scholarly journals Comparison of Innovative and Traditional Cardiometabolic Indices in Estimating Atherosclerotic Cardiovascular Disease Risk in Adults

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 603
Author(s):  
Ya-Chin Huang ◽  
Jiun-Chi Huang ◽  
Chia-I Lin ◽  
Hsu-Han Chien ◽  
Yu-Yin Lin ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Visceral Adiposity ◽  
P Value ◽  
Visceral Adiposity Index ◽  
Atherosclerotic Cardiovascular Disease ◽  
Adiposity Index ◽  
Increased Risk ◽  
Ascvd Risk

This study aimed to investigate the performance of innovative and traditional cardiometabolic indices, including body mass index (BMI), waist circumference (WC), Chinese visceral adiposity index (CVAI), visceral adiposity index, lipid accumulation product, a body shape index (ABSI), body roundness index, conicity index (CI), triglyceride-glucose (TyG) index, TyG-BMI, and TyG-WC, in estimating atherosclerotic cardiovascular disease (ASCVD) risk in 3143 Taiwanese adults aged 20–79 years. Elevated 10-year ASCVD risk was defined as ≥7.5% using the Pooled Cohort Equations. The performance of different indices in estimating elevated ASCVD risk was assessed by receiver operating characteristic (ROC) curves. In multivariate-adjusted logistic regression analyses, all cardiometabolic indices (p-value < 0.001) were significantly associated with elevated ASCVD risk in both genders, except for ABSI and CI in women. In particular, CVAI had the largest area under the curve (AUC) in men (0.721) and women (0.883) in the ROC analyses. BMI had the lowest AUC in men (0.617), while ABSI had the lowest AUC in women (0.613). The optimal cut-off value for CVAI was 83.7 in men and 70.8 in women. CVAI performed best among various cardiometabolic indices in estimating elevated ASCVD risk. CVAI may be a reliable index for identifying people at increased risk of ASCVD.

scholarly journals Cohort study on the effects of depression on atherosclerotic cardiovascular disease risk in Korea

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026913 ◽  
Author(s):  
Yon Ho Jee ◽  
Hyoungyoon Chang ◽  
Keum Ji Jung ◽  
Sun Ha Jee
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Population Based ◽  
Western World ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
National Health Insurance System ◽  
Increased Risk

ObjectivesDepression has been reported to be a risk factor of cardiovascular disease in the western world, but the association has not yet been studied among Asian populations. The aim of this study was to investigate whether depression increases the risk of developing atherosclerotic cardiovascular disease (ASCVD) in a large Korean cohort study.DesignPopulation based cohort study.SettingDatabase of National Health Insurance System, Republic of Korea.Participants481 355 Koreans (260 695 men and 220 660 women) aged 40–80 years who had a biennial health check-up between 2002 and 2005.Main outcome measureThe main outcome in this study was the first ASCVD event (hospital admission or death).ResultsDepression increased the risk of developing ASCVD by 41% for men and 48% for women. In men, 3–4 outpatient visits for depression increased the risk of angina pectoris by 2.12 times (95% CI 1.55 to 2.90) and acute myocardial infarction by 2.29 times (95% CI 1.33 to 3.95). Depression was also associated with stroke in men (HR 1.29, 95% CI 1.19 to 1.39) and in women (HR 1.37, 95% CI 1.29 to 1.46). However, no increased risk of ASCVD was found for men who received 10 or more depressive treatments, compared with those without any outpatient visit for depression.ConclusionsIn this cohort, depressed people were at increased risk of ASCVD incidence. Therefore, individuals with depression may need routine monitoring of heart health that may prevent their future CVD risk.

