Prediction of fatal and non-fatal cardiovascular events in young and middle-aged healthy workers: The IberScore model

AIMS

Our primary objective was to improve risk assessment for fatal and non-fatal cardiovascular events in a working population, mostly young and healthy.

METHODS

We conducted a prospective cohort study to derive a survival model to predict fatal and non-fatal 10-year cardiovascular risk. We recruited 992,523 workers, free of diagnosed cardiovascular disease at entry, over six years, from 2004-2009. We divided the sample into two independent cohorts: a derivation one (626,515 workers; from 2004-2006) and a temporal validation one (366,008 workers; over 2007-2009). Then, we followed both cohorts over 10 years and registered all fatal and non-fatal cardiovascular events. We built a new risk calculator using an estimation of cardiovascular biological age as a predictor and named it IberScore. There were remarkable differences between this new model and Systematic Coronary Risk Evaluation (SCORE) (in both the specification and the equation).

RESULTS

Over the 10-year follow-up, we found 3762 first cardiovascular events (6‰) in the derivation cohort. Most of them (80.3%) were non-fatal ischaemic events. If we had been able to use our model at the beginning of the study, we had classified in the 'high-risk' or 'very high-risk' groups 82% of those who suffered a cardiovascular event during the follow-up. All the post-estimation tests showed superior performance (true positive rate: 81.8% vs 11.8%), higher discrimination power and better clinical utility (standardised net benefit: 58% vs 13%) for IberScore when compared to SCORE.

CONCLUSION

Risk assessment of fatal and non-fatal cardiovascular events in young and healthy workers was improved when compared to the previously used model (SCORE). The latter was not reliable to predict cardiovascular risk in our sample. The new model showed superior clinical utility and provided four useful measures for risk assessment. We gained valuable insight into cardiovascular ageing and its predictors.

P3403Clinical utility of the integration of Life Simple 7 designed by the American Heart Association and the model for cardiovascular risk prediction IberScore

Background/Introduction

Practice guidelines are agreed on the importance of lifestyle advice for cardiovascular risk reduction as well as cardiovascular risk prediction in planning preventive strategies.

Purpose

To assess the clinical usefulness of the application of the predictive model of cardiovascular risk (CVR) IberScore combined with the recommendations of “Life's Simple 7” (LS7) of the American Heart Association (AHA) in a working population.

Methods

IberScore model is a predictive function for fatal and non-fatal cardiovascular (CV) events derived from a cohort of 774,404 workers (70.4% of the target population) between 16–65 years (average of 35.7 (SD = 10.7)) without CV disease at admission, which was followed for a period of 10 years. Age, sex, total cholesterol, HDL, SBP, glycemia, obesity and a history of dyslipidemia, hypertension and diabetes were used as factors of CVR. Using this model, patients were classified into 4 risk levels. It was also assessed the ideal health status according to the recommendations of “Life's Simple 7” (which includes healthy diet, physical activity, smoking cessation, BMI <25 kg/m2, total cholesterol without treatment <200mg/dl, blood pressure without treatment <120/80 mmHg and basal glycemia <100 mg/dl). Finally, these classifications were compared with the appearance of CV events in a 10-year follow-up.

Results

The results showed a high sensitivity (given that the predictive capacity reached 82% of the cardiovascular events) by using the IberScore, a logistic flexible parametric model to predict 10-year cardiovascular risk. Likewise, the clinical usefulness of the “Life's Simple 7” recommendations could be verified in order to reduce the incidence of total CV events (fatal and non-fatal).

Conclusions

The integration of the predictive model IberScore with the preventive recommendations “Life's simple 7” of the AHA applied to the working population would allow a more efficient cardiovascular prevention.

