Total Cardiovascular Risk Estimation Research Articles

Cross‐sectional association between cardiovascular risk score and cognitive performance in middle‐aged UK Biobank participants

AbstractBackgroundCardiovascular diseases (CVD) have been linked with faster cognitive decline and incident dementia. The actual risk factors for CVD also tie to these adverse cognitive consequences in elderly adults. The cardiovascular risk score (CRS) provides direct estimation of total cardiovascular risk that suits well to the constraints of primary prevention. Further data especially in larger populations are required to examine whether CRS is also associated with cognitive performance in middle age.MethodsWe evaluated data from 420,381 participants [aged 37‐73 (mean: 55.9; SD: 8.1) years old; female: 234,464 (55.8%)] in the UK Biobank who were free from dementia and circulatory system diseases at enrollment. Four neurocognitive tests were administered to assess cognition in different domains, i.e., information processing speed (reaction time test, RT), visual episodic memory (pairs matching test, pairs), reasoning (fluid intelligence test, FI), and prospective memory (PM). Longer RT, making more errors during pairs test, lower FI, or making incorrect first choice during PM indicates poorer cognitive performance. To estimate CRS, we applied the 10‐year risk of fatal CVD estimation—the SCORE system—that is based on age, sex, systolic blood pressure, total cholesterol level, and current smoking status. Linear regression models (or logistic regression for PM) examined the associations of CRS with each cognitive outcome, with adjustment for ethnicity, college, social‐economic status, mental and behavioral disorders, diseases of the nervous system, and number of treatments/medications. Sensitivity analyses were done 10 times with randomly chosen subsets of 1/10 participants.ResultsThe cohort had a median 10‐year risk of 2.51% (inter‐quantile range: 1.02%‐4.84%; range: 0.08%‐74.3%) in developing fatal CVD. Increased CRS was associated with worse cognitive performance. Specifically, compared with those with CRS<5%, participants with CRS≥5%(higher CVD risk) took 1 ms longer in RT, made 1 more mistake in pairs test, had lower FI score by 0.27, and had 31.4% lower chance of making the correct choice during PM (all p’s<1E‐93). These observations were consistent across 10 sensitivity analyses.ConclusionIncreased cardiovascular risk during middle life is associated with poorer cognitive performance. Further studies are required to examine whether cardiovascular risk predicts future cognitive decline or dementia.

European Society of Cardiology / European Atherosclerosis Society 2019 Dyslipidemia Treatment Guideline: What Has Changed?

After 3 years, European Society of Cardiology and the European Atherosclerosis Society published the new guideline for the management of dyslipidemias on August 2019. Comparing with the 2016 version, based on the latest prospective studies, randomized trials and Mendelian randomization studies, there are major changes in the recommendations; especially in the areas of total cardiovascular risk estimation, treatment targets and management of treatment, focusing on the combination therapy. Aforementioned studies indicated that it is possible to prevent atherosclerotic cardiovascular diseases by reducing low density lipoprotein cholesterol as early as and as much as possible since there is a correlation between the concentration of low density lipoprotein cholesterol in the blood and the risk of atherosclerotic cardiovascular diseases. In the light of those information the recommendation for patients at very high risk was changed as a low density lipoprotein cholesterol goal of Keywords: dyslipidemia, guidelines, risk assessment, LDL cholesterol

Estimation of total cardiovascular risk using the 2019 WHO CVD prediction charts and comparison of population-level costs based on alternative drug therapy guidelines: a population-based study of adults in Bangladesh

ObjectiveThe objective of this study was to estimate the population distribution of 10-year cardiovascular disease (CVD) risk among Bangladeshi adults aged 40 years and above, using the 2019 WHO CVD...