Abstract 014: Comparative Cost-Effectiveness of 10-Year Atherosclerotic Cardiovascular Disease Risk Equations Over 10 Years of Follow-up: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Gabriel S Tajeu ◽  
Ciaran Kohli-Lynch ◽  
Yiyi Zhang ◽  
Paul Muntner ◽  
Steven Shea ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cost Effectiveness ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Statin Treatment ◽  
Moderate Intensity ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ethnic Study ◽  
Policy Model ◽  
Ascvd Risk

Introduction: Uncertainty remains regarding the most efficient and cost-effective 10-year atherosclerotic cardiovascular disease (ASCVD) risk prediction tool for identifying moderate to high-risk patients for primary prevention statin treatment. Methods: We utilized the CVD Policy Model, a computer microsimulation model of ASCVD incidence, prevalence, mortality, and costs, to compare cost-effectiveness of statin treatment at varying 10-year predicted ASCVD risk thresholds for Framingham CVD (FRS-CVD), Reynolds Risk Score (RRS), and Pooled Cohorts Risk Equations over a 10-year time horizon in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Cost effectiveness was assessed at predicted 10-year risk ≥ 20.0%, 15.0%, 10.0%, 7.5%, 5.0%, and 2.5%. We restricted the simulation cohort to participants aged 50 to 74 years who were not taking statins at baseline (n = 2,871). Moderate intensity statin treatment effectiveness was parameterized in the model as a 29% low-density lipoprotein cholesterol reduction. Total cost comprised statins ($100/year), side effect costs, and ASCVD event costs. Disability from treatment side effects and ASCVD events were included. Results: Average FRS-CVD, RRS, and Pooled Cohorts 10-year predicted ASCVD risks were 18.8%, 11.3%, 12.2%, for men and 8.9%, 4.3%, 6.6%, for women, respectively. At the same predicted risk, FRS-CVD consistently selected the most patients for treatment, and RRS the fewest ( Figure ). Compared with no treatment, treating patients with RRS ≥ 20% was cost saving in men. Subsequent risk threshold strategies with incremental cost effectiveness <$75,000/quality-adjusted life-year (QALY) for men were: FRS-CVD ≥ 20% ($13,046), RRS ≥ 7.5% ($17,774), and RRS ≥ 5.0% ($19,891). For women, the non-dominated thresholds were: Pooled Cohorts ≥ 15% ($27,908) and Pooled Cohorts ≥ 7.5% ($72,377). Conclusions: At cost-effectiveness thresholds less than $75,000/QALY, RRS was the highest value tool for men while the Pooled Cohorts Risk Equations performed best for women.

Abstract 024: Effects Of Diet On 10-year Atherosclerotic Cardiovascular Disease Risk Using The Pooled Cohort Equations Risk Calculator: Results From The Dash Trial

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Sun Young Jeong ◽  
Lara Kovell ◽  
Timothy B Plante ◽  
Christina C Wee ◽  
Edgar R Miller ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Disease Risk ◽  
Control Diet ◽  
Cardiovascular Disease Risk ◽  
Hdl Cholesterol ◽  
Risk Scores ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Dash Diet ◽  
Ascvd Risk

Background: The Dietary Approaches to Stop Hypertension (DASH) diet is known to reduce cardiovascular disease (CVD) risk factors, but its effects on 10-year CVD risk based on the pooled cohort estimating equation has not been reported. Objective: To determine the effects of adopting the DASH diet on 10-year atherosclerotic cardiovascular disease (ASCVD) risk compared to a typical American (control) diet or a diet rich fruit and vegetables (F/V), but otherwise similar to control. Methods: The DASH trial was a 3-arm, parallel-group, randomized controlled feeding trial of 459 adults aged 22 to 75 years without CVD and not taking anti-hypertensive or diabetes medications. These participants were randomized to a control diet, a F/V diet, or the DASH diet for 8 weeks. Weight was kept constant. Blood pressure (BP) and lipids were measured at baseline and at 8-weeks to compare 10-year ASCVD risk scores across dietary assignments. Comparisons were performed via linear regression adjusted for baseline ASCVD risk score. Results: The mean age of participants was 45 years; 49% were women, 60% were black, and 10% were current smokers. Mean systolic BP was 131.3±10.8 mm Hg, mean LDL cholesterol was 121±32 mg/dL, and mean HDL cholesterol was 48±14 mg/dL. Both DASH and F/V diets shifted the distribution of ASCVD risk scores downward compared to the control diet ( Figure, Panel A ). Compared to the control diet, the DASH and F/V diets reduced 10-year ASCVD risk by 10.0% (95% CI: -17.7, -1.5; P = 0.02) and 11.7% (95% CI: -19.3, -3.3; P = 0.007) respectively ( Figure, Panel B ). There was no difference between the DASH and F/V diets (-1.9%; 95% CI: -10.3, 7.4; P = 0.68). Conclusions: Compared to the control diet, the DASH and F/V diets reduced 10-year ASCVD risk, while the DASH and F/V had similar effects.