Acknowledgement/Funding

This project received a research grant from the Carlos III Health Institute (Ministry of Science, Innovation and Universities, Spain). Ref. PI18/01809

[Shock wave treatment in a case of complicated plantaris muscle rupture]

Muscle injuries are frequent in the workplace. They are produced by sudden direct or indirect trauma that involves a rupture of the fibres, causing bruising. Currently, there is no single protocol-based model of treatment. We present the case of a patient diagnosed with complete muscular rupture of the plantaris muscle by an indirect traumatic mechanism (abrupt muscular elongation), with an associated large-volume hematoma. Clinical study consisted of ultrasound, magnetic resonance (MR), pain assessment (VAS) at the beginning and at the end of the treatment (3 weeks), as well as duration of occupational disability. The patient underwent extracorporeal shockwave therapy (ESWT) according to the protocol. At the end of treatment, the hematoma was resolved and there were no complications. ESWT could be a complementary therapeutic alternative to conventional treatment in this entity. However, there is a need for further, randomised controlled studies including a larger number of patients.

Estimating the impact of obesity and metabolic phenotype on sickness absence. Results from the ICARIA study

BACKGROUND AND AIMS

To assess the impact of obesity and being overweight on sickness absence (SA) as a function of healthy/unhealthy metabolic phenotype.

METHODS AND RESULTS

A total of 173 120 healthy workers who underwent a routine check-up, consisting of a structured interview, anthropometric measurements and blood pressure and fasting blood analysis, were included as the study sample (67.1% males; 49.2% manual workers; mean age 40.6 ± 21.9 years). Workers were classified according to their body mass index (BMI) and metabolic phenotype. A metabolically unhealthy phenotype was defined as the presence of three or more of the following criteria: glycaemia ≥110 mg/dL or previously diagnosed type I/II diabetes or treatment for diabetes; triglycerides ≥150 mg/dL or lipid-lowering therapy; HDL <40/50 mg/dL M/F; blood pressure ≥130/85 mmHg or previously diagnosed hypertension or antihypertensive therapy; waist circumference >102/88 cm M/F. A one-year follow-up was conducted to evaluate the incidence of work-related and non-work-related SA (WRSA/NWRSA). The association of BMI with SA was tested using Poisson regression (standard error correction), segmenting on the basis of metabolic phenotype. The overall percentages of workers who were overweight, obese and/or had a metabolically unhealthy phenotype were 37.7%, 16.3% and 8.8%, respectively. BMI was associated with increased incidence of NWRSA in both phenotypes. It was also associated with WRSA in subjects with a BMI in the range of 35-39.99 kg/m² and in metabolically healthy individuals. WRSA was lower in subjects with a BMI ≥40 kg/m² and among metabolically unhealthy individuals.

CONCLUSION

Obesity is associated with health problems that have a significant impact on SA.

Comparison of application of different methods to estimate lifetime cardiovascular risk

BACKGROUND

Recent guidelines recommend assessment of lifetime cardiovascular risk on the basis of traditional risk factors in adults who are not at high short-term risk. The aim of this study is to determine the implications of estimating the lifetime cardiovascular risk in individuals in a large occupational cohort in Spain.

DESIGN

National cross-sectional study in an occupational cohort with an in-person interview including laboratory tests.

METHODS

Volunteer workers who were examined between January 2011 and December 2011 were included. A total of 580,236 workers were eligible during this year and 259,834 were examined (participation rate of 44.7%). Short-term (10-year) and lifetime cardiovascular risk were estimated using the American College of Cardiology (ACC) and the American Heart Association (AHA) tool and the QRISK2 and QRISK.

RESULTS

Sixty-eight per cent were male, mean age was 39 years, with an age range of 16 to 75 years. Total number of individuals included in this study was 258,676. The percentage of patients at high short-term risk was 6.85% (95% confidence interval (CI) 6.75%-6.95% and 20.83% (95% CI 20.60%-21.07%) with the QRISK2, and the ACC/AHA risk equations, respectively. Of the percentage of patients classified as not at high risk with the different tools 1.61% (95% CI 1.55%-1.66%) were high lifetime risk on QRISK, and 27.41% (95% CI 27.11%-27.70%) on ACC/AHA risk.

CONCLUSIONS

Application of lifetime cardiovascular risk engages greater numbers of individuals at high risk with substantial differences between the different methods available. These differences can have important clinical implications specifically in the percentage of candidates for lifestyle changes and eventually lipid lowering drugs.