Nouvelles recommandations sur la prise en charge des dyslipidémies: Comparaison des recommandations françaises de la HAS et des recommandations européennes ESC/EAS

Total cardiovascular risk estimation using a system such as SCORE is recommended for adults>40years of age without evidence of cardiovascular disease, diabetes, chronic kidney disease, severe hypertension or familial hypercholesterolemia. Before treatment, a full lipid profile is recommended, fasting in French guidelines, fasting or non-fasting in European guidelines. LDL-C has to be used as the primary target for treatment. For patients with elevated triglycerides, non-HDL-C level is also recommended as the secondary goal for treatment. In patients at very high and high cardiovascular risk, LDL-C goals are respectively below<0.70g/L and<1.0g/L. For subjects at very high and high cardiovascular risk, French guidelines do not mention that a≥50% reduction in LDL-C should be achieved. Statins are the treatment of choice to reach LDL-C goals. If the goal is not reached on maximally tolerated dose of statin, combination with another LDL lowering drug, mainly ezetimibe, is recommended. Fibrates are mainly proposed for patients with severe hypertriglyceridemia (TG>5g/L after lifestyle changes).

The Association of Elevated HDL Levels With Carotid Atherosclerosis in Middle-Aged Women With Untreated Essential Hypertension.

High-density lipoprotein cholesterol (HDL-C), a negative risk factor, is positively associated with a decreased risk of coronary heart disease. We investigated the association between high HDL-C levels and target organ damage (TOD) in never treated women with hypertension. We measured HDL-C levels in 117 women followed by estimation of TODs, that is, pulse wave velocity, microalbuminuria, left ventricular mass index, coronary flow reserve, and carotid intima-media thickness (cIMT). Women were divided into 2 groups (HDLH and HDLL), regarding HDL-C quartiles (upper quartile vs the first 3 lower quartiles). In HDLH group : HDL ≥70 mg/dL), cIMT was nonindependently, negatively related to HDL-C (ρ = -.42, P < .05). Using receiver -operating characteristic curve (ROC) analysis in the HDLH group, we concluded that the cutoff value of HDL ≥76.5 mg/dL moderately predicted the absence of carotid atherosclerosis (area under the curve: 0.77, P = .02; confidence interval: 0.57-0.97; sensitivity 73% and specificity 67%). Increased HDL-C may predict the absence of carotid atherosclerosis in middle-age women with untreated essential hypertension and consequently contribute to total cardiovascular risk estimation and treatment planning.

Серцево-судинний ризик та коморбідність – гострі проблеми погіршання стану здоров’я суспільства

The aim of the work was to evaluate the epidemiological situation of major chronic non-communicable diseases and risk factors, taking into account comorbidity in organized and unorganized population of Kharkiv region. Now, in the world of medical practice, the comorbidity not only acts as a global problem and determines the individual prognosis for each patient (duration and quality of life, functionality, disability and mortality), but also has a major social impact at the population level. We have carried out an analysis of quality of life, conducted a retrospective evaluation of the dynamics and the identification of comorbidity in hospitalized patients with increased cardiovascular risk. The investigation of organized youth population, defined biochemical criteria have important prognostic value and the ability to assess the additional ethio factors that form atherosclerotic vascular lesions with comorbid diseases and conditions, the effectiveness of antihypertensive and lipid-lowering therapy, and adherence to treatment in patients with high cardiovascular risk. Estimation of total cardiovascular risk, taking into account comorbidity is a leading task, due to the fact that hypertension - a major risk factor modified, with proven dependent increase in blood pressure and an increase in the risk of nonfatal and fatal events as well as the rapid progression of cardiorenal disease. However, even in a group of healthy individuals among young people, there are risk factors (eg, lack of exercise, poor nutrition, excessive psycho-emotional stress, passive smoking), which require urgent measures to lifestyle modifications

Should non-cardiovascular mortality be considered in the SCORE model? Findings from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort.