scholarly journals To Assess the Level of Vit B12, Vit C and Homocysteine in Chronic Smokers in Central India

2021 ◽  
pp. 29-33
Author(s):  
Dattu Hawale ◽  
Ranjit S. Ambad ◽  
Minal Kalambe
Keyword(s):  
Cardiovascular Disease ◽  
Vitamin B12 ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Central India ◽  
P Value ◽  
Homocysteine Concentration ◽  
Increased Risk ◽  
Group 1 ◽  
Vit C

Background: Smoking is related to an increased risk of morbidity and mortality. Cigarette smoking has been related to higher levels of homocysteine in the blood. Both have been associated with a higher risk of cardiovascular disease. Smokers also have lower levels of vitamin B12, which affects homocysteine levels by serving as a cofactor or co substrate (folate) for the enzymes that regulate the metabolism of homocysteine. Materials: This study was a case-control study, conducted in the Department of Biochemistry and medicine at DMMC & SMHRC, Nagpur in collaboration with ABVRH, Sawangi (Meghe). In the present study, the total number of subjects included was 200 having age Group between 30-60. The subjects were divided in two groups. Group 1: 100 subjects chronic smokers and Group 2: 100 subjects   non- smokers. Results: The homocysteine concentration significantly increased in group 1 ( chronic smokers)  18.50±8.40 as compared to group 02( non smokers ) 8.30±5.30 and p value p<0.005.vitamin B12 concentration significantly decreased in  group 01 ( chronic smokers)  340.80±124.70 as compared to group 02 (non smokers) 485.45±175.68 and p value p<0.005. vitamin c concentration significantly decreased in group 1 (chronic smokers) 0.46±0.07 as compared to group 02 (non smokers) 1.12±0.15 and p value p<0.005. Conclusion: On the basis of findings we concluded that the smoking increases Homocysteine levels and lowers the level of Vit B12 and Vit C leading to increase cardiovascular disease risk among chronic smokers.

Abstract 17098: Liver Fibrosis and Associated Cardiovascular Disease Risk and Its Predictors Among US Adults With and Without Diabetes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nathan D Wong ◽  
Matthew Bang ◽  
WENJUN FAN ◽  
Aprille Espinueva
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Liver Fibrosis ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Atherosclerotic Cardiovascular Disease ◽  
Advanced Fibrosis ◽  
Alcoholic Fatty Liver ◽  
Female Sex ◽  
Ascvd Risk

