Identification of biomarkers for risk stratification of cardiovascular events using genetic algorithm with recursive local floating search

PROTEOMICS ◽  
2009 ◽  
Vol 9 (8) ◽  
pp. 2286-2294 ◽  
Author(s):  
Xiaobo Zhou ◽  
Honghui Wang ◽  
Jun Wang ◽  
Yuan Wang ◽  
Gerard Hoehn ◽  
...  
Keyword(s):  
Genetic Algorithm ◽  
Risk Stratification ◽  
Cardiovascular Events

scholarly journals Simple cardiovascular risk stratification using anthropometric measures instead of serum cholesterol. The MORGAM Prospective Cohort Project

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kristensen ◽  
V Rosberg ◽  
J Vishram-Nielsen ◽  
M Pareek ◽  
A Linneberg ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Total Cholesterol ◽  
Serum Cholesterol ◽  
Cardiovascular Events ◽  
Smoking Status ◽  
Predictive Ability ◽  
Serum Total Cholesterol ◽  
Anthropometric Measures ◽  
Blood Pressures

Abstract Background Body composition predicts cardiovascular outcomes, but it is uncertain whether anthropometric measures can replace the more expensive serum total cholesterol for cardiovascular risk stratification in low resource settings. Purpose The purpose of the study was to compare the additive prognostic ability of serum total cholesterol with that of body mass index (BMI), waist/hip ratio (WHR), and estimated fat mass (EFM, calculated using a validated prediction equation), individually and combined. Methods We used data from the MORGAM (MONICA, Risk, Genetics, Archiving, and Monograph) Prospective Cohort Project, an international pooling of cardiovascular cohorts, to determine the relationship between anthropometric measures, serum cholesterol, and cardiovascular events, using multivariable Cox proportional-hazards regression analysis. We further investigated the ability of these measures to enhance prognostication beyond a simpler prediction model, consisting of age, sex, smoking status, systolic blood pressures, and country, using comparison of area under the receiver operating characteristics curve (AUCROC) derived from binary logistic regression models. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of death from coronary heart disease, myocardial infarction, or stroke. Results The study population consisted of 52,188 apparently healthy subjects (56.3% men) aged 47±12 years ranging from 20 to 84, derived from 37 European cohorts, with baseline between 1982–2002 all followed for 10 years during which MACE occurred in 2465 (4.7%) subjects. All anthropometric measures (BMI: hazard ratio (HR) 1.04 [95% confidence interval (CI): 1.03–1.05] per kg/m2; WHR: HR 7.5 [4.0–14.0] per unit; EFM: HR 1.02 [1.01–1.02] per kg) as well as serum total cholesterol (HR 1.20 [1.16–1.24] per mmol/l) were significantly associated with MACE (P<0.001 for all), independently of age, sex, smoking status, systolic blood pressures, and country. The addition of serum cholesterol significantly improved the predictive ability of the simple model (AUCROC 0.818 vs. 0.814, P<0.001), as did the combination of WHR, BMI, and EFM (AUCROC 0.817 vs. 0.814, P=0.004). When assessed individually, BMI (AUCROC 0.816 vs. 0.814, P=0.004) and WHR (AUCROC 0.815 vs. 0.814, P=0.02) improved model performance, while EFM narrowly missed significance (AUCROC 0.815 vs. 0.814, P=0.06). There was no significant difference in the predictive ability of a model including serum cholesterol versus that including all three anthropometric measures (AUCROC 0.818 vs. 0.817, P=0.13). The figure shows the pertinent areas under the ROC curve in predicting MACE. Conclusion In this large population-based cohort study, the addition of a combination of anthropometric measures, i.e. BMI, WHR, and EFM, raised the predictive ability of a simple prognostic model comparable to that obtained by the addition of serum total cholesterol. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract P019: A Single Model For Predicting Major Adverse Cardiovascular Events In Individuals With And Without History Of Atherosclerotic Cardiovascular Disease: The Atherosclerosis Risk In Communities (aric) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Yejin Mok ◽  
Lena Mathews ◽  
Ron C Hoogeveen ◽  
Michael J Blaha ◽  
Christie M Ballantyne ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Risk Stratification ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Single Model ◽  
History Of ◽  
Very High