Competing non-cardiovascular related deaths were not accounted for in the Systematic COronary Risk Evaluation (SCORE) model. In this study we assessed the impact of non-cardiovascular related deaths on the prognostic performance and yield of the SCORE model. 5,752 participants from the Prevention of Renal and Vascular End stage Disease cohort aged 40 years and older who were free of atherosclerotic cardiovascular disease (CVD) at baseline were included. A cause-specific hazards (CSH) CVD-related mortality prediction model that accounted for non-CVD-related deaths was developed. The prognostic performance of this model was then compared with a refitted SCORE model. During a median follow-up period of 12.5 years, 139 CVD and 495 non-CVD-related deaths were reported. Discriminatory performance was comparable between the models (C-index = 0.64). The models showed good calibration although the CSH model underestimated risk in the highest decile while the refitted SCORE model showed overestimation. The CSH model classified more non-events into the low risk group compared to the refitted SCORE model (n = 51), yet it was accompanied by a misclassification of six events into the low risk group. The refitted SCORE model classified more individuals as high risk. However, the potential overtreatment that may result from utilizing the refitted SCORE model, when compared with the CSH model, still falls within acceptable limits. Our findings do not support the incorporation of non-cardiovascular mortality into the estimation of total cardiovascular risk in the SCORE model.

La ecuación ERICE: la nueva ecuación autóctona de riesgo cardiovascular para una población mediterránea envejecida y de bajo riesgo en España

Introduction and objectivesIn Spain, data based on large population-based cohorts adequate to provide an accurate prediction of cardiovascular risk have been scarce. Thus, calibration of the EuroSCORE and Framingham scores has been proposed and done for our population. The aim was to develop a native risk prediction score to accurately estimate the individual cardiovascular risk in the Spanish population. MethodsSeven Spanish population-based cohorts including middle-aged and elderly participants were assembled. There were 11 800 people (6387 women) representing 107 915 person-years of follow-up. A total of 1214 cardiovascular events were identified, of which 633 were fatal. Cox regression analyses were conducted to examine the contributions of the different variables to the 10-year total cardiovascular risk. ResultsAge was the strongest cardiovascular risk factor. High systolic blood pressure, diabetes mellitus and smoking were strong predictive factors. The contribution of serum total cholesterol was small. Antihypertensive treatment also had a significant impact on cardiovascular risk, greater in men than in women. The model showed a good discriminative power (C-statistic = 0.789 in men and C = 0.816 in women). Ten-year risk estimations are displayed graphically in risk charts separately for men and women. ConclusionsThe ERICE is a new native cardiovascular risk score for the Spanish population derived from the background and contemporaneous risk of several Spanish cohorts. The ERICE score offers the direct and reliable estimation of total cardiovascular risk, taking in consideration the effect of diabetes mellitus and cardiovascular risk factor management. The ERICE score is a practical and useful tool for clinicians to estimate the total individual cardiovascular risk in Spain.Full English text available from:www.revespcardiol.org/en

The ERICE-score: the New Native Cardiovascular Score for the Low-risk and Aged Mediterranean Population of Spain

Introduction and objectivesIn Spain, data based on large population-based cohorts adequate to provide an accurate prediction of cardiovascular risk have been scarce. Thus, calibration of the EuroSCORE and Framingham scores has been proposed and done for our population. The aim was to develop a native risk prediction score to accurately estimate the individual cardiovascular risk in the Spanish population. MethodsSeven Spanish population-based cohorts including middle-aged and elderly participants were assembled. There were 11800 people (6387 women) representing 107915 person-years of follow-up. A total of 1214 cardiovascular events were identified, of which 633 were fatal. Cox regression analyses were conducted to examine the contributions of the different variables to the 10-year total cardiovascular risk. ResultsAge was the strongest cardiovascular risk factor. High systolic blood pressure, diabetes mellitus and smoking were strong predictive factors. The contribution of serum total cholesterol was small. Antihypertensive treatment also had a significant impact on cardiovascular risk, greater in men than in women. The model showed a good discriminative power (C-statistic=0.789 in men and C=0.816 in women). Ten-year risk estimations are displayed graphically in risk charts separately for men and women. ConclusionsThe ERICE is a new native cardiovascular risk score for the Spanish population derived from the background and contemporaneous risk of several Spanish cohorts. The ERICE score offers the direct and reliable estimation of total cardiovascular risk, taking in consideration the effect of diabetes mellitus and cardiovascular risk factor management. The ERICE score is a practical and useful tool for clinicians to estimate the total individual cardiovascular risk in Spain.

