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Durairaj G, Oommen AT, Gopalakrishna Pillai M. A cross-sectional validation study comparing the accuracy of different risk scores in assessing the risk of acute coronary syndrome among patients in a tertiary care hospital in Kerala. Indian Heart J 2020; 72:113-118. [PMID: 32534683 PMCID: PMC7296236 DOI: 10.1016/j.ihj.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/25/2019] [Accepted: 03/28/2020] [Indexed: 11/05/2022] Open
Abstract
Background There are many cardiovascular disease (CVD) risk score calculators in practice, which are not based on Indian population data. Objectives To identify the best CVD risk score calculator applicable in the Indian population. Materials and methods A total of 1000 patients presenting with acute coronary syndrome (ACS) were included in the study and their CVD risk score, had they presented before the event, was calculated. The Framingham risk score (FRS–body mass index [BMI], FRS–fasting lipid profile [FLP]), the American College of Cardiology/American Heart Association pooled cohort equation risk calculator (ACC/AHA PCE), Joint British Society risk calculator 3 (JBS3) and the World Health Organization (WHO) risk prediction charts (WHO TC and WHO without TC [WHO NO TC]) were used. Results It was seen that among the 1000 people included in the study, the FRS-BMI (59.2%), FRS-FLP (61.5%), ACC/AHA (70.1%) and the JBS3 (62.5%) identified a majority as having a risk of ≥20%, whereas both the WHO TC (65.3%) and the WHO NO TC (64.5%) identified a majority of the ACS patients as having a risk of <20%. The sensitivity was highest for the ACC/AHA (87.8%), FRS-FLP (85.1%) and then JBS3 (80.1%), whereas the specificity was highest for the WHO TC (83.6%) and the WHO NO TC (82.1%). When looking at the accuracy, the FRS-FLP was the most accurate with 80.1%, whereas the ACC/AHA and the JBS3 followed at 74.7% and 73.1%, respectively. Conclusion The ACC/AHA seems to be an acceptable risk prediction system to be used in the Indian population and is also relatively easy and cheap to use.
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Affiliation(s)
- Gnanaguru Durairaj
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, India.
| | - Akash Thomas Oommen
- Department of General Medicine, Amrita Institute of Medical Sciences, Kochi, India.
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Sadarangani TR, Chyun D, Trinh-Shevrin C, Yu G, Kovner C. Cardiovascular Disease Risk Among Older Immigrants in the United States: A Comparison of Risk Measures. J Cardiovasc Nurs 2019; 33:544-550. [PMID: 29727376 PMCID: PMC6813816 DOI: 10.1097/jcn.0000000000000498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND In the United States, 16 million immigrants are 50 years and older, but little is known about their cardiometabolic health and how to best assess their cardiovascular disease (CVD) risk. Aging immigrants may therefore not be benefitting from advances in CVD prevention. OBJECTIVE In this study, we estimate and compare CVD risk in a nationally representative sample of aging immigrants using 3 different measures. METHODS This was a cross-sectional analysis using National Health and Nutrition Examination Survey data. Immigrants 50 years and older with no history of CVD were eligible. The Framingham Risk Score (FRS), the American College of Cardiology/American Heart Association Pooled Cohort Risk Equation, and presence of metabolic syndrome (MetS) were used to estimate risk. Bivariate statistics were analyzed using SPSS version 23.0 Complex Survey module to account for National Health and Nutrition Examination Survey unique weighting scheme. RESULTS The mean age of the sample was 61.3 years; 40% had hypertension, 17% had diabetes, 10% were smokers, and 95% did not meet the recommended physical activity guidelines. Proportions at an elevated CVD risk were as follows: American College of Cardiology/American Heart Association, 42% female and 76% male; FRS, 17.4% female and 76% male; and MetS, 22% female and 24% male. CONCLUSIONS Immigrants had a lower overall risk using MetS and the American College of Cardiology/American Heart Association equation than has been found using these tools in similarly aged samples. The opposite was true for the FRS. The discrepancy between the proportion at risk and those being treated may reflect healthcare access gaps that warrant further investigation. A more holistic approach to risk measurement is needed that accounts for determinants of health that disproportionately affect immigrants, including language and socioeconomic status.