Background: In the 2018 AHA/ACC Cholesterol guideline, risk stratification is an essential element. The use of a Pooled Cohort Equation (PCE) is recommended for individuals without atherosclerotic cardiovascular disease (ASCVD), and the new dichotomous classification of very high-risk vs. high-risk has been introduced for patients with ASCVD. These distinct risk stratification systems mainly rely on traditional risk factors, raising the possibility that a single model can predict major adverse cardiovascular events (MACEs) in persons with and without ASCVD. Methods: We studied 11,335 ARIC participants with (n=885) and without (n=10,450) a history of ASCVD (myocardial infarction, ischemic stroke, and symptomatic peripheral artery disease) at baseline (1996-98). We modeled factors in the PCE and the new classification for ASCVD patients (Figure legend) in a single CVD prediction model. We examined their associations with MACEs (myocardial infarction, stroke, and heart failure) using Cox models and evaluated the discrimination and calibration for a single model including those factors. Results: During a median follow-up of 18.4 years, there were 3,658 MACEs (3,105 in participants without ASCVD). In general, the factors in the PCE and the risk classification system for ASCVD patients were associated similarly with MACEs regardless of baseline ASCVD status, although age and systolic blood pressure showed significant interactions. A single model with these predictors and the relevant interaction terms showed good calibration and discrimination for those with and without ASCVD (c-statistic=0.729 and 0.704, respectively) (Figure). Conclusion: A single CVD prediction model performed well in persons with and without ASCVD. This approach will provide a specific predicted risk to ASCVD patients (instead of dichotomy of very high vs. high risk) and eliminate a practice gap between primary vs. secondary prevention due to different risk prediction tools.

scholarly journals The Role of C-reactive Protein in Patient Risk Stratification and Treatment

2021 ◽  
Vol 16 ◽  
Author(s):  
Ramón Arroyo-Espliguero ◽  
María C Viana-Llamas ◽  
Alberto Silva-Obregón ◽  
Pablo Avanzas
Keyword(s):  
Risk Stratification ◽  
Cardiovascular Events ◽  
Specific Treatment ◽  
Cardiovascular Prevention ◽  
Chronic Inflammatory Disease ◽  
Residual Risk ◽  
C Reactive Protein ◽  
Inflammatory Biomarker ◽  
Reactive Protein

Atherosclerosis is a chronic inflammatory disease. Several circulating inflammatory markers have been proposed for clinical use due to their ability to predict future cardiovascular events and may be useful for identifying people at high risk who might benefit from specific treatment to reduce this risk. Moreover, the identification of new therapeutic targets will allow the development of drugs that can help reduce the high residual risk of recurrence of cardiovascular events in patients with coronary artery disease. The clinical benefits of reducing recurrent major cardiovascular events recently shown by canakinumab and colchicine have renewed the cardiology community’s interest in inflammation as an aetiopathogenic mechanism for atherosclerosis. This review explores the use of C-reactive protein, which is the most frequently studied biomarker in this context; the concept of residual risk in primary and secondary cardiovascular prevention; and the current recommendations in international guidelines regarding the role of this inflammatory biomarker in cardiovascular risk stratification.

scholarly journals Risk Stratification for Postoperative Cardiovascular Events via Noninvasive Assessment of Endothelial Function

Circulation ◽  
2002 ◽  
Vol 105 (13) ◽  
pp. 1567-1572 ◽  
Author(s):  
Noyan Gokce ◽  
John F. Keaney ◽  
Liza M. Hunter ◽  
Michael T. Watkins ◽  
James O. Menzoian ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Endothelial Function ◽  
Cardiovascular Events ◽  
Noninvasive Assessment

