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Oliva-Sánchez PF, Landeros-López S, Rosas-Dossetti MM, Grobeisen-Levin S, Islas-Martínez JA, Aznar-Guerra D, Valdez-Celiz AP, Soto-Ramírez L. Comparison of Four Predictive Scores for Cardiovascular Risk in Mexican People with HIV. AIDS Res Hum Retroviruses 2024. [PMID: 38666685 DOI: 10.1089/aid.2023.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Persons with HIV (PWH) face an increased risk of cardiovascular events due to immune activation, comorbidities, and certain antiretrovirals (ARVs). However, the current cardiovascular risk (CVR) scores are not specifically directed toward PWH. This study aimed to assess the agreement between different predictive CVR scores and explore their relationship with clinical and demographic data in Mexican PWH. A descriptive cross-sectional analysis was conducted in 200 PWH with a mean age of 42 years who were treated at a Mexican urban center from 2017 to 2018. The majority (83%) was on ARV treatment and 79.5% had undetectable viral loads (VLs). Moderate- to high-risk scores were infrequent, with Framingham Risk Score for Hard Coronary Heart Disease scores showing higher values, with very low concordance among all scores. Logistic regression analysis revealed significant associations between the CVR scores and the initial recorded VL, CD4 cell count, and elevated triglyceride levels. However, no associations were found with measures such as body mass index or abdominal circumference. Treatment with integrase strand transfer inhibitors (INSTIs), particularly first-generation inhibitors, showed strong associations with all predictive scores, notably ASCVD (odds ratio = 7.03, 95% confidence interval 1.67-29.64). The poor concordance among the CVR scores in PWH highlights the need for a specific score that considers comorbidities and ARV drugs. Despite the relatively young age of the participants, significant correlations were observed between INSTI use, initial VL, CD4 cell count, and triglyceride levels, which are factors not considered in the existing risk scores. Regardless of the actual value of the scores, screening for CVR in PWH is recommended.
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Affiliation(s)
- P F Oliva-Sánchez
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana - Xochimilco, Mexico City, Mexico
| | - S Landeros-López
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - M M Rosas-Dossetti
- Hospital General "Vicente Villada", Instituto de Salud del Estado de México, Toluca, Mexico
| | - S Grobeisen-Levin
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana - Xochimilco, Mexico City, Mexico
| | - J A Islas-Martínez
- Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, Mexico
| | - D Aznar-Guerra
- Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, Mexico
| | - A P Valdez-Celiz
- Facultad de Medicina, Universidad Autónoma de Baja California, Mexicali, Mexico
| | - L Soto-Ramírez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de Mexico, Mexico
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Howard G, Cushman M, Blair J, Wilson NR, Yuan Y, Safford MM, Levitan EB, Judd SE, Howard VJ. Comparative Discrimination of Life's Simple 7 and Life's Essential 8 to Stratify Cardiovascular Risk: Is the Added Complexity Worth It? Circulation 2024; 149:905-913. [PMID: 37830200 PMCID: PMC10948319 DOI: 10.1161/circulationaha.123.065472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Life's Simple 7 (LS7) is an easily calculated and interpreted metric of cardiovascular health based on 7 domains: smoking, diet, physical activity, body mass index, blood pressure, cholesterol, and fasting glucose. The Life's Essential 8 (LE8) metric was subsequently introduced, adding sleep metrics and revisions of the previous 7 domains. Although calculating LE8 requires additional information, we hypothesized that it would be a more reliable index of cardiovascular health. METHODS Both the LS7 and LE8 metrics yield scores with higher values indicating lower risk. These were calculated among 11 609 Black and White participants free of baseline cardiovascular disease (CVD) in the Reasons for Geographic and Racial Differences in Stroke study, enrolled in 2003 to 2007, and followed for a median of 13 years. Differences in 10-year risk of incident CVD (coronary heart disease or stroke) were calculated as a function LS7, and LE8 scores were calculated using Kaplan-Meier and proportional hazards analyses. Differences in incident CVD discrimination were quantified by difference in the c-statistic. RESULTS For both LS7 and LE8, the 10-year risk was approximately 5% for participants around the 99th percentile of scores, and a 4× higher 20% risk for participants around the first percentile. Comparing LS7 to LE8, 10-year risk was nearly identical for individuals at the same relative position in score distribution. For example, the "cluster" of 2013 participants with an LS7 score of 7 was at the 35.8th percentile in distribution of LS7 scores, and had an estimated 10-year CVD risk of 8.4% (95% CI, 7.2%-9.8%). In a similar location in the LE8 distribution, the 1457 participants with an LE8 score of 60±2.5 at the 39.4th percentile of LE8 scores had a 10-year risk of CVD of 8.5% (95% CI, 7.1%-10.1%), similar to the cluster defined by LS7. The age-race-sex adjusted c-statistic of the LS7 model was 0.691 (95% CI, 0.667-0.705), and 0.695 for LE8 (95% CI, 0.681-0.709) (P for difference, 0.12). CONCLUSIONS Both LS7 and LE8 were associated with incident CVD, with discrimination of the 2 indices practically indistinguishable. As a simpler metric, LS7 may be favored for use by the general population and clinicians.
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Affiliation(s)
- George Howard
- Department of Biostatistics, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL
| | - Mary Cushman
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Jessica Blair
- Department of Biostatistics, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL
| | - Nicole R. Wilson
- Department of Biostatistics, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL
| | - Ya Yuan
- Department of Biostatistics, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL
| | - Monika M. Safford
- Department of Internal Medicine, Weill Cornell Medical Center, New York, NY
| | - Emily B. Levitan
- Department of Epidemiology, UAB School of Public Health, Birmingham, AL
| | - Suzanne E. Judd
- Department of Biostatistics, University of Alabama at Birmingham (UAB) School of Public Health, Birmingham, AL
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Nordin S, Norberg M, Braf I, Johansson H, Lindahl B, Lindvall K, Nordin M, Nyman E, Vallström C, Wennberg P, Liv P, Näslund U. Associations between emotional support and cardiovascular risk factors and subclinical atherosclerosis in middle-age. Psychol Health 2023:1-15. [PMID: 37994844 DOI: 10.1080/08870446.2023.2286296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/31/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To test the hypothesis of low emotional support being associated with lifestyle and biomedical cardiovascular disease (CVD) risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults. METHODS AND MEASURES Cross-sectional data were obtained from participants aged 40-60 years who had one or more conventional CVD risk factor. They underwent assessment based on questionnaires, clinical examination, blood sampling, and carotid ultrasound of plaque formation and carotid intima-media wall thickness (cIMT). Based on the Interview Schedule for Social Interaction, the participants were categorised as either low in emotional support (n = 884) or as a referent (n = 2570). Logistic regression analyses were conducted to study the associations. RESULTS Logistic regression analyses showed that low emotional support was significantly associated with smoking, alcohol consumption and physical inactivity (OR = 1.53 - 1.94), estimated risk of CVD morbidity and mortality (OR = 1.56 - 1.68), and plaque formation (OR = 1.39). No significant associations were found regarding biomedical CVD risk factors or cIMT. CONCLUSION The findings suggest that low social support is associated with lifestyle CVD risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults, encouraging causal evaluation with longitudinal data investigating an impact of emotional support on mechanisms underlying CVD.