Background: Liver fibrosis is a complication of non-alcoholic fatty liver disease (NAFLD) and is associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. Whether this risk may be enhanced in persons with pre-diabetes (pre-DM) or diabetes (DM), however, is not established. We examined the association of liver fibrosis with estimated ASCVD risk and its predictors according to DM status. Methods: We studied 30,895 adults (3,983 or 12.9% with DM) from the National Health and Nutrition Examination Surveys 1999-2014 with liver function measures to calculate FIB-4 scores; values of 1.3-2.67 and >2.67 indicated a moderate and high probability of advanced fibrosis, respectively. We studied the prevalence high FIB-4 scores in those with and without pre-DM and DM and the 10-year ASCVD risk based on the ACC/AHA Pooled Cohort Risk Calculator in persons without known ASCVD. In addition, multiple logistic regression examined predictors of high FIB-4 scores. Results: The prevalence of FIB-4 scores of 1.3-2.67 and >2.67 ranged from 17.8% and 1.5% in those without pre-DM/DM, 29.9% and 2.5% in those with pre-DM, and 35.3% and 3.5% in those with DM, respectively (p<0.0001). The figure shows the 10-year ASCVD risk by FIB-4 scores and presence of pre-DM and DM. Multivariable indicators of a FIB-4 score >2,67 were age (odds ratio [OR]=3.0 / 10 years), female sex (OR=0.53), non-Hispanic Black ethnicity (OR=2.0), waist circumference (OR=0.76/SD), alcohol use (OR=1.5), and NALFD (OR=3.3) in those without DM, and age (OR=2.2/10 years), female sex (OR=0.48), systolic blood pressure (1.4/SD), diastolic blood pressure (0.76/SD), and current smoking (OR=2.2) in those with DM (all p<0.05 to p<0.0001). Conclusions: Advanced fibrosis is more prevalent in those with vs. without DM. The presence of DM with higher FIB-4 scores is associated with especially high estimated ASCVD risks warranting increased efforts to address prevention and treatment of liver fibrosis.

scholarly journals Evaluating algorithmic fairness in the presence of clinical guidelines: the case of atherosclerotic cardiovascular disease risk estimation

2021 ◽  
Author(s):  
Agata Foryciarz ◽  
Stephen R. Pfohl ◽  
Nigam Shah ◽  
Birju Patel
Keyword(s):  
Cardiovascular Disease ◽  
Disease Risk ◽  
Risk Estimation ◽  
Cardiovascular Disease Risk ◽  
False Negative ◽  
Decision Rules ◽  
Heart Association ◽  
Error Rates ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ascvd Risk

The American College of Cardiology and the American Heart Association guidelines on primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend using 10-year ASCVD risk estimation models to initiate statin treatment. For guideline-concordant decision making, risk estimates need to be calibrated. However, existing models are often miscalibrated for race, ethnicity, and sex based subgroups. This study evaluates two algorithmic fairness approaches to adjust the risk estimators (group recalibration and equalized odds) for their compatibility with the assumptions underpinning the guidelines' decision rules. Using an updated Pooled Cohorts dataset, we derive unconstrained, group-recalibrated, and equalized odds-constrained versions of the 10-year ASCVD risk estimators, and compare their calibration at guideline-concordant decision thresholds. We find that, compared to the unconstrained model, group-recalibration improves calibration at one of the relevant thresholds for each group, but exacerbates differences in false positive and false negative rates between groups. An equalized odds constraint, meant to equalize error rates across groups, does so by miscalibrating the model overall and at relevant decision thresholds. Hence, because of induced miscalibration, decisions guided by risk estimators learned with an equalized odds fairness constraint are not concordant with existing guidelines. Conversely, recalibrating the model separately for each group can increase guideline compatibility, while increasing inter-group differences in error rates. As such, comparisons of error rates across groups can be misleading when guidelines recommend treating at fixed decision thresholds. The illustrated tradeoffs between satisfying a fairness criterion and retaining guideline compatibility underscore the need to evaluate models in the context of downstream interventions.

scholarly journals External validation of three atherosclerotic cardiovascular disease risk equations in rural areas of Xinjiang, China

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yunxing Jiang ◽  
Rulin Ma ◽  
Heng Guo ◽  
Xianghui Zhang ◽  
Xinping Wang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Rural Areas ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
External Validation ◽  
Final Analysis ◽  
Atherosclerotic Cardiovascular Disease ◽  
Men And Women ◽  
Risk Equation ◽  
Ascvd Risk

