Systematic Coronary Risk Evaluation Research Articles

КЛИНИКО-ЛАБОРАТОРНЫЕ ХАРАКТЕРИСТИКИ ЖЕНЩИН – ПАЦИЕНТОК АМБУЛАТОРНОГО ПРИЕМА ЛИПИДОЛОГА

Introduction. Lipid metabolism disorders are one of the most important factors contributing significantly to the probability of developing cardiovascular diseases, death from coronary heart disease and mortality of the population. Aim. To identify the features of anamnestic, clinical and laboratory parameters in female patients of the lipid cabinet and to determine the frequency of detection of familial hypercholesterolemia in them. Material and methods. The study included 777 female patients of the outpatient appointment of a doctor of the lipid cabinet. The examination of patients with dyslipidemia included an examination by a cardiologist-lipidologist (with the calculation of the risk of cardiovascular complications on the Systemic COronary Risk Evaluation scale, the probability of familial hypercholesterolemia on the British Simon Broom scale and the criteria of the Dutch lipid clinics. Results and discussion. The total number of 777 patients were 63% of the total number of patients in the lipid cabinet; aged 19-90 years old, average age 58.49±9.48. The average level of total cholesterol was 7.74±1.98 mmol/l, low-density lipoprotein cholesterol 4.84±1.4 mmol/l, high-density lipoprotein cholesterol 1.46±0.44 mmol/l, triglycerides 1.61±1.42 mmol/l, non-high-density lipoprotein cholesterol 6.32±1.97 mmol/l. In 23% of patients, lipid metabolism disorders are secondary. Atherosclerosis of brachiocephalic arteries was diagnosed in 68.4% of patients, hypertension was in 41.4%. 15.1% of patients were diagnosed with atherosclerotic cardiovascular disease. Conclusions. The most significant for the development of atherosclerotic cardiovascular disease in women with lipid metabolism disorders were body mass index, burdened family history, duration of menopause and level of physical activity. Smoking, diabetes mellitus, hypertension, external signs of dyslipidemia were not associated with atherosclerotic cardiovascular diseases.

Effect of thrombocytosis on cardiovascular risk in rheumatoid arthritis

BACKGROUND: Patients with rheumatoid arthritis have a high level of comorbidity, and their most common and socially significant conditions are cardiovascular diseases, which represent a major cause of mortality. Currently, there are no data on the differences in cardiovascular risk scales in patients with rheumatoid arthritis depending on the presence or absence of thrombocytosis.
 AIM: To assess and compare cardiovascular risk according to conventional scales in patients with thrombocytosis and normal thrombocytes.
 MATERIALS AND METHODS: The study involved 85 patients diagnosed with rheumatoid arthritis: 40 with thrombocytosis [including 25 (62,5%) women] and 45 with normal thrombocytes [including 29 (64,4%) women]. The following scales were used to assess risk of cardiovascular complications: Systematic COronary Risk Evaluation with adjustment factor 1.5 (mSCORE), Reynolds Risk Score (RRS), QRESEARCH Cardiovascular Risk Algorithm (QRISK3), Assessing Cardiovascular Risk to Scottish Intercollegiate Guidelines Network / SIGN to Assign Preventative Treatment (ASSIGN).
 RESULTS: The obtained findings have demontrated that according to the mSCORE and RRS scales the patients of both groups had almost identical parameters; however, according to the ASSIGN and QRISK3 high risk of cardiovascular complications has been detected nearly twice as frequently in the patients with rheumatoid arthritis and thrombocytosis in comparison with those with normal level of thrombocytes. It is also worth noting that more frequent determination of high risk of cardiovascular complications by the QRISK3 was statistically significant.
 CONCLUSIONS: The QRISK3 calculation has shown significantly higher prevalence of high-risk cardiovascular complications among the patients with platelet counts 450 ∙ 109/l compared with those with platelet levels within the reference values. Thus, the QRISK3 scale can be considered as more informative for estimating risk of cardiovascular complications in rheumatoid arthritis.

Association of CETP Gene Polymorphisms and Haplotypes with Cardiovascular Risk.

