drinking indicators, and all values of integrated discrimination improvement were <0.5%.ConclusionsExtending the high-risk SCORE by hazardous drinking parameters failed to improve its prognostic performance across male CEE/FSU population samples. Our findings tentatively support the use of the original high-risk SCORE in male CEE/FSU populations. More research is needed on the potential use of hazardous drinking in cardiovascular risk prediction.

The prognostic value of myocardial perfusion scintigraphy compared to coronary angiography in women with positive stress test results

Modern diagnostic strategy in coronary artery disease (CAD) makes it necessary not only to establish a diagnosis but also to assess the cardiovascular risk. It is not clear which strategy should be followed in the case of women with positive ECG stress test results to assess prognosis and start appropriate diagnostics and treatment.The aim of the study was to assess the prognostic value of myocardial perfusion scintigraphy in comparison with coronary angiography in women suspected of CAD and with positive ECG stress test results. The study population comprised 115 women (mean age 58.08 ± 8.8 years) suspected of CAD, with a history of chest pain and positive stress test results, who underwent myocardial perfusion scintigraphy. In 58 women coronary angiography was performed as the next step of the diagnostic procedure. All the patients were interviewed and had a physical examination, including the assessment of the cardiovascular risk in accordance with the SCORE (Systematic Coronary Risk Evaluation) scale and the probability of CAD (POST-TEST) in accordance with the ESC guidelines. The gated single photon emission computed tomography (GSPECT) with Tc-99m-MIBI was considered positive if moderate perfusion changes were observed in at least two segments or severe reversible perfusion disorders were found, regardless of the number of involved segments.The degree of coronary stenosis was assessed visually and changes greater than 50% stenosis of the luminal diameter were considered haemodynamically significant. The evaluation period covered 43.2 ± 30.8 months on average. The sensitivity of myocardial perfusion scintigraphy against cardiovascular events was 100% and the sensitivity of coronary angiography was 92.3%. The specificity was 93.1%and 88.9% respectively. The PPV of scintigraphy for cardiovascular events was 65% and of coronary angiography was 70.6%. The NPV was 100% and 97.6%respectively. The accuracy of myocardial perfusion scintigraphy for cardiovascular events was 93.9% and the accuracy of coronary angiography for cardiovascular events was 89.7%. The survival analysis confirmed the high prognostic value of SPECT and coronary angiography. However, if compared, myocardial perfusion scintigraphy was a better predictor of survival without cardiovascular events than coronary angiography was (c2 = 9.39, p < 0.01).The most important factors in assessing the cardiovascular risk in the study population included: positive result of myocardial perfusion scintigraphy, positive result of coronary angiography,and high SCORE and high POST-TEST values. Myocardial perfusion scintigraphy is superiorto coronary angiography in the prediction of necessary revascularisation procedures in women suspected of coronary artery disease and with positive stress test results.

The prognostic value of myocardial perfusion scintigraphy compared to coronary angiography in women with positive stress test results

BACKGROUND: Modern diagnostic strategy in coronary arterydisease (CAD) makes it necessary not only to establish a diagnosisbut also to assess the cardiovascular risk. It is not clearwhich strategy should be followed in the case of women withpositive ECG stress test results to assess prognosis and startappropriate diagnostics and treatment.The aim of the study was to assess the prognostic value ofmyocardial perfusion scintigraphy in comparison with coronaryangiography in women suspected of CAD and with positive ECGstress test results. MATERIAL AND METHODS: The study population comprised115 women (mean age 58.08 ± 8.8 years) suspected of CAD, witha history of chest pain and positive stress test results, who underwent myocardial perfusion scintigraphy. In 58 women coronaryangiography was performed as the next step of the diagnosticprocedure. All the patients were interviewed and had a physicalexamination, including the assessment of the cardiovascularrisk in accordance with the SCORE (Systematic Coronary RiskEvaluation) scale and the probability of CAD (POST-TEST) inaccordance with the ESC guidelines. The gated single photonemission computed tomography (GSPECT) with Tc-99m-MIBIwas considered positive if moderate perfusion changes wereobserved in at least two segments or severe reversible perfusiondisorders were found, regardless of the number of involved segments.The degree of coronary stenosis was assessed visuallyand changes greater than 50% stenosis of the luminal diameterwere considered haemodynamically significant. RESULTS: The evaluation period covered 43.2 ± 30.8 monthson average. The sensitivity of myocardial perfusion scintigraphyagainst cardiovascular events was 100% and the sensitivity ofcoronary angiography was 92.3%. The specificity was 93.1%and 88.9% respectively.The PPV of scintigraphy for cardiovascular events was 65% and ofcoronary angiography was 70.6%. The NPV was 100% and 97.6%respectively. The accuracy of myocardial perfusion scintigraphy forcardiovascular events was 93.9% and the accuracy of coronaryangiography for cardiovascular events was 89.7%. The survivalanalysis confirmed the high prognostic value of SPECT and coronaryangiography. However, if compared, myocardial perfusionscintigraphy was a better predictor of survival without cardiovascularevents than coronary angiography was (c2 = 9.39, p &lt; 0.01).The most important factors in assessing the cardiovascular riskin the study population included: positive result of myocardialperfusion scintigraphy, positive result of coronary angiography,and high SCORE and high POST-TEST values. CONCLUSIONS: Myocardial perfusion scintigraphy is superiorto coronary angiography in the prediction of necessary revascularisation procedures in women suspected of coronary arterydisease and with positive stress test results.