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Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Margareta Norberg
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Irma Braf
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Helene Johansson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bernt Lindahl
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kristina Lindvall
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Maria Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Emma Nyman
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Patrik Wennberg
- Section of Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Uyan U. Comparison of HEAR and HEART Scores for Major Adverse Cardiovascular Events. Cureus 2023; 15:e46721. [PMID: 38021826 PMCID: PMC10630923 DOI: 10.7759/cureus.46721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Early identification of patients with low and high risk for acute coronary syndrome in the emergency department (ED) is important for process management and proper resource use. The aim of this study was to compare the HEAR and HEART scores to determine the risk for major adverse cardiovascular events (MACE) over 30 days. METHODS Demographic data and clinical evaluations of the patients who presented to the ED with chest pain were recorded. ECGs were evaluated without knowing the clinical status of the patients. The HEART (including history, ECG, age, coronary risk factors, and troponin level) and HEAR (including four items with no troponin) risk scores were calculated. MACE was defined as all MI, all coronary revascularization procedures (PCI and CABG), all-cause death, cardiac arrest, cardiogenic shock, or life-threatening cardiac arrhythmias within 30 days. Patients with MACE were evaluated as Group 1, and patients without MACE were considered as Group 2, and the data from the two groups were compared. RESULTS A total of 230 patients were included in the study. There were 56 (24.3%) patients with MACEs. According to the ROC analysis, the threshold value was determined as ≤3 for both scoring systems. According to this threshold value, sensitivity and specificity were found to be 0.77 and 0.78 for the HEAR score and 0.82 and 0.77 for the HEART score. CONCLUSIONS Although the HEAR and HEART scoring systems are useful for the management of patients with chest pain in the ED, the HEART score was evaluated to be more effective.
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Affiliation(s)
- Umut Uyan
- Department of Cardiology, İzmir Ödemiş State Hospital, İzmir, TUR
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Hwang IC, Kim CH, Kim JY, Choi HM, Yoon YE, Cho GY. Rate of Change in 10-Year Atherosclerotic Cardiovascular Disease Risk and Its Implications for Primary Prevention. Hypertension 2023; 80:1697-1706. [PMID: 37470768 DOI: 10.1161/hypertensionaha.122.20678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/09/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Contemporary cardiovascular primary prevention is based on the assessment of the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). However, the clinical implications of temporal change in the 10-year ASCVD risk estimate (∆10-year ASCVD risk/year) are unknown. METHODS A total of 211 077 participants without established ASCVD and with repetitive 10-year ASCVD risk assessment at an interval of 4 to 5 years were selected from the Korean National Health Insurance Service data. The primary end point was a composite of myocardial infarction, stroke, coronary revascularization, and all-cause death. RESULTS ASCVD event rates were proportional to the ∆10-year ASCVD risk/year regardless of the baseline 10-year ASCVD risk. Adjusted hazard ratio for ASCVD events per 1% increase in ∆10-year ASCVD risk/year was 1.53 (95% CI, 1.44-1.63), 1.24 (95% CI, 1.15-1.32), 1.18 (95% CI, 1.13-1.23), and 1.05 (95% CI, 1.00-1.10) in those with a baseline 10-year ASCVD risk of <5%, 5% to 7.5%, 7.5% to 20%, and ≥20%, respectively. Appropriate control of risk factors, including low-density lipoprotein cholesterol, blood pressure, body mass index, exercise habits, and smoking status, was associated with lower ASCVD event rates, whereas failure to control these risk factors resulted in higher ASCVD event rates. CONCLUSIONS The temporal change in 10-year ASCVD risk over a period of 4 to 5 years reflects success or failure in controlling major cardiovascular risk factors and indicates the risk of future ASCVD events. The ∆10-year ASCVD risk/year can be used as an indicator of primary prevention and guide the application of preventive measures.
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Affiliation(s)
- In-Chang Hwang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea (I.-C.H., H.-M.C., Y.E.Y., G.-Y.C.)
- Department of Internal Medicine, Seoul National University College of Medicine, South Korea (I.-C.H., H.-M.C., Y.E.Y., G.-Y.C.)
| | - Chee Hae Kim
- Veteran Health Service Medical Center, Seoul, South Korea (C.H.K.)
| | - Jae-Young Kim
- Department of Statistics, Soonchunhyang University Bucheon Hospital, Gyeonggi, South Korea (J.-Y.K.)
| | - Hong-Mi Choi
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea (I.-C.H., H.-M.C., Y.E.Y., G.-Y.C.)
- Department of Internal Medicine, Seoul National University College of Medicine, South Korea (I.-C.H., H.-M.C., Y.E.Y., G.-Y.C.)
| | - Yeonyee E Yoon
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea (I.-C.H., H.-M.C., Y.E.Y., G.-Y.C.)
- Department of Internal Medicine, Seoul National University College of Medicine, South Korea (I.-C.H., H.-M.C., Y.E.Y., G.-Y.C.)
| | - Goo-Yeong Cho
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea (I.-C.H., H.-M.C., Y.E.Y., G.-Y.C.)
- Department of Internal Medicine, Seoul National University College of Medicine, South Korea (I.-C.H., H.-M.C., Y.E.Y., G.-Y.C.)