Cholesteryl ester transfer protein (CETP) is known to influence HDL-C levels, potentially altering the profile of HDL subfractions and consequently cardiovascular risk (CVR). This study aimed to investigate the effect of five single-nucleotide polymorphisms (SNPs; rs1532624, rs5882, rs708272, rs7499892, and rs9989419) and their haplotypes (H) in the CETP gene on 10-year CVR estimated by the Systematic Coronary Risk Evaluation (SCORE), the Framingham Risk Score for Coronary Heart Disease (FRSCHD) and Cardiovascular Disease (FRSCVD) algorithms. Adjusted linear and logistic regression analyses were used to investigate the association of SNPs and 10 haplotypes (H1-H10) on 368 samples from the Hungarian general and Roma populations. The T allele of rs7499892 showed a significant association with increased CVR estimated by FRS. H5, H7, and H8 showed a significant association with increased CVR based on at least one of the algorithms. The impact of H5 was due to its effect on TG and HDL-C levels, while H7 showed a significant association with FRSCHD and H8 with FRSCVD mediated by a mechanism affecting neither TG nor HDL-C levels. Our results suggest that polymorphisms in the CETP gene may have a significant effect on CVR and that this is not mediated exclusively by their effect on TG and HDL-C levels but also by presently unknown mechanisms.

Comparison of the European and US guidelines for lipid-lowering therapy in primary prevention of cardiovascular disease.

Population-wide impacts of new guidelines in the primary prevention of atherosclerotic cardiovascular disease (ASCVD) should be explored in independent cohorts. Assess and compare the lipid-lowering therapy eligibility and predictive classification performance of 2016 and 2021 European Society of Cardiology (ESC), 2019 American Heart Association/American College of Cardiology (AHA/ACC), and 2022 US Preventive Services Task Force (USPSTF) guidelines. Participants from the CoLaus|PsyCoLaus study, without ASCVD and not taking lipid-lowering therapy at baseline. Derivation of 10-year risk for ASCVD using Systematic COronary Risk Evaluation (SCORE1), SCORE2 [including SCORE2-Older Persons (SCORE2-OP)], and pooled cohort equation. Computation of the number of people eligible for lipid-lowering therapy based on each guideline and assessment of discrimination and calibration metrics of the risk models using first incident ASCVD as an outcome. Among 4,092 individuals, 158 (3.9%) experienced an incident ASCVD during a median follow-up of 9 years (interquartile range, 1.1). Lipid-lowering therapy was recommended or considered in 40.2% (95% confidence interval, 38.2-42.2), 26.4% (24.6-28.2), 28.6% (26.7-30.5), and 22.6% (20.9-24.4) of women and in 62.1% (59.8-64.3), 58.7% (56.4-61.0), 52.6% (50.3-54.9), and 48.4% (46.1-50.7) of men according to the 2016 ESC, 2021 ESC, 2019 AHA/ACC, and 2022 USPSTF guidelines, respectively. 43.3 and 46.7% of women facing an incident ASCVD were not eligible for lipid-lowering therapy at baseline according to the 2021 ESC and 2022 USPSTF, compared with 21.7 and 38.3% using the 2016 ESC and 2019 AHA/ACC, respectively. Both the 2022 USPSTF and 2021 ESC guidelines particularly reduced lipid-lowering therapy eligibility in women. Nearly half of women who faced an incident ASCVD were not eligible for lipid-lowering therapy.

Cardiovascular risk in myositis patients compared with the general population.

We aimed to evaluate cardiovascular (CV) risk in patients with idiopathic inflammatory myopathies (IIM) compared with healthy controls (HC) and to assess its association with disease-specific features. Ninety IIM patients and 180 age-/sex-matched HC were included. Subjects with a history of CV disease (angina pectoris, myocardial infarction and cerebrovascular/peripheral arterial vascular events) were excluded. All participants were prospectively recruited and underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition. The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE) and its modifications. Compared with HC, IIM patients had a significantly higher prevalence of traditional CV risk factors, carotid artery disease (CARD), abnormal ABI and PWV. After propensity score matching (using traditional CV risk factors), the prevalence of CARD and pathological PWV remained significantly higher in IIM than HC. No significant difference in SCORE was observed. The most unfavourable CV risk profile was observed in patients with necrotizing myopathy, especially in statin-induced anti-HMGCR+ patients. The calculated CV risk scores by SCORE, SCORE2 and SCORE multiplied by the coefficient 1.5 (mSCORE) were reclassified according to CIMT and the presence of carotid plaques. SCORE was demonstrated to be most inaccurate in predicting CV risk in IIM. Age, disease activity, lipid profile, body composition parameters and blood pressure were the most significant predictors of CV risk in IIM patients. Significantly higher prevalence of traditional risk factors and subclinical atherosclerosis was observed in IIM patients compared with HC.