Abstract Background To externally validate the Prediction for ASCVD Risk in China (PAR) risk equation for predicting the 5-year atherosclerotic cardiovascular disease (ASCVD) risk in the Uyghur and Kazakh populations from rural areas in northwestern China and compare its performance with those of the pooled cohort equations (PCE) and Framingham risk score (FRS). Methods The final analysis included 3347 subjects aged 40–74 years without CVD at baseline. The 5-year ASCVD risk was calculated using the PAR, PCE, and FRS. Discrimination, calibration, and clinical usefulness of the three equations in predicting the 5-year ASCVD risk were assessed before and after recalibration. Results Of 3347 included subjects, 1839 were female. We observed 286 ASCVD events in within 5-year follow-up. All three risk equations had moderate discrimination in both men and women. C-indices of PAR, PCE, and FRS were 0.727 (95% CI, 0.725–0.729), 0.727 (95% CI, 0.725–0.729), and 0.740 (95% CI, 0.738–0.742), respectively, in men; the corresponding C-indices were 0.738 (95% CI, 0.737–0.739), 0.731 (95% CI, 0.730–0.732), and 0.761 (95% CI, 0.760–0.762), respectively, in women. PCE, PAR and FRS substantially underestimated the 5-year ASCVD risk in women by 70, 23 and 51%, respectively. However, PAR and FRS fairly predicted the risk in men and PAR was well calibrated. The calibrations of the three risk equations could be changed by recalibration. The decision curve analyses demonstrated that at the threshold risk of 5%, PCE was the most clinically useful in both men and women after recalibration. Conclusions All three risk equations underestimated the 5-year ASCVD risk in women, while PAR and FRS fairly predicted that in men. However, the results of predictive performances for three risk equations are inconsistent, more accurate risk equations are required in the primary prevention of ASCVD aiming to this Uyghur and Kazakh populations.

scholarly journals 941. Incarcerated patients living with HIV: Atherosclerotic cardiovascular disease risk and management

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S503-S504
Author(s):  
Sarah M Michienzi ◽  
Thomas D Chiampas ◽  
Amy Valkovec ◽  
Siria Arzuaga ◽  
Mahesh C Patel ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Statin Therapy ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Heart Association ◽  
Blood Cholesterol ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Panel ◽  
Ascvd Risk ◽  
Living With Hiv

Abstract Background The 2018 American Heart Association and American College of Cardiology (AHA/ACC) 2018 Guideline on the Management of Blood Cholesterol included human immunodeficiency virus (HIV) as an atherosclerotic cardiovascular disease (ASCVD) risk enhancer for the first time. Our study investigates if patients living with HIV in the Illinois Department of Corrections (IDOC) were prescribed appropriate HMG-CoA reductase inhibitor (statin) therapy following release of these guidelines based on risk. Methods This was a retrospective study of patients with &gt; 1 visit in our multidisciplinary HIV IDOC Telemedicine Clinic from 1/1/19-6/1/19. Our prescriptive authority is limited to HIV and directly related conditions, and we provide recommendations to on-site providers for other comorbidities. Included patients were &gt; 18 years of age, HIV positive, and incarcerated within IDOC. Excluded patients had existing ASCVD. Data from the first visit in the study period were extracted from the electronic medical record and analyzed utilizing descriptive statistics. Primary objectives were to quantify ASCVD risk and appropriate statin use in our population. Results Of the 158 patients included, average age was 42 years. The majority were male (89%), Black (73%), overweight/obese (117/148, 79%), on an integrase single-tablet regimen (78%), with CD4 &gt;200 cells/µL (97%), and HIV RNA &lt; 20 copies/mL (85%). Of the 18 females, 8 were transgender. Within the prior year, 65% had a lipid panel. For the 50 patients meeting criteria for 10-year ASCVD estimation, median (range) risk was 6.6% (0.8% - 31.9%). Only 12 patients were on statins. Of these, all were indicated per AHA/ACC guidelines with 10 prescribed appropriate intensity. An additional 45 patients had indications for statins but were untreated. In total, 47 patients (30%) were not receiving appropriate statin therapy. Conclusion Results of our study suggest ASCVD risk management is an area of improvement for inmates living with HIV, especially as we look towards caring for an aging HIV population. Future directions include comparing these data to data from a later time point to evaluate time for guideline uptake. Disclosures Thomas D. Chiampas, PharmD, BCPS, AAHIVP, Gilead (Employee)

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