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Qin L, Luo Q, Hu Y, Yan S, Yang X, Zhang Y, Xiong F, Wang H. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk. Open Med (Wars) 2023; 18:20230703. [PMID: 37215054 PMCID: PMC10193404 DOI: 10.1515/med-2023-0703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Framingham risk score (FRS), systematic coronary risk evaluation (SCORE), the 10-year atherosclerotic cardiovascular disease risk algorithm (ASCVD), and their modified risk scores are the most common cardiovascular risk scores. The aim of this case-control study was to evaluate the performance of cardiovascular risk scores in detecting carotid subclinical atherosclerosis (SCA) in patients with idiopathic inflammatory myopathies (IIMs). A total of 123 IIMs patients (71.5% female, mean age 50 ± 14 years) and 123 age- and gender-matched healthy controls were included in this study. Carotid SCA was more prevalent in IIMs patients compared with controls (77.2 vs 50.4%, P < 0.001). Moreover, patients with carotid SCA+ had older age, and all risk scores were significantly higher in IIMs patients with SCA+ compared to subjects with SCA- (all P < 0.001). According to FRS, SCORE, and ASCVD risk scores, 77.9, 96.8, and 66.7% patients with SCA+ were classified as low risk category, respectively. The modified scores also demonstrated a modest improvement in sensitivity. Notably, by adopting the optimal cutoff values, these risk scores had good discrimination on patients with SCA+, with area under curves of 0.802-0.893. In conclusion, all cardiovascular risk scores had a poor performance in identifying IIMs patients at high cardiovascular risk.
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Affiliation(s)
- Li Qin
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, 610031, Sichuan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Qiang Luo
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, 610031, Sichuan, China
| | - Yinlan Hu
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, 610031, Sichuan, China
| | - Shuangshuang Yan
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, 610031, Sichuan, China
| | - Xiaoqian Yang
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, 610031, Sichuan, China
| | - Yiwen Zhang
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, 610031, Sichuan, China
| | - Feng Xiong
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, No. 82, Qinglong Street,, Chengdu, 610031, Sichuan, China
| | - Han Wang
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, No. 82, Qinglong Street,, Chengdu, 610031, Sichuan, China
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Li Y, Xu Y, Le Roy C, Hu J, Steves CJ, Bell JT, Spector TD, Gibson R, Menni C, Rodriguez-Mateos A. Interplay between the (Poly)phenol Metabolome, Gut Microbiome, and Cardiovascular Health in Women: A Cross-Sectional Study from the TwinsUK Cohort. Nutrients 2023; 15:nu15081900. [PMID: 37111123 PMCID: PMC10141398 DOI: 10.3390/nu15081900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Dietary (poly)phenol consumption is inversely associated with cardiovascular disease (CVD) risk in epidemiological studies, but little is known about the role of the gut microbiome in this relationship. METHODS In 200 healthy females, aged 62.0 ± 10.0 years, from the TwinsUK cohort, 114 individual (poly)phenol metabolites were measured from spot urine using ultra-high-performance liquid chromatography-mass spectrometry. The associations between metabolites, the gut microbiome (alpha diversity and genera), and cardiovascular scores were investigated using linear mixed models adjusting age, BMI, fibre, energy intake, family relatedness, and multiple testing (FDR < 0.1). RESULTS Significant associations were found between phenolic acid metabolites, CVD risk, and the gut microbiome. A total of 35 phenolic acid metabolites were associated with the Firmicutes phylum, while 5 metabolites were associated with alpha diversity (FDR-adjusted p < 0.05). Negative associations were observed between the atherosclerotic CVD (ASCVD) risk score and five phenolic acid metabolites, two tyrosol metabolites, and daidzein with stdBeta (95% (CI)) ranging from -0.05 (-0.09, -0.01) for 3-(2,4-dihydroxyphenyl)propanoic acid to -0.04 (-0.08, -0.003) for 2-hydroxycinnamic acid (FDR-adjusted p < 0.1). The genus 5-7N15 in the Bacteroidetes phylum was positively associated with the same metabolites, including 3-(3,5-dihydroxyphenyl)propanoic acid, 3-(2,4-dihydroxyphenyl)propanoic acid, 3-(3,4-dihydroxyphenyl)propanoic acid), 3-hydroxyphenylethanol-4-sulfate, and 4-hydroxyphenylethanol-3-sulfate)(stdBeta (95% CI): 0.23 (0.09, 0.36) to 0.28 (0.15, 0.42), FDR-adjusted p < 0.05), and negatively associated with the ASCVD score (stdBeta (95% CI): -0.05 (-0.09, -0.01), FDR-adjusted p = 0.02). Mediation analysis showed that genus 5-7N15 mediated 23.8% of the total effect of 3-(3,4-dihydroxyphenyl)propanoic acid on the ASCVD score. CONCLUSIONS Coffee, tea, red wine, and several vegetables and fruits, especially berries, are the most abundant food sources of phenolic acids that have the strongest associations with CVD risk. We found that the gut microbiome, particularly the genus 5-7N15, partially mediates the negative association between urinary (poly)phenols and cardiovascular risk, supporting a key role of the gut microbiome in the health benefits of dietary (poly)phenols.
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Affiliation(s)
- Yong Li
- Department of Nutritional Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Yifan Xu
- Department of Nutritional Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Caroline Le Roy
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Jiaying Hu
- Department of Nutritional Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Jordana T Bell
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Rachel Gibson
- Department of Nutritional Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Ana Rodriguez-Mateos
- Department of Nutritional Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
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Ocsovszky Z, Martos T, Otohal J, Berényi B, Merkely B, Csabai M, Bagyura Z. [Relationship between cardiovascular risk assessment and health behavior in the light of psychosocial factors.]. Orv Hetil 2023; 164:119-131. [PMID: 36709436 DOI: 10.1556/650.2023.32685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Even though preventive measures have been taken to reduce cardiovascular risk, cardiovascular mortality is increasing. Cardiovascular screening can be a population strategy that contributes to the reduction of mortality over the long term when implemented in a systematic, protocol-based, expanded manner. OBJECTIVE In this study, we examine changes in participants' health behavior between 2012 and 2019 as a follow-up to the Budakalász Epidemiological Study (BEV). METHOD A cardiovascular health index was developed to enable effective follow-up. This study included subjects with medium and high cardiovascular risks who participated in the BEV complex cardiovascular risk assessment in 2012 (n = 502). Besides the basic data from the BEV baseline study (demographics, healthy lifestyle, risk behavior, diseases treated by medicine), the 2019 follow-up questionnaire included newly added psychological questionnaires (Perceived Stress, WHO Well-being, Beck Hopelessness Scale, Health-Related Social Support, ABCD Risk Questionnaire). RESULTS All factors of the cardiovascular health index created in our analysis showed an improvement of over 70% between 2012 and 2019. 37.6% of the participants did something for their health, according to their confession, by 30.3%, BEV had a big or very big impact on their lives from the 2012 BEV test in the year after the test, and by 24.7%, BEV had and still has a big or very big impact on their lives. The improving health indices show a significant correlation with psychological factors. Psychological factors showed a positive correlation with well-being (tau_b = 0.344) and a negative correlation with perceived stress (tau_b = -0.225) and hopelessness (tau_b = -0.206). CONCLUSION The participants in the study showed a significant change in health behavior seven years after the BEV cardiovascular risk assessment. A higher level of mental well-being is associated with improved values. By analyzing the impact of BEV on the health behavior change and the lifestyle, we can conclude that the cardiovascular risk assessment facilitates health behavior change. Orv Hetil. 2023; 164(4): 119-131.