LIPOPROTEIN(A) IN CVR EVALUATION

Objective: High values of lipoprotein(a), related to atherosclerosis progression, are often considered a marker of thrombosis. We assessed the lipoprotein(a) profile in a group of patients with high vascular risk and no cardiovascular events, established its correlation with other cardiovascular risk factors (CVRF) and inferred the results for patients with metabolic disorders and, at least, two risk factors. Design and method: This longitudinal observational study included 516 patients, who had at least two cardiovascular risk factors and regularly attended, for at least two years, the outpatient consultations at a clinic of metabolism and vascular risk for primary prevention. Sociodemographic, clinical and anthropometric parameters were obtained at the baseline visit. Hepatic morphology was assessed in 509 patients (98.6%) by ultrasonography. The 10-year vascular risk was estimated using Framingham risk score (FRS), atherosclerotic cardiovascular disease (ASCVD) and systematic coronary risk evaluation (SCORE) tables. Results: Significant correlations were found between lipoprotein(a) levels and the addressed vascular risk factors, as well as between lipoprotein(a), and FRS, ASCVD and SCORE evaluation charts. Lipoprotein(a) values were also considerably higher in patients with steatosis. Increased lipoprotein(a) values were directly associated with all markers of cardiovascular risk and with non-alcoholic hepatic steatosis. Conclusions: Due to its high availability and low cost, lipoprotein(a) should become part of the routine evaluation of patients at vascular and should be decisive part in the calculation of vascular risk regardeless of age group.

ОЦЕНКА ПРЕДИКТОРНОЙ ВОЗМОЖНОСТИ ИСКУССТВЕННО ИНТЕЛЛЕКТУАЛЬНЫХ МЕТОДОВ В ПРОГНОЗИРОВАНИИ КАРДИОВАСКУЛЯРНЫХ СОБЫТИЙ

Introduction. Predicting the risk of cardiovascular diseases and adverse outcomes are a promising direction in medicine. Using machine learning methods to process large databases to identify new predictors and establish more complex and deeper interactions between them creates other predictive capabilities in a personalized approach to risk assessment. The new approach to improving forecasting is the ability to use artificial intelligence techniques by creating a combination of sophisticated mathematical models and algorithms under certain conditions of computational power and improved database quality. Aim. To estimate the accuracy and reliability of models based on machine learning for solving problems of cardiovascular disease risk prediction. Materials and Methods. Data from a one-stage anonymous survey of volunteers in Primorsky Krai were collected in a multicenter observational study «Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation». A total of 2 131 participants took part in the study. The main and additional predictors of cardiovascular diseases were selected for further analysis and inclusion in prediction models. Models were created and evaluated using statistical and neural network libraries of the Python programming language. The quality of the models was determined by calculating the total area under the receiver operating characteristic curve. Results and discussion. Compared to the established risk prediction algorithm by calculating the area under the receiver operating characteristic curve, machine-learning algorithms improved the prediction: random forest +1.7%, logistic regression +3.2%, neural networks +3.6%. The algorithm with the highest performance (neural networks) predicted 320 cases (sensitivity 70.2%) and 1217 non-cases (specificity 74.7%), correctly predicting 248 (+7.6%) more patients who developed cardiovascular disease compared to the established absolute cardiovascular risk calculation scale Systematic Coronary Risk Evaluation. Conclusion. The use of neural networks with multilayer perceptron, as one of the methods of layer-by-layer construction of machine learning algorithm, is the best option for creating a prognostic model and currently provides the most reliable results.

Estimation of 10-year risk of fatal and non-fatal cardiovascular disease in a portuguese population

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD) is the most common noncommunicable disease and actually the leading cause of death globally. Hence, it is important to identify individuals who may benefit from CVD preventive strategies. The European Society of Cardiology (ESC) has recently updated the European Systematic Coronary Risk Evaluation (SCORE) to SCORE2 and SCORE2-OP risk prediction algorithms. Those tools were recalibrated to four groups of countries (low, moderate, high and very high CVD risk) based on national CVD mortality rates published by the WHO, with Portugal being now considered a moderate risk country. Purpose To evaluate the application of SCORE2 and SCORE2-OP in a Portuguese population sample. Methods We conducted a cross-sectional study, including individuals aged 40-90 years, without known established Atherosclerotic Cardiovascular Disease, Diabetes mellitus, Chronic Kidney Disease or Familial Hypercholesterolemia. The sample was recruited at a local cardiovascular screening event in Portugal that took place in May 2022. The 10-year fatal and non-fatal CVD risk was calculated using SCORE2 (for individuals aged < 70 years) and SCORE2-OP (for individuals aged ≥ 70 years) tools. Based on CVD risk category, patients were stratified into 3 categories: low to moderate, high and very high risk according to new SCORE algorithms. Primary outcome was the assessment of 10-year risk of fatal and non-fatal CVD with SCORE2 e SCORE2-OP in a local Portuguese population. According to the data distribution, appropriate statistical tests were conducted to compare independent samples. Multivariable linear regression was used to analyze 10-year CVD risk. Results This cohort included 431 individuals. Median age was 71 years (Q1-Q3: 65-75) and 66.8% of individuals were women. Regarding baseline characteristics of the included individuals, 48.1% had hypertension, 38.3% had dyslipidemia, 25.5% were obese and 6.6% were smokers. Based on the SCORE2 model 92 (26.1%) individuals were classified into low to moderate risk, 162 (46.0%) into high risk and 98 (27.8%) into very high-risk category. SCORE2 median was 3.43 % (Q1-Q3: 5.5-8.0 p< 0.01) and SCORE2-OP median was 12.70 % (Q1-Q3: 9.7-12.7). Active smoking was the only independent predictor of 10-years CVD risk both in SCORE2 (RR 3.28, 95% CI: 1.93-4.66, p=0.001) and SCORE2-OP (RR 6.31, 95% CI: 2.67-9.52, p<0.001). Conclusions Most individuals in this sample were stratified into high or very high risk of developing 10-year fatal and non-fatal cardiovascular events. This data is in accordance with the updated risk category of Portugal based on World Health Organization cardiovascular mortality rates. These results not only validate the application of SCORE to the Portuguese setting, but also reinforce how this easily applicable tool can help to identify patients who will benefit from CVD preventive strategies.

