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Riquelme-Gallego B, García-Molina L, Cano-Ibáñez N, Sánchez-Delgado G, Andújar-Vera F, García-Fontana C, González-Salvatierra S, García-Recio E, Martínez-Ruiz V, Bueno-Cavanillas A, Muñoz-Torres M, García-Fontana B. Circulating Undercarboxylated Osteocalcin as Estimator of Cardiovascular and Type 2 Diabetes Risk in Metabolic Syndrome Patients. Sci Rep 2020; 10:1840. [PMID: 32020009 PMCID: PMC7000396 DOI: 10.1038/s41598-020-58760-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/14/2020] [Indexed: 01/08/2023] Open
Abstract
Undercarboxylated osteocalcin (ucOC) could be a biomarker of glucose disturbances and cardiovascular risk. Our study aimed to determine the association between serum levels of ucOC and cardiovascular risk in metabolic syndrome (MetS) patients and to analyse its potential role as estimator of type 2 diabetes (T2D) risk in this population. This cross-sectional study included 235 patients with MetS, 53.2% women, aged 55–75 years. Circulating ucOC levels were measured by ELISA. Cardiovascular risk was determined as Z-score of the diagnostic criteria for MetS (CV-ZS). Linear regression model was performed to analyse the association between circulating ucOC and CV-ZS. A receiver operating curve (ROC) was performed to analyse the usefulness of ucOC as T2D risk estimator. Patients above the CV-ZS median showed significant lower ucOC levels. We found an inverse association between ucOC levels and CV-ZS in MetS patients without T2D. Patients with ucOC levels below the 25th percentile showed worse cardiometabolic profile and higher cardiovascular and T2D risk. The area under the curve performed better when ucOC levels were included along with the classic T2D risk factors. The measurement of circulating ucOC could be a useful tool to identify increased cardiovascular and T2D risk in MetS patients without T2D.
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Affiliation(s)
- Blanca Riquelme-Gallego
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain
| | - Laura García-Molina
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain
| | - Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain
| | - Guillermo Sánchez-Delgado
- PROFITH "PROmotingFITness and Health through physical activity" Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Francisco Andújar-Vera
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Cristina García-Fontana
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Sheila González-Salvatierra
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.,Department of Medicine, Faculty of Medicine, University of Granada, Granada, Spain
| | - Enrique García-Recio
- Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain
| | - Manuel Muñoz-Torres
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain. .,Department of Medicine, Faculty of Medicine, University of Granada, Granada, Spain. .,Bone Metabolic Unit, Endocrinology and Nutrition Division, San Cecilio University Hospital, Granada, Spain. .,CIBER of Fragility and Healthy Aging (CIBERFES), Carlos III Institute of Health, Madrid, Spain.
| | - Beatriz García-Fontana
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain. .,Bone Metabolic Unit, Endocrinology and Nutrition Division, San Cecilio University Hospital, Granada, Spain. .,CIBER of Fragility and Healthy Aging (CIBERFES), Carlos III Institute of Health, Madrid, Spain.
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Debray TPA, Damen JAAG, Riley RD, Snell K, Reitsma JB, Hooft L, Collins GS, Moons KGM. A framework for meta-analysis of prediction model studies with binary and time-to-event outcomes. Stat Methods Med Res 2019; 28:2768-2786. [PMID: 30032705 PMCID: PMC6728752 DOI: 10.1177/0962280218785504] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
It is widely recommended that any developed-diagnostic or prognostic-prediction model is externally validated in terms of its predictive performance measured by calibration and discrimination. When multiple validations have been performed, a systematic review followed by a formal meta-analysis helps to summarize overall performance across multiple settings, and reveals under which circumstances the model performs suboptimal (alternative poorer) and may need adjustment. We discuss how to undertake meta-analysis of the performance of prediction models with either a binary or a time-to-event outcome. We address how to deal with incomplete availability of study-specific results (performance estimates and their precision), and how to produce summary estimates of the c-statistic, the observed:expected ratio and the calibration slope. Furthermore, we discuss the implementation of frequentist and Bayesian meta-analysis methods, and propose novel empirically-based prior distributions to improve estimation of between-study heterogeneity in small samples. Finally, we illustrate all methods using two examples: meta-analysis of the predictive performance of EuroSCORE II and of the Framingham Risk Score. All examples and meta-analysis models have been implemented in our newly developed R package "metamisc".