New risk markers for cardiovascular prevention.

The importance of total cardiovascular (CV) risk estimation before management decisions are taken is well established. Models have been developed that allow physicians to stratify the asymptomatic population in subgroups at low, moderate, high, and very high total CV risk. Most models are based on classical CV risk factors: age, gender, smoking, blood pressure, and lipid levels. The impact of additional risk factors is discussed here, looking separately at the predictive increments of novel biomarkers and of indicators of subclinical atherosclerotic disease. The contribution of biomarkers to the total CV risk estimation is generally modest, and their usage should be limited to subjects at intermediate total CV risk. Detection of subclinical vascular damage may improve total CV risk estimation in asymptomatic subjects who are close to a threshold that could affect management decisions and in whom the chances of re-classification in a different risk category are great. There is, however, an urgent need for trials in which the value of using total CV risk estimation models is tested.

Application of Total Cardiovascular Risk Estimation in The Management of A Patient with Cardiovascular Risk

Medical intervention based on the concept of total coronary risk in the asymptomatic population without cardiovascular disease (CVD) is widely advocated throughout the world.All adults above 40 years, without history of CVD or diabetes, and who are not on treatment for blood pressure (BP) or lipids, should be considered for a comprehensive risk assessment in primary care once every five years. Our patient is an asymptomatic obese, hypertensive, dyslipidaemic individual who is also a smoker. He has a family history of premature atherosclerotic disease. His co-morbidities include mild asthma and hepatic impairment. His estimated total cardiovascular risk according to Joint British Society risk score1 for 10 year cardiovascular event is 40% which qualifies him in the high risk category.His estimated score according to HEART score based on the SCORE project2 is 7% which refers to a 10-year risk mortality. According to HEARTSCORE, a score of more than 5 is considered to be at high risk. The following discussion aims to cut down his cardiovascular risk by having life-style changes and use of cardioprotective medication where appropriate. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10207 UHJ 2011; 7(1): 28-34

Effect of eprosartan-based therapy on systolic blood pressure and total cardiovascular risk in a large international population: preliminary report of the observational POWER study

Background:Estimation of total cardiovascular risk is useful for developing preventive strategies for individual patients. The POWER (Physicians’ Observational Work on Patient Education According to their Vascular Risk) survey, a 6-month, open-label, multinational, post-marketing observational evaluation of eprosartan, an angiotensin II receptor blocker, was undertaken to assess the efficacy and safety of eprosartan-based therapy in the treatment of high arterial blood pressure in a large population recruited from 16 countries with varying degrees of baseline cardiovascular risk, and the effect of eprosartan-based therapy on total cardiovascular risk, as represented by the SCORE® (Systematic Coronary Risk Assessment) or Framingham risk equations.Methods:Participating physicians recruited > 29,000 hypertensive patients whom they considered to be candidates (according to specified criteria) for treatment with eprosartan 600 mg/day, with other drugs added at the discretion of the physician.Results:During treatment, systolic blood pressure decreased by 25.8 ± 14.4 mmHg to 134.6 ± 11.4 mmHg (P < 0.001), mean diastolic blood pressure fell by 12.6 ± 9.5 mmHg to 81.1 ± 7.6 mmHg, and pulse pressure fell by 13.2 ± 13.5 mmHg to 53.6 ± 11.4 mmHg (both P < 0.01). Calculated total cardiovascular risk declined in parallel with the reduction in blood pressure.Conclusion:The POWER study has demonstrated, in a large and nonselected population, the feasibility and practicability of reducing total cardiovascular risk through systematic management of high blood pressure.