External validation of Systematic COronary Risk Evaluation 2 - Older Persons (SCORE2-OP) in the EPIC-Norfolk prospective population study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): EPIC Norfolk was supported by the Medical Research Council UK (programme grants numbers MRC G0401527, MRC G0701863, MRC G1000143) and Cancer Research UK (programme grant number CRUK 8257). Introduction The Systematic COronary Risk Evaluation 2 – Older Persons (SCORE2-OP) algorithm is developed to assess 10-year risk of fatal and non-fatal cardiovascular disease (CVD) in apparently healthy individuals aged ≥70 years. We evaluated the performance of SCORE2-OP in the European Prospective Investigation of Cancer Norfolk (EPIC-Norfolk) prospective population cohort. Purpose To validate the SCORE2-OP model in men and women aged 70-80 years without prior myocardial infarction or stroke. Methods We included individuals aged 70-80 without prior myocardial infarction or stroke. We compared SCORE2-OP (low-risk algorithm) calculated 10-year risk with 10-year observed event rates in the EPIC-Norfolk cohort. SCORE2-OP was calculated using baseline EPIC-Norfolk data (1993-1997). Cardiovascular events were defined as a composite outcome of (i) death due to ischemic heart disease, cardiac failure, cerebrovascular disease or peripheral-artery disease, (ii) non-fatal myocardial infarction or (iii) non-fatal stroke. Observed rates were adjusted for competing fatal events. We evaluated discriminative power using C-statistic and calibration by plotting predicted versus observed event rates and calculating the observed/predicted ratios. Results SCORE2-OP was evaluated in 3,712 individuals (54% women) with a median (IQR) age of 73 (72-75) years. Ten-year SCORE2-OP was 10.3% (95% confidence interval (CI) 10.2-10.4) versus observed CVD of 16.8% (95% CI 15.6-18.0), yielding a ratio of 1.6 (95% CI 1.5-1.7). Observed events consisted of 9.4% (95% CI 8.4-10.3) fatal CVD events, 10.6% (95% CI 9.6-11.5) non-fatal myocardial infarctions, 10.5% (95% CI 9.5-11.5) non-fatal strokes, adjusted for 68.9% (95% CI 67.4-70.4) competing mortality events. C-statistic was 0.60 (95% CI 0.58-0.63), with a calibration plot demonstrating underestimation of risk across sex and risk groups.(Figure). Conclusion SCORE2-OP underestimates risk in individuals aged 70-80 years, and demonstrates suboptimal discriminative ability. However some underestimation of risk is to be expected given the EPIC-Norfolk baseline between 1993-1997, a low SCORE2-OP calculated risk should not be used as a standalone argument to withhold preventive efforts in older individuals.

Spatial analysis of 10-year predicted risk and incident cardiovascular atherosclerotic diseases in a swiss urban population