Evaluation of mechanical arterial properties: clinical, experimental and therapeutic aspects

2001 ◽  
Vol 102 (1) ◽  
pp. 51-67 ◽  
Author(s):  
Gary E. MCVEIGH ◽  
Paul K. HAMILTON ◽  
David R. MORGAN
Keyword(s):  
Mechanical Properties ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Blood Vessel ◽  
Risk Stratification ◽  
Cardiovascular Events ◽  
Pressure Measurements ◽  
Widespread Application ◽  
Disease States ◽  
Measurement Tools

Ageing and disease states associated with an increase in cardiovascular events alter the physical characteristics of blood vessel walls and impair the pulsatile function of arteries. An accumulating body of evidence indicates that impaired pulsatile function of arteries provides important prognostic and therapeutic information beyond that provided by traditional blood pressure measurements. A variety of techniques are currently employed to evaluate the mechanical properties of arteries. All techniques have theoretical, technical and practical limitations that impact on their widespread application in the clinical setting and use as measurement tools to improve cardiovascular risk stratification. A detailed discussion of these issues forms the basis of this review.

scholarly journals CAROTID­SUBCLAVIAN GRAFTING IN OCCLUSION OF THE FIRST PORTION OF SUBCLAVIAN ARTERY AND MULTIFOCAL ATHEROSCLEROSIS: FIVE YEAR FOLLOW­UP DATA

2018 ◽  
Vol 17 (2) ◽  
pp. 29-34 ◽  
Author(s):  
R. S. Tarasov ◽  
A. N. Kazantsev ◽  
N. N. Burkov ◽  
A. I. Anufriev ◽  
A. R. Shabaev ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Subclavian Artery ◽  
Optimal Strategy ◽  
Cardiovascular Events ◽  
Vocal Cords ◽  
Postsurgical Complications ◽  
Selection Of

Aim.Analysis of the prevalence and structure of hospital and five year postsurgical complications in patients with occlusion of the first portion of subclavian artery and multifocal atherosclerosis.Material and methods.To the study, 45 patients included, who had underwent carotid­subclavian shunting during 2008­2015y.Results.In hospital period of follow­up there were no significant adverse cardiovascular events. Among the comlications, in several cases there were vocal cords paresis, paresis of the diaphragm dome, limphorrhea. The study shows that significant cardiovascular events occurred only in long term of the disease period and were related to the following stage of revascularization.Conclusion.The obtained results underscore the significance of risk stratification and selection of the optimal strategy of revascularization in the cohort of patients, that is impossible unless an approach is personified.

scholarly journals SAT-566 Avoiding the Heartache: A Case of Familial Hypercholesterolemia

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Mustafa Kinaan ◽  
Arelys Ramos Rivera ◽  
Hanford Yau
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Total Cholesterol ◽  
Cardiovascular Events ◽  
Total Cholesterol Level ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
History Of