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Affiliation(s)
- Tina R Sadarangani
- Tina R. Sadarangani, PhD Assistant Professor/Faculty Fellow, New York University Rory Meyers College of Nursing, New York. Deborah Chyun, PhD Dean and Professor, University of Connecticut School of Nursing, Storrs. Chau Trinh-Shevrin, DrPh Associate Professor, Department of Population Health, New York University School of Medicine, New York. Gary Yu, PhD Associate Research Scientist and Assistant Professor/Faculty Fellow, New York University Rory Meyers College of Nursing, New York. Christine Kovner, PhD Mathy Mezey Professor of Geriatric Nursing, New York University Rory Meyers College of Nursing, New York
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Srinivasan MP, Kamath PK, Bhat NM, Pai ND, Bhat RU, Manjrekar PA, Mahabala C. Manipal diabetes coronary artery severity score. Diabetes Metab Syndr 2017; 11 Suppl 1:S33-S37. [PMID: 27569728 DOI: 10.1016/j.dsx.2016.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/22/2016] [Indexed: 11/18/2022]
Abstract
AIMS To develop a risk score, for identifying severe and complex CAD in patients with type 2 diabetes mellitus. METHODS In this cross sectional study, 179 patients with type 2 diabetes mellitus undergoing coronary angiogram for the evaluation of suspected coronary artery disease (CAD) were recruited at a tertiary-care hospital. Patients were divided into developmental (n=124) and validation (n=55) cohorts. Biochemical and anthropometric parameters were analysed. Predictors of severe and complex CAD (SYNTAX Score>22) were identified by multiple logistic regression analysis. RESULTS Insulin resistance>3.4 (OR: 21.26, 95% CI: 5.71-79.09), duration of diabetes>5years (OR: 13.50, 95% CI: 3.13-58.25), total cholesterol/HDL-C ratio>5 (OR: 2.75, 95% CI: 0.66-11.55) and waist circumference>96cm (OR: 5.08, 95% CI: 1.27-20.42) were independent predictors of severe and complex CAD, and Manipal Diabetes Coronary Artery Severity Score was developed. CONCLUSIONS The prediction of severe and complex CAD was achieved with this simple score, and thus enabling effective identification of patients beforehand, who are not likely to be suitable for angioplasty.
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Affiliation(s)
- Mukund P Srinivasan
- Department of Internal Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Padmanabh K Kamath
- Department of Cardiology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Narayan M Bhat
- Department of Cardiology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Narasimha D Pai
- Department of Cardiology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Rajesh U Bhat
- Department of Cardiology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Poornima A Manjrekar
- Department of Biochemistry, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Chakrapani Mahabala
- Department of Internal Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
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DeFilippis AP, Young R, Carrubba CJ, McEvoy JW, Budoff MJ, Blumenthal RS, Kronmal RA, McClelland RL, Nasir K, Blaha MJ. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med 2015; 162:266-75. [PMID: 25686167 PMCID: PMC4414494 DOI: 10.7326/m14-1281] [Citation(s) in RCA: 354] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Accurate risk assessment of atherosclerotic cardiovascular disease (ASCVD) is essential to effectively balance the risks and benefits of therapy for primary prevention. OBJECTIVE To compare the calibration and discrimination of the new American Heart Association (AHA) and American College of Cardiology (ACC) ASCVD risk score with alternative risk scores and to explore preventive therapy as a cause of the reported risk overestimation using the AHA-ACC-ASCVD score. DESIGN Prospective epidemiologic study of ASCVD. SETTING MESA (Multi-Ethnic Study of Atherosclerosis), a community-based, sex-balanced, multiethnic cohort. PATIENTS 4227 MESA participants aged 50 to 74 years and without diabetes at baseline. MEASUREMENTS Observed and expected events for the AHA-ACC-ASCVD score were compared with 4 commonly used risk scores-and their respective end points-in MESA after a 10.2-year follow-up. RESULTS The new AHA-ACC-ASCVD and 3 older Framingham-based risk scores overestimated cardiovascular events by 37% to 154% in men and 8% to 67% in women. Overestimation was noted throughout the continuum of risk. In contrast, the Reynolds Risk Score overestimated risk by 9% in men but underestimated risk by 21% in women. Aspirin, lipid-lowering or antihypertensive therapy, and interim revascularization did not explain the overestimation. LIMITATION Comparability of MESA with target populations for primary prevention and possibility of missed events in MESA. CONCLUSION Of the 5 risk scores, 4, including the new AHA-ACC-ASCVD score, showed overestimation of risk (25% to 115%) in a modern, multiethnic cohort without baseline clinical ASCVD. If validated, overestimation of ASCVD risk may have substantial implications for individual patients and the health care system. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Andrew P. DeFilippis