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Swiss National Science Foundation GlaxoSmithKline. Introduction Whether cardiovascular risk score geographically aggregates and informs on spatial development of atherosclerotic cardiovascular disease (ASCVD) remains unknown. Aims We first determined the spatial distribution of cardiovascular risk predicted in an urban population. Second, we compared risk maps with clustering of incident ASCVD over a 10-year follow-up. Sensitivity analyses were conducted to identify explanatory risk factors for both clusters of predicted risk and observed ASCVD. Methods Using data from a population-based cohort study, we computed the Systematic Coronary Risk Evaluation Score 2 (SCORE2 and SCORE2-OP) in participants free from ASCVD at baseline (2003-2006). Geographical distributions of predicted risk and incident ASCVD were determined using global and local spatial autocorrelation statistics. Different models were tested to identify explanatory variables (alcohol consumption, body mass index, socio-economic status, anxiety disorder, major depressive disorder, Mediterranean diet, sport activity, polygenic risk score, mean noise, concentration of PM2.5, normalized difference vegetation index, land surface temperature). Results 6203 individuals (56% women, mean age 52.5 ± SD 10.7) with a median follow-up of 10 years (IQR, 6-10) were included in the analyses. Over the period, there was persistent geographical clustering of predicted risk and ASCVD (Figures 1 and 2). Predicted risk and incident ASCVD marginally overlapped spatially. Body-mass index (BMI) and alcohol consumption explained most of the spatial distribution of predicted risk, reducing high-risk clusters from 286 to 5 and low-risk clusters from 391 to 44. For ASCVD, high clusters either persisted or were reinforced depending upon locations, after adjustment for potential risk factors, with an increase from 100 to 118. Low clusters reduced from 293 to 76 after the adjustment. Incidence rate of ASCVD was 2.5% (IC95%, 3.7-2.4%]) in high-risk clusters compared to the rest of the population. Conclusions Using a population-based cohort, we showed that in an urban area there exists clusters of high and low incidence of ASCVD. Geographical distribution of clusters of high clinical risk score was not congruent with that of incident ASCVD, limiting the use of clinical risk scores in identifying areas where ASCVD may develop.

Performance of the Systematic COronary Risk Evaluation 2 (SCORE2) in the EPIC-Norfolk prospective population study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): EPIC-Norfolk is supported by programme grants from the Medical Research Council UK (MRC G0401527, MRC G0701863, MRC G1000143) and Cancer Research UK (CRUK 8257). Introduction The latest European guidelines recommend the use of the Systematic COronary Risk Evaluation 2 (SCORE2) to assess 10-year risk of fatal and non-fatal cardiovascular disease (CVD) in individuals aged 40-70 years. Therefore, validation of the SCORE2 algorithm in a large population is needed. Purpose To assess the predictive performance of SCORE2 in individuals without prior myocardial infarction, stroke or diabetes mellitus. Methods Individuals aged 40-70 without prior myocardial infarction, stroke or diabetes mellitus were included from the European Prospective Investigation of Cancer Norfolk (EPIC-Norfolk) prospective population cohort. We assessed discriminative power using the C-statistic; calibration was assessed by plotting calculated SCORE2 (low-risk algorithm) 10-year risks against observed CVD event rates. We defined the composite cardiovascular outcome as death due to ischemic heart disease, cardiac failure, cerebrovascular disease or peripheral-artery disease, or non-fatal myocardial infarction or non-fatal stroke. Observed probabilities were adjusted for competing mortality events. Results We included 20,318 individuals (56% women) with a median (IQR) age of 56 (50-63) years, with baseline measures between 1993-1997. Mean predicted 10-year risk was 3.7% (95% confidence interval (CI) 3.7-3.8) versus adjusted observed 4.2% (95% CI 3.9-4.5) 10-year CVD incidence, yielding a ratio of 1.1 (95% CI 1.1-1.2).(Figure) Observed events consisted of 1.5% (95% CI 1.3-1.7) fatal CVD events, 1.8% (95% CI 1.6-2.0) non-fatal myocardial infarctions, 1.5% (95% CI 1.3-1.6) non-fatal strokes and 23.4% (95% CI 22.1-23.2) competing mortality events. Overall C-statistic was 0.75 (95% CI 0.73-0.77). Conclusion SCORE2 demonstrates reasonable discriminative ability and accurate risk estimations in low-risk individuals in a large, prospective population cohort. However, as actual CVD incidence is expected to be lower given the baseline between 1993-1997, these findings do not indicate that SCORE2 is suitable for current use for risk assessment in individuals from the United Kingdom.

Effectiveness of SCORE2 and ASCVD Risk Scores in Combination With Aortic Arch Calcification on Chest Radiograph in Predicting Significant Coronary Artery Disease.

