Evaluation of cardiovascular risk in blood donors: results of the CARDIORISK study in the Parma Transfusion Service

Homocysteine and education but not lipoprotein (a) predict estimated 10-year risk of cardiovascular disease in blood donors: a community based cross-sectional study

Background

With aging of the population, screening and prevention health programs for blood donors will increasingly be a priority. We aimed at: assessing the 10 year-cardiovascular disease (CVD) risk in blood donors, according to Italian CUORE risk score (CRS); determining the association of homocysteine (Hcy), lipoprotein (Lp)(a) and socio-demographic or lifestyle variables with estimated 10-year CVD risk.

Methods

Between June 2015 and July 2017, 1,447 (61.2% men) unselected blood donors (aged 18–69 years) were enrolled at the Blood Transfusion Service of the Pescara General Hospital, Italy. The project entailed evaluation of unalterable (age and gender) and modifiable CV risk factors (total cholesterol, HDL, LDL, triglycerides, fasting glucose, smoking, hypertension). The educational attainment, socio-demographic and lifestyle behavior information were obtained through a structured self-report questionnaire, and Health-related quality of life (HRQoL) through the Short Form Survey (SF-12). Plasma Hcy and Lp(a) were determined in the fasting state.

Results

A CRS within the moderate-high risk range was reported in 21.7% donors. Multivariate logistic regression, after adjustment for clinical and demographic variables, showed that Hcy [OR (95% CI): 1.09 (1.04–1.13); p < 0.001) and low educational attainment [1.71 (1.09–2.73); p = 0.019] are independent risk factors for moderate-to-high CVD risk. Instead, Lp(a), evaluated in 774 donors, was > 30 mg/dL in 22.4% of the examined population, but without any significant correlation with CRS.

Conclusions

Our study highlights a previously unappreciated need for CV risk assessment in blood donors, which may include evaluation of educational attainment as a non-traditional risk marker.

The relationship between ABO blood group and cardiovascular disease: results from the Cardiorisk program

BACKGROUND

The ABO blood group exerts a profound influence on hemostasis, and it has hence been associated with the development of thrombotic cardiovascular adverse events. In this study, we evaluated the relationship between the ABO blood group and the risk of cardiovascular disease assessed with the Cardiorisk score.

METHODS

All blood donors aged between 35 and 65 years were enrolled in the Cardiorisk program, which included the assessment of 8 variables (sex, age, total cholesterol, high-density lipoprotein (HDL) cholesterol, plasma glucose, arterial blood pressure, anti-hypertensive therapy and smoking) which were used to generate a score. Individuals with a resulting score ≥20, considered at high cardiovascular risk, underwent additional instrumental tests (chest X-ray, stress electrocardiogram and Doppler ultrasound of supra-aortic trunks) and were closely clinically monitored.

RESULTS

Between January 2005 and December 2015, 289 blood donors with Cardiorisk ≥20 were identified, 249 of whom were included in the study with at least 2 years of follow-up. Among these, 36 (14.5%) had instrumental abnormality tests and developed adverse cardiovascular events (10 acute coronary syndrome, 2 cerebral ischemia, 3 cardiac arrhythmia, 8 stenosis of supra-aortic trunks or iliac arteries) during a median follow-up of 5.3 years. In this group of 249 high risk individuals, a statistically significant association (P=0.02) was found between the non-O blood type and the risk of developing subclinical or clinical cardiovascular events (odds ratio, 3.3; 95% CI, 1.1-10.1; P=0.033).

CONCLUSIONS

The results of this study underline the both key role of ABO blood group for the risk of developing arterial thrombotic events and the need for including such unmodifiable variable on the scores assessing the thrombotic risk.