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Affiliation(s)
- Zsófia Ocsovszky
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika Budapest, Városmajor u. 68., 1122 Magyarország
| | - Tamás Martos
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Pszichológiai Intézet Szeged Magyarország
| | - József Otohal
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika Budapest, Városmajor u. 68., 1122 Magyarország
| | - Blanka Berényi
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika Budapest, Városmajor u. 68., 1122 Magyarország
| | - Béla Merkely
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika Budapest, Városmajor u. 68., 1122 Magyarország
| | - Márta Csabai
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Elméleti és Transzlációs Orvostudományok Doktori Iskola Budapest Magyarország
| | - Zsolt Bagyura
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika Budapest, Városmajor u. 68., 1122 Magyarország.,3 Semmelweis Egyetem, Általános Orvostudományi Kar, Elméleti és Transzlációs Orvostudományok Doktori Iskola Budapest Magyarország
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Lontano A, Marziali E, Galletti C, Mazza E, Gambioli S, Galasso V, Mingarelli A, D'Ambrosio F, Tamburrano A, Paolini M, Bande A, Damiani G, de Waure C, Laurenti P. A real opportunity to modify cardiovascular risk through primary care and prevention: A pilot study. Front Public Health 2023; 10:1009246. [PMID: 36703856 PMCID: PMC9871452 DOI: 10.3389/fpubh.2022.1009246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Cardiovascular diseases (CVDs) represent a major threat to health and primary prevention outstands as the most effective instrument to face this issue, addressing multiple risk factors at a time and influencing behavioral patterns. Community nurses have been involved in many interdisciplinary prevention activities, resulting in effective control of CV risk factors. We conducted a pilot study aiming at describing the impact on the CV risk profile of an 18-month interdisciplinary intervention on lifestyle habits. From September 2018 to May 2020, four general practitioners (GPs) working in the Roman neighborhood of Torresina recruited patients having a cardiovascular risk score (CRS) equal to or higher than 3% and lower than 20%; those patients were included in a nutritional, physical, and psychological counseling program. Assessments of patients' health status were led at baseline, 6, 12, and 18 months by a nutritionist, a physiotherapist, a psychologist, their GPs, and a community nurse. The CRS was estimated at every examination, based on the Italian Progetto Cuore algorithm. A total of 76 patients were included (mean age of 54.6 years; 33 men and 43 women). Mean CRS showed a significant reduction between baseline and 12 months (from 4.9 to 3.8); both total cholesterol and systolic blood pressure (SBP) significantly decreased at 6 months of follow-up (respectively, from 211.1 to 192 and from 133.1 to 123.1). Nonetheless, the reduction was later maintained only for SBP. However, during the last 6 months of the intervention, the COVID-19 pandemic broke out, thus, it is not possible to know how much the results achieved at 18 months were influenced by the restrictive measures introduced by the Italian government. When stratifying according to the presence of hypertension/diabetes and physical activity, no differences in the CRS could be highlighted between the two groups. Our pilot study proved that an interdisciplinary counseling intervention program can improve CV risk profile and could be further spread to people that, according to their CRS, would benefit more from changes in lifestyles.
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Affiliation(s)
| | - Eleonora Marziali
- Università Cattolica del Sacro Cuore, Rome, Italy,*Correspondence: Eleonora Marziali ✉
| | | | - Eduardo Mazza
- Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | | | | | - Alessandro Mingarelli
- DiagnostiCare ONLUS, Rome, Italy,Scuola di Specializzazione in Psicologia della Salute–Università degli Studi di Roma “La Sapienza”, Rome, Italy
| | | | | | | | | | - Gianfranco Damiani
- Università Cattolica del Sacro Cuore, Rome, Italy,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Patrizia Laurenti
- Università Cattolica del Sacro Cuore, Rome, Italy,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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10
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Strongman H, Herrett E, Jackson R, Sweeting M, Lyon AR, Stanway S, Lawson C, Kadam U, Smeeth L, Bhaskaran K. Cancer history as a predictor in cardiovascular risk scores: a primary care cohort study. Br J Gen Pract 2023; 73:e34-42. [PMID: 36443065 DOI: 10.3399/BJGP.2022.0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/03/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cardiovascular risks are raised in cancer survivors but cancer history is not included in cardiovascular risk scores that inform preventive decisions. AIM To assess whether cancer diagnosis should be included in cardiovascular risk scores. DESIGN AND SETTING Cohort study using data from English general practices linked to hospital, cancer registration, and death registration data from 1990 to 2015. METHOD Adults alive 1 year after a first cancer diagnosis and age, sex, general practice, and calendar- time matched cancer-free individuals were included. Individuals with <2 years of follow-up before index, recent statin prescriptions, or pre-existing coronary heart or cerebrovascular disease were excluded. Cox proportional hazard models used to develop QRISK3 scores were replicated with added cancer history variables. Whether independent hazard ratios for these variables met thresholds for inclusion in QRISK3 (>10% relative difference with P<0.01) was assessed. RESULTS In total, 81 420 cancer survivors and 413 547 cancer-free individuals were followed for a median 5.2 years (interquartile range [IQR] 2.8- 9.1) and 6.3 years (IQR 3.5-10.2), respectively. Including a 1-year cancer survivorship variable in a QRISK3-based model met the threshold for inclusion for males (independent hazard ratio [iHR] 1.16, 95% confidence interval [CI] = 1.11 to 1.20, P<0.001) but not females (iHR 1.07, 95% CI = 1.01 to 1.14, P = 0.02). When including cancer type, the threshold was met for both sexes with history of haematological cancer (males: iHR 1.27, 95% CI = 1.16 to 1.40, P <0.001; females: iHR 1.59, 95% CI = 1.32 to 1.91, P<0.001) and for males but not females with history of solid cancers (males: iHR 1.13, 95% CI = 1.08 to 1.18, P <0.001; females: iHR 1.04, 95% CI = 0.98 to 1.10, P = 0.19). CONCLUSION Developers should consider including cancer history variables in future cardiovascular risk models.