The present study evaluated 10-year atherosclerotic cardiovascular disease (ASCVD) risk using ASCVD and Systematic Coronary Risk Evaluation (SCORE2) risk models in combination with aortic arch calcification (AAC) to identify those at high risk for significant coronary artery disease (CAD) in patients undergoing coronary angiography. Of the 402 patients enrolled, 48 had normal coronary angiograms and served as group 1. The 131 patients with CAD with stenosis of <70% as group 2 and 223 patients with CAD with stenosis of ≥70% as group 3. ASCVD and SCORE2 risk scores, and the presence of AAC differed significantly among these groups. For prediction of significant CAD, the area under the curve (AUC) of ASCVD and SCORE2 risk scores in receiver operating characteristic (ROC) curve analysis were statistically similar ([AUC: .647, P < .001] and [AUC: .654, P < .001], respectively). When AAC was added to ASCVD risk and SCORE2, it increased their predictive value for significant CAD in the ROC curve analysis (P = .003, and P = .019, respectively). In addition, significant net reclassification improvement (NRI) values were obtained by adding AAC to ASCVD and SCORE2 risk models ([NRI = .10, P = .04], and [NRI = .19, P = .04], respectively). These results suggest that the predictive value of ASCVD and SCORE2 increases when AAC is combined.

Cumulative tobacco consumption has a dose-dependent effect on atheromatosis burden and improves severe atheromatosis prediction in asymptomatic middle-aged individuals: The ILERVAS study

Background and aimsSex-specific impact of cumulative tobacco consumption (CTC) on atheromatosis extension and total plaque area remains unknown. We aimed to determine the impact of CTC in atheromatosis localization and burden. MethodsWe performed a cross-sectional analysis in 8330 asymptomatic middle-aged individuals. 12-territory vascular ultrasounds in carotid and femoral arteries were performed to detect atheromatous plaque presence and to measure total plaque area. Adjusted regressions and conditional predictions by smoking habit or CTC (stratified in terciles as low (≤13.53), medium (13.54–29.3), and high (>29.3 packs-year)) were calculated. Severe atheromatosis (SA, ≥3 territories with atheroma plaque) was predicted with the Systematic COronary Risk Evaluation 2 (SCORE2) model. The improvement of SA prediction after adding CTC was evaluated. ResultsCTC was associated with an increased risk of atheromatosis, stronger in femoral than in carotid artery, but similar in both sexes. A dose-dependent effect of CTC on the number of territories with atheroma plaque and total plaque area was observed. Addition of CTC to the SCORE2 showed a higher sensitivity, accuracy, and negative predictive value in males, and a higher specificity and positive predictive value in females. In both sexes, the new SCORE2-CTC model showed a significant increase in AUC (males: 0.033, females: 0.038), and in the integrated discrimination index (males: 0.072; females: 0.058, p < 0.001). Age and CTC were the most important clinical predictors of SA in both sexes. ConclusionsCTC shows a dose-dependent association with atheromatosis burden, impacts more strongly in femoral arteries, and improves SA prediction.

The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk.

Framingham risk score (FRS), systematic coronary risk evaluation (SCORE), the 10-year atherosclerotic cardiovascular disease risk algorithm (ASCVD), and their modified risk scores are the most common cardiovascular risk scores. The aim of this case-control study was to evaluate the performance of cardiovascular risk scores in detecting carotid subclinical atherosclerosis (SCA) in patients with idiopathic inflammatory myopathies (IIMs). A total of 123 IIMs patients (71.5% female, mean age 50 ± 14 years) and 123 age- and gender-matched healthy controls were included in this study. Carotid SCA was more prevalent in IIMs patients compared with controls (77.2 vs 50.4%, P < 0.001). Moreover, patients with carotid SCA+ had older age, and all risk scores were significantly higher in IIMs patients with SCA+ compared to subjects with SCA- (all P < 0.001). According to FRS, SCORE, and ASCVD risk scores, 77.9, 96.8, and 66.7% patients with SCA+ were classified as low risk category, respectively. The modified scores also demonstrated a modest improvement in sensitivity. Notably, by adopting the optimal cutoff values, these risk scores had good discrimination on patients with SCA+, with area under curves of 0.802-0.893. In conclusion, all cardiovascular risk scores had a poor performance in identifying IIMs patients at high cardiovascular risk.

Multislice CT coronary angiography and coronary artery calcium scoring, correlation with Heart Score