Prevalence of atherogenic dyslipidemia: association with risk factors and cardiovascular risk in Spanish working population. "ICARIA" study

OBJECTIVE

The aim of this study was to assess the prevalence of atherogenic dyslipidemia (AD) and the lipid triad (LT) in the working population in Spain, their associated variables and how far they are linked to cardiovascular risk (CVR).

METHODS

Observational cross-sectional study of 70,609 workers (71.5% male (M), 28.5% female (F), mean age 39.2 ± 10), who attended medical checkups and agreed to participate. Plasma samples were analysed in a central laboratory. AD definition used was: triglycerides ≥150 mg/dl and HDL cholesterol <40 mg/dl (M)/<50 mg/dl (F) and LT when LDL cholesterol > 160 mg/dl is further added. Univariate comparisons in the absence and presence of AD and LT and the probability of AD according to different parameters and their possible association with CVR were assessed. CVR was stratified following the European SCORE model for low risk-population.

RESULTS

5.7% (95% CI 4.7-6.9) of the working population have AD and 1.1% (95% CI 1.0-1.2) LT. In univariate analysis, workers with AD and LT had a higher prevalence of obesity, hypertension, smoking and diabetes than those who had not (p < 0.001). In multivariate analysis, BMI, sex, age 40-49, diabetes, tobacco, uric acid, LDL or blood pressure significantly influenced the risk of AD. AD was significantly associated with CVR after adjusting for alcohol and obesity. However, most of the AD subjects (91.8%) were classified as low risk.

CONCLUSIONS

About 6% of the working population in Spain meets AD criteria. Assuming that these subjects have increased CVR, AD allows to identify additional 5% of subjects with increased CVR to that one the SCORE model detects, helping to improve cardiovascular risk stratification.

[Predictors of the duration of non-work-related sick leave due to anxiety disorders]

OBJECTIVES

To analyze the duration of non-work-related sick leave due to anxiety disorders and to identify demographic, occupational and clinical variables that may contribute to its prediction.

METHODS

We performed a prospective cohort study of 1,161 workers with an episode of non-work-related sick leave due to an anxiety disorder, belonging to the insured population of a mutual insurance company. We assessed the duration of non-work-related sick leave episodes and the main potentially related demographic, occupational and clinical variables. All non-work-related sick leave processes were followed-up until discharge. Cox regression analyses were conducted to establish the predictors of non-work-related sick leave duration.

RESULTS

The median duration of non-work-related sick leave due to anxiety disorders was 83 days. In a multivariate analysis, the following factors were identified as being significantly associated with increases in the duration of sick leave (p <0.05): age of over 35 years, lower educational level (primary school studies, secondary school studies or high-school diploma vs. university degree), and the existence of comorbidity and unemployment occurring during the sick leave. In contrast, being separated or divorced was associated with an earlier return to work (p <0.05).

CONCLUSIONS

Anxiety disorders are associated with long periods of non-work-related sick leave compared with other disorders and standard time duration. Demographic, occupational and clinical variables collected at the initial assessment of the sick leave episode would help to identify groups with an increased risk of prolonged sick leave, requiring strategies to facilitate return to work.

High cardiovascular risk in Spanish workers

BACKGROUND AND AIMS

To investigate the prevalence of high cardiovascular risk in the Spanish working population, and its distribution among different occupations and gender.

METHODS AND RESULTS

Cross-sectional study of 309,955 workers (72.6% males, mean age 36.5 years, range 16-74 years), who underwent a routine medical check-up. Workers were classified as high, intermediate or low cardiovascular risk, according to the SCORE system. Workers with a relative risk greater than 4 were also considered as high-risk. The prevalence of high cardiovascular risk was 7.6% (95% CI 7.5-7.7) in males and 1.7% (95% CI 1.6-1.8) in females. After adjusting for age and gender, the prevalence of high cardiovascular risk was greater in workers from the Agriculture and Construction sectors than in those from Industry and Service sectors. The prevalence of high cardiovascular risk was higher in blue-collar than in white-collar occupations.

CONCLUSIONS

A sizeable proportion of workers, especially blue-collar males, are at high cardiovascular risk. Knowledge of this risk for certain workers may serve as a basis for preventive strategies.