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11
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Neri L, Lonati C, Titapiccolo JI, Nadal J, Meiselbach H, Schmid M, Baerthlein B, Tschulena U, Schneider MP, Schultheiss UT, Barbieri C, Moore C, Steppan S, Eckardt KU, Stuard S, Bellocchio F. The Cardiovascular Literature-Based Risk Algorithm (CALIBRA): Predicting Cardiovascular Events in Patients With Non-Dialysis Dependent Chronic Kidney Disease. Front Nephrol 2022; 2:922251. [PMID: 37675027 PMCID: PMC10479593 DOI: 10.3389/fneph.2022.922251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/20/2022] [Indexed: 09/08/2023]
Abstract
Background and Objectives Cardiovascular (CV) disease is the main cause of morbidity and mortality in patients suffering from chronic kidney disease (CKD). Although it is widely recognized that CV risk assessment represents an essential prerequisite for clinical management, existing prognostic models appear not to be entirely adequate for CKD patients. We derived a literature-based, naïve-bayes model predicting the yearly risk of CV hospitalizations among patients suffering from CKD, referred as the CArdiovascular, LIterature-Based, Risk Algorithm (CALIBRA). Methods CALIBRA incorporates 31 variables including traditional and CKD-specific risk factors. It was validated in two independent CKD populations: the FMC NephroCare cohort (European Clinical Database, EuCliD®) and the German Chronic Kidney Disease (GCKD) study prospective cohort. CALIBRA performance was evaluated by c-statistics and calibration charts. In addition, CALIBRA discrimination was compared with that of three validated tools currently used for CV prediction in CKD, namely the Framingham Heart Study (FHS) risk score, the atherosclerotic cardiovascular disease risk score (ASCVD), and the Individual Data Analysis of Antihypertensive Intervention Trials (INDANA) calculator. Superiority was defined as a ΔAUC>0.05. Results CALIBRA showed good discrimination in both the EuCliD® medical registry (AUC 0.79, 95%CI 0.76-0.81) and the GCKD cohort (AUC 0.73, 95%CI 0.70-0.76). CALIBRA demonstrated improved accuracy compared to the benchmark models in EuCliD® (FHS: ΔAUC=-0.22, p<0.001; ASCVD: ΔAUC=-0.17, p<0.001; INDANA: ΔAUC=-0.14, p<0.001) and GCKD (FHS: ΔAUC=-0.16, p<0.001; ASCVD: ΔAUC=-0.12, p<0.001; INDANA: ΔAUC=-0.04, p<0.001) populations. Accuracy of the CALIBRA score was stable also for patients showing missing variables. Conclusion CALIBRA provides accurate and robust stratification of CKD patients according to CV risk and allows score calculations with improved accuracy compared to established CV risk scores also in real-world clinical cohorts with considerable missingness rates. Our results support the generalizability of CALIBRA across different CKD populations and clinical settings.
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Affiliation(s)
- Luca Neri
- Clinical and Data Intelligence Systems-Advanced Analytics, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco, Italy
| | - Caterina Lonati
- Center for Preclinical Research, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jasmine Ion Titapiccolo
- Clinical and Data Intelligence Systems-Advanced Analytics, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco, Italy
| | - Jennifer Nadal
- Department of Medical Biometry, Informatics, and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Heike Meiselbach
- Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnber, Erlangen, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics, and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Barbara Baerthlein
- Medical Centre for Information and Communication Technology (MIK), University Hospital Erlangen, Erlangen, Germany
| | | | - Markus P. Schneider
- Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnber, Erlangen, Germany
| | - Ulla T. Schultheiss
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
- Department of Medicine IV – Nephrology and Primary Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Carlo Barbieri
- Fresenius Medical Care, Deutschland GmbH, Bad Homburg, Germany
| | - Christoph Moore
- Fresenius Medical Care, Deutschland GmbH, Bad Homburg, Germany
| | - Sonia Steppan
- Fresenius Medical Care, Deutschland GmbH, Bad Homburg, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnber, Erlangen, Germany
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stefano Stuard
- Fresenius Medical Care, Deutschland GmbH, Bad Homburg, Germany
| | - Francesco Bellocchio
- Clinical and Data Intelligence Systems-Advanced Analytics, Fresenius Medical Care Deutschland GmbH, Vaiano Cremasco, Italy
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12
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Sanz JM, Sergi D, Colombari S, Capatti E, Situlin R, Biolo G, Di Girolamo FG, Lazzer S, Šimunič B, Pišot R, Passaro A. Dietary Acid Load but Not Mediterranean Diet Adherence Score Is Associated With Metabolic and Cardiovascular Health State: A Population Observational Study From Northern Italy. Front Nutr 2022; 9:828587. [PMID: 35558749 PMCID: PMC9087734 DOI: 10.3389/fnut.2022.828587] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/14/2022] [Indexed: 12/28/2022] Open
Abstract
Diet plays a pivotal role in shaping the trajectory of chronic diseases. In this regard, the Mediterranean diet has been widely shown to exert beneficial effects on cardiometabolic health. On the contrary, the Western diet, which has also been reported to be an acidogenic dietary pattern, elicits detrimental effects on both metabolic and cardiovascular (CV) health. However, the role of dietary acid load (DAL) as a predictor of cardiometabolic prognosis remains to be elucidated. Thus, this study aims to compare Mediterranean diet adherence (MDA) and DAL focusing on their relationship with metabolic and CV prognosis. A total of 448 individuals aged 55–80 years were grouped depending on their MDA, assessed using food frequency questionnaires, or DAL, evaluated using potential renal load acid (PRAL) and net-endogenous acid production (NEAP). Study participants underwent anthropometric and biochemical measurements. The metabolic syndrome (MetS) prevalence was evaluated according to the National Cholesterol Education Program-Adult Treatment Panel III. Finally, the CV risk was evaluated using three independent algorithms: atherosclerotic cardiovascular disease (ASCVD), European Systematic COronary Risk Evaluation (SCORE), and Cuore risk scores. Mediterranean diet adherence was negatively associated with PRAL and NEAP. Individuals in the higher MDA tertile group had higher HDL cholesterol as well as lower homeostasis model assessment index (HOMA-IR) and fat mass relative to the lowest MDA tertile. However, in the high-MDA tertile group, there was neither a significantly lower MetS prevalence nor CV risk. Instead, both the MetS prevalence and CV risk were higher in individuals in the higher acid PRAL quartile relative to the lower alkaline PRAL quartile. Dietary acid load, especially assessed using PRAL but not MDA, was associated with indices of metabolic and CV prognosis. Thus, DAL assessed by 24-h dietary recalls may represent a better predictor of cardiometabolic health if compared to MDA evaluated using food frequency questionnaires.