BackgroundCoronary atherosclerosis is the number one leading cause of death. According to estimates, if all primary cardiovascular diseases (CVDs) had been eradicated, life expectancy could increase by nearly seven years. Long asymptomatic latent phases of coronary heart disease allow for early preventive measures. Egypt has a high prevalence of premature Coronary Artery Disease (CAD).Aim of studyWe aimed to evaluate the correlation between the cardiovascular risk assessed by the Systematic COronary Risk Evaluation (HeartScore) and Coronary Artery Calcium Score (CACS) versus the actual extent of atherosclerotic CAD affection among a sample of Egyptian patients assessed by Multislice Computed Tomography (MSCT) due to chest pain complaints.MethodsAn observational cross section study included one hundred studied cases: aged 40 to 69 years old, of which 63% were males, 63% were hypertensive, 39% were diabetic, and 28% were smokers. Those patients presented with symptoms suggestive of coronary artery disease (chest pain). All studied cases had been subjected to history and examination, electrocardiograph (ECG), kidney functions, lipid profile, SCORE calculation, and coronary MSCT scan.ResultsOur observational study found a moderately significant positive relationship between the HeartScore and CACS and CAD; having a higher score carries a higher probability of having CAD. Having a very low score is a good negative test for exclusion. Also, there is a weak relationship between HeartScore, CACS, and the number of diseased coronaries, i.e. these cannot differentiate single vessel disease (SVD) from Multivessel Disease (MVD). In addition, both scores could not determine Obstructive Coronary Artery Disease (OCAD) and Nonobstructive Coronary Artery Disease (Non-OCAD).ConclusionsFrom the clinical point of view, our research suggests that HeartScore and CACS have moderate value in predicting CAD.

High-quality annotations for deep learning enabled plaque analysis in SCAPIS cardiac computed tomography angiography

BackgroundPlaque analysis with coronary computed tomography angiography (CCTA) is a promising tool to identify high risk of future coronary events. The analysis process is time-consuming, and requires highly trained readers. Deep learning models have proved to excel at similar tasks, however, training these models requires large sets of expert-annotated training data. The aims of this study were to generate a large, high-quality annotated CCTA dataset derived from Swedish CArdioPulmonary BioImage Study (SCAPIS), report the reproducibility of the annotation core lab and describe the plaque characteristics and their association with established risk factors. Methods and resultsThe coronary artery tree was manually segmented using semi-automatic software by four primary and one senior secondary reader. A randomly selected sample of 469 subjects, all with coronary plaques and stratified for cardiovascular risk using the Systematic Coronary Risk Evaluation (SCORE), were analyzed. The reproducibility study (n = 78) showed an agreement for plaque detection of 0.91 (0.84–0.97). The mean percentage difference for plaque volumes was −0.6% the mean absolute percentage difference 19.4% (CV 13.7%, ICC 0.94). There was a positive correlation between SCORE and total plaque volume (rho = 0.30, p < 0.001) and total low attenuation plaque volume (rho = 0.29, p < 0.001). ConclusionsWe have generated a CCTA dataset with high-quality plaque annotations showing good reproducibility and an expected correlation between plaque features and cardiovascular risk. The stratified data sampling has enriched high-risk plaques making the data well suited as training, validation and test data for a fully automatic analysis tool based on deep learning.

Comorbidity Profile and Predictors of Obstructive Sleep Apnea Severity and Mortality in Non-Obese Obstructive Sleep Apnea Patients.

Backgrounds and Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality. OSA is an independent risk factor for many different conditions, especially cardiovascular diseases. The purpose of this study was to ascertain the comorbidity profile of non-obese patients with newly diagnosed OSA and evaluate the risk for cardiovascular disease and mortality. The present study also aimed to establish predictors for OSA severity. Materials and Methods: This study included 138 newly diagnosed patients who underwent polysomnographic analysis. The 10-year risk for cardiovascular disease was assessed using a newly validated prediction model: Systematic Coronary Risk Evaluation (SCORE-2). In addition, the Charlson Comorbidity Index (CCI) was assessed as a widely-used example of a mortality comorbidity index. Results: The study population included 138 patients: 86 males and 52 females. Patients were stratified, according to AHI (apnea/hypopnea index), into four groups: 33 patients had mild OSA (5 ≤ AHI < 15), 33 patients had moderate OSA (15 ≤ AHI < 30), 31 patients had severe OSA (AHI ≥ 30), and 41 individuals had AHI < 5, which were a part of the control group. SCORE-2 increased in line with OSA severity and was higher in OSA groups compared to the control group (H = 29.913; DF = 3; p < 0.001). Charlson Index was significantly higher in OSA patients compared to controls (p = 0.001), with a higher prevalence of total comorbidities in the OSA group of patients. Furthermore, CCI 10-year survival score was significantly lower in the OSA group, suggesting a shorter survival of those patients with a more severe form of OSA. We also examined the prediction model for OSA severity. Conclusions: Determining the comorbidity profile and estimation of the 10-year risk score of OSA patients could be used to classify these patients into various mortality risk categories and, according to that, provide them with adequate treatment.