Abstract More than 70% of individuals with atherosclerotic cardiovascular disease are believed to have underlying gene-linked mechanisms leading to hyperlipidemia. It is estimated that 1 in 200 individuals in the United States has heterozygous Familial Hypercholesterolemia (FH). We present a case that highlights the importance of comprehensive care for a patient with heterozygous FH, from screening and risk stratification, to therapy. Our patient is a 43-year-old gentleman with history of hyperlipidemia. At age 25, he was diagnosed with hyperlipidemia and was started on statin therapy. He has strong family history of cardiovascular disease. His mother had her first myocardial infarction (MI) at age 40 and required coronary artery bypass. She also suffered from three strokes. His maternal aunt and uncle suffered from MIs at age 38 and 40, respectively. Additionally, his maternal grandfather passed away from MI at age 38. The patient’s daughter was found to have total cholesterol level > 300 mg/dL at age 8. He does not have history of obesity, diabetes, previous cardiovascular events, or hypothyroidism. He is athletic and follows a healthy diet. He did not have any xanthomas, xanthelasmas, nor arcus cornealis. At time of initial evaluation, the patient had low-density lipid (LDL) level of 180 mg/dL despite therapy with rosuvastatin, ezetimibe, and niacin. Based on these findings, we proceeded with genetic testing. Results of testing showed a heterozygous c.6delG (p.Trp4Glyfs*202) pathogenic mutation of the LDL receptor. We also obtained cardiovascular risk stratification studies. On cardiac CT angiogram, he was found to have extensive, four-vessel disease with 80-90% stenosis of the left ascending artery (LAD) with coronary calcium score of 136 and total score of 219 (99th percentile). Exercise, stress myocardial perfusion scan showed small reversible anteroseptal perfusion abnormality suggestive of mild to moderate ischemia. LAD stenosis was confirmed on a left heart catheter, but no intervention was required. We proceeded with aggressive lipid-lowering therapy with rosuvastatin 40mg daily and alirocumab 300mg monthly. He was also started on aspirin and beta-blocker given coronary artery disease. Following initiation of therapy, the patient’s LDL level dropped to 51 mg/dL with total cholesterol level of 153 mg/dL, HDL of 47mg/dL, and triglycerides of 109 mg/dL. The patient was encouraged to seek genetic counseling for his children and first degree relatives. His daughter was started on rosuvastatin 7.5mg daily by her pediatrician. The patient has not suffered any cardiovascular events and continues to follow up for therapy. Without aggressive lipid-lowering therapy, the lifespan of FH patients can be significantly shortened. Therefore, identifying FH patients is imperative to prevent cardiovascular disease in these patients and their afflicted family members.

scholarly journals Does coronary calcium scoring adds value to cardiovascular risk prediction in asymptomatic population?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Serrao ◽  
M Temtem ◽  
A Pereira ◽  
J Monteiro ◽  
M Santos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Risk Prediction ◽  
Cardiovascular Events ◽  
Cardiovascular Risk Prediction ◽  
Traditional Risk Factors ◽  
The Impact

Abstract Background Despite being a controversial subject, multiple guidelines mention the use of Coronary Artery Calcification (CAC) scoring in the cardiovascular risk prediction, in asymptomatic population. The inclusion of CAC scoring in traditional risk models may help in decision-make providing better cardiovascular risk stratification. Purpose The aim of our study is to estimate the impact of CAC scoring in cardiovascular events risk prediction in a model based on traditional risk factors (TRFs). Methods and results The study consisted of 1052 asymptomatic individuals free of known coronary heart disease, enrolled from GENEMACOR study and referred for computed tomography for the CAC scoring assessment. A cohort of 952 was followed for a mean of 5.2±3.2 years for the primary endpoint of all-cause of cardiovascular events. The following traditional risk factors were considered: (1) current cigarette smoking, (2) dyslipidemia, (3) diabetes mellitus, (4) hypertension and (5) family history of coronary heart disease. Among this population, the extent of CAC differs significantly between men and women in the same age group. Therefore, the distribution of CAC score by age and gender was done by using the Hoff's nomogram (a). According to this nomogram, 3 categories were created: low CAC (0≤CAC<100 and P<50); moderate CAC (100≤CAC<400 or P50–75) and high CAC (CAC≥400 or P>75). Two Cox regression models were created, the first only with TRFs and the second adding the CAC severity categories. When including CAC categories to the TRFs, the higher severity level presented a significant risk of MACE occurrence with an HR of 4.39 (95% CI 1.83–10.52; p=0.001). Conclusion Our results point to the importance of the inclusion of CAC in both primary and secondary prevention to an improved risk stratification. Larger prospective multicentre cohorts with longer follow-up should reproduce and validate these findings. Funding Acknowledgement Type of funding source: None

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