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Affiliation(s)
- Juana Maria Sanz
- Department of Chemical and Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Domenico Sergi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Simona Colombari
- University Hospital of Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | - Eleonora Capatti
- University Hospital of Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | - Roberta Situlin
- Department of Medical Surgical and Health Sciences, Clinica Medica ASUGI, University of Trieste, Trieste, Italy
| | - Gianni Biolo
- Department of Medical Surgical and Health Sciences, Clinica Medica ASUGI, University of Trieste, Trieste, Italy
| | - Filippo Giorgio Di Girolamo
- Department of Medical Surgical and Health Sciences, Clinica Medica ASUGI, University of Trieste, Trieste, Italy.,Hospital Pharmacy, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy
| | - Boštjan Šimunič
- Institute for Kinesiology Research, Science and Research Center of Koper, Koper, Slovenia
| | - Rado Pišot
- Institute for Kinesiology Research, Science and Research Center of Koper, Koper, Slovenia
| | - Angelina Passaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,University Hospital of Ferrara Arcispedale Sant'Anna, Ferrara, Italy
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13
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Asil S, Murat E, Taşkan H, Barış VÖ, Görmel S, Yaşar S, Çelik M, Yüksel UÇ, Kabul HK, Barçın C. Relationship between Cardiovascular Disease Risk and Neck Circumference Shown in the Systematic Coronary Risk Estimation (SCORE) Risk Model. Int J Environ Res Public Health 2021; 18:10763. [PMID: 34682509 PMCID: PMC8535320 DOI: 10.3390/ijerph182010763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The most important way to reduce CVD-related mortality is to apply appropriate treatment according to the risk status of the patients. For this purpose, the SCORE risk model is used in Europe. In addition to these risk models, some anthropometric measurements are known to be associated with CVD risk and risk factors. OBJECTIVES This study aimed to investigate the association of these anthropometric measurements, especially neck circumference (NC), with the SCORE risk chart. METHODS This was planned as a cross-sectional study. The study population were classified according to their SCORE risk values. The relationship of NC and other anthropometric measurements with the total cardiovascular risk indicated by the SCORE risk was investigated. RESULTS A total of 232 patients were included in the study. The patients participating in the study were analysed in four groups according to the SCORE ten-year total cardiovascular mortality risk. As a result, the NC was statistically significantly lower among the SCORE low and moderate risk group than all other SCORE risk groups (low-high and very high 36(3)-38(4) (IQR) p: 0.026, 36(3)-39(4) (IQR) p < 0.001, 36(3)-40(4) (IQR) p < 0.001), (moderate-high and very high 38(4) vs. 39(4) (IQR) p: 0.02, 38(4) vs. 40(4) (IQR) p < 0.001, 39(4) vs. 40(4) (IQR) p > 0.05). NC was found to have the strongest correlation with SCORE than the other anthropometric measurements. CONCLUSIONS Neck circumference correlates strongly with the SCORE risk model which shows the ten-year cardiovascular mortality risk and can be used in clinical practice to predict CVD risk.
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Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Ender Murat
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Hatice Taşkan
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Veysel Özgür Barış
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Training and Research Hospital, 27010 Gaziantep, Turkey;
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Salim Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Hasan Kutsi Kabul
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
| | - Cem Barçın
- Department of Cardiology, Gülhane Training and Research Hospital, 06010 Ankara, Turkey; (E.M.); (H.T.); (S.G.); (S.Y.); (M.Ç.); (U.Ç.Y.); (H.K.K.); (C.B.)
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14
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Jeon-Slaughter H, Chen X, Ramanan B, Tsai S. Assessing Performance of the Veterans Affairs Women Cardiovascular Risk Model in Predicting a Short-Term Risk of Cardiovascular Disease Incidence Using United States Veterans Affairs COVID-19 Shared Data. Int J Environ Res Public Health 2021; 18:ijerph181910005. [PMID: 34639306 PMCID: PMC8508488 DOI: 10.3390/ijerph181910005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
The current study assessed performance of the new Veterans Affairs (VA) women cardiovascular disease (CVD) risk score in predicting women veterans’ 60-day CVD event risk using VA COVID-19 shared cohort data. The study data included 17,264 women veterans—9658 White, 6088 African American, and 1518 Hispanic women veterans—ever treated at US VA hospitals and clinics between 24 February and 25 November 2020. The VA women CVD risk score discriminated patients with CVD events at 60 days from those without CVD events with accuracy (area under the curve) of 78%, 50%, and 83% for White, African American, and Hispanic women veterans, respectively. The VA women CVD risk score itself showed good accuracy in predicting CVD events at 60 days for White and Hispanic women veterans, while it performed poorly for African American women veterans. The future studies are needed to identify non-traditional factors and biomarkers associated with increased CVD risk specific to African American women and incorporate them to the CVD risk assessment.
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Affiliation(s)
- Haekyung Jeon-Slaughter
- VA North Texas Health Care System, Dallas, TX 75216, USA; (B.R.); (S.T.)
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Correspondence:
| | | | - Bala Ramanan
- VA North Texas Health Care System, Dallas, TX 75216, USA; (B.R.); (S.T.)
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Shirling Tsai
- VA North Texas Health Care System, Dallas, TX 75216, USA; (B.R.); (S.T.)