- From the University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; University of Colorado, Boulder, Colorado; Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California; and Baptist Medical Group, Miami, Florida
| | - Rebekah Young
- From the University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; University of Colorado, Boulder, Colorado; Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California; and Baptist Medical Group, Miami, Florida
| | - Christopher J. Carrubba
- From the University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; University of Colorado, Boulder, Colorado; Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California; and Baptist Medical Group, Miami, Florida
| | - John W. McEvoy
- From the University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; University of Colorado, Boulder, Colorado; Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California; and Baptist Medical Group, Miami, Florida
| | - Matthew J. Budoff
- From the University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; University of Colorado, Boulder, Colorado; Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California; and Baptist Medical Group, Miami, Florida
| | - Roger S. Blumenthal
- From the University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; University of Colorado, Boulder, Colorado; Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California; and Baptist Medical Group, Miami, Florida
| | - Richard A. Kronmal
- From the University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; University of Colorado, Boulder, Colorado; Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California; and Baptist Medical Group, Miami, Florida
| | - Robyn L. McClelland
- From the University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; University of Colorado, Boulder, Colorado; Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California; and Baptist Medical Group, Miami, Florida
| | - Khurram Nasir
- From the University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; University of Colorado, Boulder, Colorado; Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California; and Baptist Medical Group, Miami, Florida
| | - Michael J. Blaha
- From the University of Louisville, Louisville, Kentucky; University of Washington, Seattle, Washington; University of Colorado, Boulder, Colorado; Johns Hopkins Medicine Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California; and Baptist Medical Group, Miami, Florida
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Abstract
BACKGROUND National guidelines recommend lipid-lowering therapy for patients with coronary heart disease (CHD), its equivalent (eg, diabetes mellitus, peripheral arterial disease, cerebrovascular disease), and those at high risk of CHD. Quality-of-care studies demonstrate that patients at high risk of CHD are undertreated. Overtreatment of patients at low risk of CHD remains relatively unexplored. Our study aimed to determine patient characteristics associated with under- and overtreatment of hyperlipidemia. METHODS We conducted a retrospective chart review of patients aged 35 to 80 years attending an inner-city ambulatory teaching clinic. We noted patients' 10-year cardiovascular risk based on the Framingham Heart Study equation, other patient demographics, pretreatment lipid levels, and whether they received a prescription for lipid-lowering therapy. RESULTS Of 676 patients included, 46% were at high (>15% for 10 years) and 37% were at low (<5%) risk. Of the patients at high risk for CHD, 34% received no drug therapy, including 5% of patients with known CHD; 37% of patients with diabetes mellitus; and 59% of patients without CHD equivalents. Undertreatment was associated with lower low-density lipoprotein (LDL; odds ratio [OR] per 30 mg/dL 2.7, confidence interval [CI] 2.0-3.6), fewer risk factors (OR per risk factor 1.5 CI 1.1-2.1), and not receiving other preventive care interventions (OR 2.1, CI 1.0-4.5). Of 247 patients at low risk for CHD, 8% received drug therapy. Overtreatment was associated with higher LDL (OR per 30 mg/dL 3.0, CI 1.7-5.3) and more cardiac risk factors (OR per risk factor 3.1, CI 1.4-6.7). Age, race, sex, and specific risk factors were not associated with overtreatment or undertreatment. CONCLUSIONS Both overtreatment and under-treatment are common. Physicians' decisions appear to reflect LDL values and number of risk factors rather than calculated cardiovascular risk.
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