Subclinical atherosclerosis in menopausal women with low to medium calculated cardiovascular risk

BackgroundThe menopausal status is closely related with cardiovascular disease (CVD). Nevertheless, it is still not included in risk stratification by total cardiovascular risk estimation systems. The present study aimed to evaluate the extent of subclinical vascular disorders in young healthy postmenopausal women. MethodsThis cross-sectional study consecutively recruited 120 healthy postmenopausal women without clinically overt CVD or diabetes, aged 41–60years and classified as not high-risk by the Heartscore (<5%). In addition to risk factors used for Heartscore calculations, years since menopause and associated risk factors (triglycerides (range 37–278mg/dl), waist circumference (62–114cm), fasting blood glucose (69–114mg/dl) and HOMA-IR (0.44–5)) were also assessed. Carotid–femoral pulse wave velocity, carotid and femoral intima–media thickness in the abnormal range as well as atheromatous plaques both in carotid and femoral arteries were used to define the presence of subclinical atherosclerosis. ResultsSubclinical atherosclerosis and the presence of at least one plaque were identified in 55% and 28% of women, respectively. Subjects with subclinical atherosclerosis had higher age, years since menopause, HOMA-IR and blood pressure. By multivariate analysis years since menopause and systolic blood pressure independently determined subclinical atherosclerosis while 79% of intermediate-risk women (Heartscore 2–4.9%) being in menopause for at least 4years would be reclassified to a higher risk for the presence of atherosclerosis. ConclusionSubclinical atherosclerosis was highly prevalent in postmenopausal women with low to medium Heartscore. Thus our data suggest that menopausal status and associated risk factors should be additionally weighted in risk calculations, regarding primary prevention strategies in this population.

Formalization of Medical Guidelines

Formalization of medical guidelines by means of a general GLIF graphic model is demonstrated in the formalized 2003 European Guidelines on Cardiovascular Disease Prevention and 2003 ESH/ESC Hypertension Guidelines. It leads a user through the decision algorithm in diagnostics of several diseases, total cardiovascular risk estimation and appropriate treatment. Moreover, it can show both the basic information and the appropriate part of guidelines (GL) complete text concerning the selected GLIF model element. The formalization of GL can function as a feedback for authors to remove uncertainties and information inconsistencies in GL. Estimation of the total cardiovascular risk and selection of a drug class is easier compared to a time consuming manipulation with tables of paper guidelines. It offers to physicians a system for a decision support and it checks their decision algorithms in comparison with those of GL. It could serve as a tool for an audit of physicians work by their professional society using the automatic system, preferably with a direct data access from a structured electronic health record in future. Computer GL presentation has the potential for an easier GL knowledge implementation than the classical paper GL form and thus to improve the primary care of cardiovascular diseases.

Prevention Conference V: Beyond secondary prevention: identifying the high-risk patient for primary prevention: medical office assessment: Writing Group I.

Writing Group I of Prevention Conference V reviewed the role of medical office assessment in the detection of risk factors and estimation of total cardiovascular risk. The primary focus was on identification of known risk factors for coronary heart disease (CHD). Population screening may identify risk factors that prompt people to seek clinical consultation. Risk factors may also be identified in patients who are seeking medical treatment for other conditions. Physicians have the responsibility to evaluate cardiovascular risk in all their patients. Medical office assessment permits the identification of many high-risk patients without the need for noninvasive testing for atherosclerotic burden or subclinical myocardial ischemia. Techniques for office assessment available to clinicians include history, physical examination, laboratory testing, and electrocardiography (ECG). Routine evaluation and testing provides most of the information needed to estimate risk and make treatment decisions. The essential information required for estimating risk for CHD lies in the known risk factors for coronary disease. These risk factors must first be identified and their severity determined. The relationship between risk factors and development of CHD is strong but variable. When a risk factor is causally and independently related to disease, the physician should make recommendations to the patient about risk factor modification. When risk factors are associated with increased risk for CHD but are not directly causative, the risk factor is considered to be a marker for increased risk . In the following discussion, the major risk factors and risk markers for CHD that can be detected in medical office assessment are reviewed. The different categories of risk are then considered. Finally, the special characteristics of each risk factor in relation to global risk assessment are reviewed. Special groups, including older patients and those with diabetes, are considered, and suggestions are made for modifying the existing guidelines for risk …