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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15
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Wu X, Wang H, Chen C, Xiong Y, Zhu L, Jia J, Yang T, Ma F. The association between cardiovascular risk burden and cognitive function amongst the old: a 9-year longitudinal cohort study. Eur J Neurol 2021; 28:2907-2912. [PMID: 34075662 DOI: 10.1111/ene.14947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Cardiovascular risk burden in midlife has been linked to cognitive decline in later life, but whether this association still exists in older cohorts is unclear. METHODS The association between the cardiovascular risk score and cognitive function was investigated using 9-year follow-up data. The risk score algorithms were from the Chinese guidelines on the prevention and treatment of dyslipidemia in adults (2016 revised), which were assessed at baseline and categorized into tertiles (low, middle and high). Full intelligence quotient (FIQ), verbal intelligence quotient (VIQ) and performance intelligence quotient (PIQ) were assessed at follow-ups with the Wechsler Adult Intelligence Scale-Chinese, revised (WAIS-RC). Data were analyzed using the linear mixed-effects model. RESULTS A total of 924 participants (mean age 78.06 ± 7.58 years) were included in our study. In all participants, the risk score ranged from 0.02 to 0.55 (mean score 0.16 ± 0.08). Compared with the low tertile, a higher risk score was associated with lower FIQ (β -0.094, 95% confidence interval [CI] -0.181, -0.007) and VIQ (β -0.100; 95% CI -0.192, -0.007) at the follow-up. There is a more significant association between higher risk score and lower FIQ amongst females (β -0.263; 95% CI -0.462, -0.065) and VIQ (β -0.268; 95% CI -0.478, -0.057). CONCLUSIONS A higher cardiovascular risk score was associated with lower FIQ and VIQ. Higher cardiovascular risk burden increased the risk of cognition impairment and accelerated its progression over time. This study has implications for early detection of cognition impairment.
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Affiliation(s)
- Xiaomin Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Hualou Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Chong Chen
- Department of Clinical Laboratory, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, National Human Genetic Resources Sharing Service Platform, Tianjin, China
| | - Ying Xiong
- Department of Community Service, Wangdingdi Hospital of Tianjin Nankai District, Tianjin, China
| | - Liping Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Jingya Jia
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Tong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Fei Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
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16
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Masyuko SJ, Page ST, Kinuthia J, Osoti AO, Polyak SJ, Otieno FC, Kibachio JM, Mogaka JN, Temu TM, Zifodya JS, Otedo A, Nakanjako D, Hughes JP, Farquhar C. Metabolic syndrome and 10-year cardiovascular risk among HIV-positive and HIV-negative adults: A cross-sectional study. Medicine (Baltimore) 2020; 99:e20845. [PMID: 32629671 PMCID: PMC7337552 DOI: 10.1097/md.0000000000020845] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To determine the prevalence and correlates of metabolic syndrome (MetS) and compare 10-year cardiovascular disease (CVD) risk among Kenyan adults with and without HIV infection.We conducted a cross-sectional study among adults ≥30 years of age with and without HIV infection seeking care at Kisumu County Hospital. Participants completed a health questionnaire and vital signs, anthropomorphic measurements, and fasting blood were obtained. MetS was defined using 2009 Consensus Criteria and 10-year Atherosclerotic CVD (ASCVD) risk score was calculated. Chi-square, independent t tests, Wilcoxon ranksum test and multivariable logistic regression were used to determine differences and associations between HIV and MetS, CVD risk factors and ASCVD risk score.A total of 300 people living with HIV (PLWHIV) and 298 HIV-negative participants with median age 44 years enrolled, 50% of whom were female. The prevalence of MetS was 8.9% overall, but lower among PLWHIV than HIV-negative participants (6.3% vs 11.6%, respectively; P = .001). The most prevalent MetS components were elevated blood pressure, decreased high density lipoprotein, and abdominal obesity. Adjusting for covariates, PLWHIV were 66% less likely to have MetS compared to HIV-negative participants (adjusted odds ratio [aOR] 0.34; 95% confidence interval [95%CI] 0.18, 0.65; P = .005). Median ASCVD risk score was also lower among PLWHIV compared to HIV-negative participants (1.7% vs 3.0%, P = .002).MetS was more common among HIV-negative than HIV-positive adults, and HIV-negative adults were at greater risk for CVD compared to PLWHIV. These data support integration of routine CVD screening and management into health programs in resource-limited settings, regardless of HIV status.
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Affiliation(s)
| | - Stephanie T. Page
- Department of Global Health
- Department of Medicine, University of Washington, Seattle, WA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital
| | - Alfred O. Osoti
- Department of Global Health
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Stephen J. Polyak
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Fredrick C. Otieno
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | | | | | | | | | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Carey Farquhar
- Department of Global Health
- Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
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Ghaddar F, Salameh P, Saleh N, Farhat F, Chahine R, Lahoud N, Hleyhel M, Zeidan RK. Noncardiac Lebanese hospitalized adult patients' awareness of their coronary artery disease risk factors. Vasc Health Risk Manag 2018; 14:371-382. [PMID: 30510428 PMCID: PMC6231450 DOI: 10.2147/vhrm.s176167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Noncommunicable diseases are the leading cause of death in Lebanon, with cardiovascular diseases accounting for almost half of the annual deaths. PURPOSE We aimed to determine awareness of noncardiac Lebanese hospitalized patients for their coronary artery disease risk factors, their level of adherence to medications or lifestyle modifications, and assess factors associated with awareness. MATERIALS AND METHODS A cross-sectional study was conducted in 14 hospitals with a total of 382 patients. Levels of awareness were evaluated by the comparison of self-report with measurements and laboratory test results. Healthy behaviors and adherence to treatment were evaluated. Factors associated with better awareness were studied using multivariate regressions, while adherence to treatments and healthy lifestyle were described for the different risk factors and in the Framingham Risk Score categories. RESULTS Our work revealed a moderate-to-high level of awareness (58.7% for overweight/obesity, 75% for hypertension, 85.7% for diabetes, and 86.4% for dyslipidemia) among patients for most cardiovascular risk factors, but a low-to-moderate level of adherence for some interventions such as physical exercise, weight loss, and smoking cessation. CONCLUSION The results emphasize on the importance of educational campaigns on healthy habits and screening to improve early diagnosis, increase patients' awareness of their risk factors, and, therefore, optimize primary prevention.