Cardiovascular profile of patients with type 2 Diabetes

The diabetic patient is a subject at high cardiovascular risk. Accurate determination of cardiovascular risk requires reliable tools to implement preventive measures. Can risk equations, and in particular the SCORE (Systematic Coronary Risk Evaluation) equation, still be of interest in assessing the risk of the type 2 diabetic patient in the face of new methods such as the coronary calcium score? The objective of the work is to determine the cardiovascular profile of type 2 diabetic patients through Score. Material and methods: Observational and descriptive study involving 176 type 2 diabetic patients conducted during the month of April 2021. All of them benefited from a clinical examination, a metabolic, degenerative and cardiovascular risk calculation according to the Score. Results: The average age is 58.7 years with extremes of 28 to 85 years. A female predominance was noted (74.4%) with a sex ratio of 0.3. The average duration of diabetes evolution is 8.84 years with extremes ranging from 1 month to 44 years. 57.1% of patients were on oral treatment, versus 36.3% on insulin and 6.5% on diabetic diet only. Glycemic imbalance exists in more than 62% (estimated by HbA1c). The other associated risk factors found are: hypertension (56%), obesity and overweight (82.1%), smoking (12%) and sedentary lifestyle (60.7%), dyslipidemia was found in 66 patients (56.5%); 89.6% of women were menopausal. Microangiopathic complications are noted in 60.7% of cases: nephropathy (38.2%), retinopathy (33.3%), neuropathy (59.8%). Macroangiopathic complications affect 23.2%. In our population, 67.3% have a very high cardiovascular risk (&gt; 10%) according to the SCORE. Conclusion: Type 2 diabetic patients are already at high cardiovascular risk. The seriousness of cardiovascular complications in diabetic patients reflects the importance of assessing their cardiovascular risk and of comprehensive management integrating the various risk factors. The Score remains an important and simple tool for estimating cardiovascular risk in patients with type 2 diabetes.

Cardiovascular Risk, Risk Knowledge, and Related Factors in Patients

Objective: The aim of this study was to investigate cardiovascular risk, risk knowledge, and related factors in patients. Method: The descriptive and corelational study was carried out with 340 patients who applied to the state hospital between November 2018 and March 2019 and agreed to participate in the study. Data was collected through face-to-face interviews with the scale of the Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) and Systematic Coronary Risk Evaluation (SCORE) Calculator. Results: In the study, it was found that patients were in the middle risk group in terms of cardiovascular risk, and their risk information level was slightly higher than the average. There was no statistically significant relationship between the level of knowledge of patients and the level of cardiovascular risk (r= -.062, p=.256). Conclusion: The study emphasises that initiatives should be developed to increase awareness of cardiovascular disease risks in Turkey and to increase the level of cardiovascular disease risk information available in order to prevent diseases. Preventative strategies can reduce the risk of cardiovascular disease and improve outcomes. Nurses should assess risk knowledge in patients to ensure best outcomes.

Cardiovascular risk profiles in patients with inflammatory bowel disease differ from matched controls from the general population.

Inflammatory bowel disease (IBD) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). We compared cardiovascular disease (CVD) risk factors and 10-year risk in IBD patients to the general population. In this cross-sectional study, consecutive IBD patients ≥45 years were included. History of ASCVD and CVD risk factors (smoking, hypertension, overweight, hypercholesterolaemia, diabetes, and metabolic syndrome) were assessed. The Systematic COronary Risk Evaluation (SCORE2) algorithm was used to estimate 10-year CVD risk. One to four age/sex-matched controls were derived from the prospective population-based Rotterdam Study cohort. In total, 235 IBD patients were included {56% women, median age 59 years [interquartile range (IQR) 51-66]} and matched to 829 controls [56% women, median age 61 years (IQR 56-67)]. Inflammatory bowel disease patients experienced ASCVD events more often compared with matched controls [odds ratio (OR) 2.01, 95% confidence interval (CI) 1.23-3.27], specifically heart failure (OR 2.02, 95% CI 1.02-4.01) and coronary heart disease (OR 2.01, 95% CI 1.7-3.13). Inflammatory bowel disease patients showed lower odds of overweight (OR 0.48, 95% CI 0.35-0.66) and hypercholesterolaemia (OR 0.45, 95% CI 0.31-0.65) and higher odds of hypertension (OR 1.67, 95% CI 1.19-2.32), as well as higher waist circumference (+4 cm, P = 0.006) and triglyceride levels (+0.6 mmol/L, P < 0.001) as compared with controls. Mean 10-year CVD risk was 4.0% [standard deviation (SD) ±2.6] in 135 IBD patients vs. 6.0% (SD ±1.6) in 506 controls. The increased CVD risk in IBD is discrepant with the 10-year CVD risk estimate. Systematic COronary Risk Evaluation may underestimate CVD risk in IBD patients due to differing CVD risk profiles compared with the general population, including a lower prevalence of hypercholesterolaemia and overweight and a higher prevalence of hypertension, abdominal obesity, and hypertriglyceridaemia.