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Affiliation(s)
- Fatima Ghaddar
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
| | - Pascale Salameh
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
- National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon,
- Laboratory of Epidemiological and Clinical Research, Lebanese University, Beirut, Lebanon,
| | - Nadine Saleh
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
- National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon,
| | - Firas Farhat
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Ramez Chahine
- Faculty of Public Health, La Sagesse University, Beirut, Lebanon
| | - Nathalie Lahoud
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
- National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon,
- Laboratory of Epidemiological and Clinical Research, Lebanese University, Beirut, Lebanon,
- CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Mira Hleyhel
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
- National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon,
- CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Rouba K Zeidan
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
- National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon,
- CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon
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18
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Lecca LI, Campagna M, Portoghese I, Galletta M, Mucci N, Meloni M, Cocco P. Work Related Stress, Well-Being and Cardiovascular Risk among Flight Logistic Workers: An Observational Study. Int J Environ Res Public Health 2018; 15:E1952. [PMID: 30205457 DOI: 10.3390/ijerph15091952] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/26/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
Abstract
Work-related stress is a known occupational hazard, with a putative role on the development of cardiovascular diseases (CVD). Although several investigations have explored the association in various workplace scenarios, none have focused on the airport flight logistic support personnel, a transportation business of crucial importance, potentially exposed to job stress and consequently to an increase in CVD risk. We explored the relationship between work-related stress and cardiovascular risk in 568 healthy workers of a flight logistic support company using the Health and Safety Executive questionnaire, the Framingham Heart Study General Cardiovascular Disease (CVD) Risk Prediction Score, and the WHO general well-being index (WHO-5). We used univariate and multivariate statistical methods to take account of possible confounders. Our results show that a low job support significantly increases the CVD risk score and decreases the WHO well-being index with reference to subjects reporting high support on the job. In addition, the well-being index of workers with high strain jobs appears lower in respect to workers employed in low strain job. The multivariate analysis confirms a protective effect of job support, and shows a detrimental influence on CVD risk by physical inactivity, regular intake of alcohol, and a low educational level. In addition, job control, job support, low strain, and high demand coupled with high control (active job) showed a beneficial effect on psychological well-being. Our results suggest that a combination of general risk factors and organizational factors contributes to increase CVD risk and well-being, representing a crucial target for intervention strategies to promote health in the workplace.
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Blagojevic IP, Eror T, Pelivanovic J, Jelic S, Kotur-Stevuljevic J, Ignjatovic S. Women with Polycystic Ovary Syndrome and Risk of Cardiovascular Disease. J Med Biochem 2017; 36:259-269. [PMID: 30568543 PMCID: PMC6287215 DOI: 10.1515/jomb-2017-0020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/02/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is associated with reproductive and metabolic abnormalities. The aim of this study was to analyse risk of cardiovascular disease (CVD) in PCOS, to define individual risk factors and assess their ability to predict risk. METHODS Fifty-four young women with PCOS (22 obese and 32 normal weight) were compared to 46 respective controls (17 obese and 29 normal weight). Anthropometric parameters, lipid status parameters, inflammation markers, concentrations of glucose, transaminases, sex and anterior pituitary hormones, sex hormone binding globulin (SHBG) and androgens were measured. Cardiovascular Risk Score (CVRS), indices for identifying Non-Alcoholic Fatty Liver Disease (NAFLD) and the Index of Central Obesity (ICO) were calculated. RESULTS Significantly higher CVRS values (p<0.05) were found in obese PCOS women compared to normal weight control and normal weight PCOS groups. Anthropometric parameters, lipid status parameters and fibrinogen (p<0.001, p<0.01) were higher in women with higher CVRS. The most significant CVRS predictors in all PCOS women were SHBG, androstenedione, follicle-stimulating hormone (FSH) and dehydroepiandrosterone sulphate (DHEAS). ICO and all NAFLD indices exhibited significant positive correlation with CVRS and a model consisting of these indices provided good diagnostic accuracy (AUC>0.8) in identifying patients with increased cardiovascular risk (CVR). CONCLUSIONS Obesity is a higher risk for developing CVD than PCOS alone. Anthropometric parameters, lipid parameters, fibrinogen, NAFLD indices and ICO increase CVR in PCOS women. For the prediction of CVR in PCOS, we suggest a combination of NAFLD indices and ICO.
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Affiliation(s)
- Iva Perovic Blagojevic
- Department of Laboratory Diagnostic, Clinical Hospital Center »Dr Dragisa Misovic – Dedinje«, Belgrade, Serbia
| | - Tatjana Eror
- Clinic of Internal Medicine, Clinical Hospital Center »Dr Dragisa Misovic – Dedinje«, Belgrade, Serbia
| | - Jovana Pelivanovic
- Department for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Svetlana Jelic
- University Hospital Medical Center »Bezanijska kosa«, Belgrade, Serbia
| | - Jelena Kotur-Stevuljevic
- Department for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Svetlana Ignjatovic
- Department for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
- Center for Medical Biochemistry, Clinical Center Serbia, Belgrade, Serbia
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20
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Dell'anna P, Adorni D, Bernuzzi G, Cantarelli S, Cepparulo A, Cocchi T, Dell'anna L, Formentini A, Sassi M, Scognamiglio F, Vescovi M, Franchini M. Evaluation of cardiovascular risk in blood donors: results of the CARDIORISK study in the Parma Transfusion Service. Blood Transfus 2010; 8:155-8. [PMID: 20671874 DOI: 10.2450/2009.0097-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 05/21/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiovascular disease, which is one of the main causes of mortality in industrialised countries, is ever increasingly the focus of prevention. In this study, called "Cardiorisk", we evaluated cardiovascular risk in the population of blood donors at the Service of Immunohaematology and Transfusion Medicine in Parma. PATIENTS AND METHODS Between January 2007 and December 2008, 6,172 consecutive blood donors (aged 35-65 years) were enrolled in this project which entailed calculating each subject's cardiovascular risk score, based on an evaluation of both unalterable risk factors (age and gender) and modifiable risk factors (total cholesterol, HDL, LDL, triglycerides, glycaemia, smoking, hypertension) as well as anti-hypertensive and/or cholesterol-lowering therapy. RESULTS Of the 6,172 donors enrolled in the study, 5,039 (81.7%) had a low cardiovascular risk (score from 0-10), 774 (12.5%) had a moderate cardiovascular risk (score from 11-19) and 359 (5.8%) donors had a high cardiovascular risk (score from 20-28). CONCLUSIONS In our opinion, the calculation of cardiovascular risk is an important instrument for preventive medicine in blood donors.
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