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Affiliation(s)
- Thomas PA Debray
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical
Center Utrecht, Utrecht, The Netherlands
| | - Johanna AAG Damen
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical
Center Utrecht, Utrecht, The Netherlands
| | - Richard D Riley
- Research Institute for Primary Care and
Health Sciences, Keele University, Staffordshire, UK
| | - Kym Snell
- Research Institute for Primary Care and
Health Sciences, Keele University, Staffordshire, UK
| | - Johannes B Reitsma
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical
Center Utrecht, Utrecht, The Netherlands
| | - Lotty Hooft
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical
Center Utrecht, Utrecht, The Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine,
University of Oxford, Oxford, UK
| | - Karel GM Moons
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical
Center Utrecht, Utrecht, The Netherlands
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3
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Damen JA, Pajouheshnia R, Heus P, Moons KGM, Reitsma JB, Scholten RJPM, Hooft L, Debray TPA. Performance of the Framingham risk models and pooled cohort equations for predicting 10-year risk of cardiovascular disease: a systematic review and meta-analysis. BMC Med 2019; 17:109. [PMID: 31189462 PMCID: PMC6563379 DOI: 10.1186/s12916-019-1340-7] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/07/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Framingham risk models and pooled cohort equations (PCE) are widely used and advocated in guidelines for predicting 10-year risk of developing coronary heart disease (CHD) and cardiovascular disease (CVD) in the general population. Over the past few decades, these models have been extensively validated within different populations, which provided mounting evidence that local tailoring is often necessary to obtain accurate predictions. The objective is to systematically review and summarize the predictive performance of three widely advocated cardiovascular risk prediction models (Framingham Wilson 1998, Framingham ATP III 2002 and PCE 2013) in men and women separately, to assess the generalizability of performance across different subgroups and geographical regions, and to determine sources of heterogeneity in the findings across studies. METHODS A search was performed in October 2017 to identify studies investigating the predictive performance of the aforementioned models. Studies were included if they externally validated one or more of the original models in the general population for the same outcome as the original model. We assessed risk of bias for each validation and extracted data on population characteristics and model performance. Performance estimates (observed versus expected (OE) ratio and c-statistic) were summarized using a random effects models and sources of heterogeneity were explored with meta-regression. RESULTS The search identified 1585 studies, of which 38 were included, describing a total of 112 external validations. Results indicate that, on average, all models overestimate the 10-year risk of CHD and CVD (pooled OE ratio ranged from 0.58 (95% CI 0.43-0.73; Wilson men) to 0.79 (95% CI 0.60-0.97; ATP III women)). Overestimation was most pronounced for high-risk individuals and European populations. Further, discriminative performance was better in women for all models. There was considerable heterogeneity in the c-statistic between studies, likely due to differences in population characteristics. CONCLUSIONS The Framingham Wilson, ATP III and PCE discriminate comparably well but all overestimate the risk of developing CVD, especially in higher risk populations. Because the extent of miscalibration substantially varied across settings, we highly recommend that researchers further explore reasons for overprediction and that the models be updated for specific populations.
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Affiliation(s)
- Johanna A Damen
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Str. 6.131, 3508, GA, Utrecht, The Netherlands.
| | - Romin Pajouheshnia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Str. 6.131, 3508, GA, Utrecht, The Netherlands
| | - Pauline Heus
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Str. 6.131, 3508, GA, Utrecht, The Netherlands
| | - Karel G M Moons
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Str. 6.131, 3508, GA, Utrecht, The Netherlands
| | - Johannes B Reitsma
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Str. 6.131, 3508, GA, Utrecht, The Netherlands
| | - Rob J P M Scholten
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Str. 6.131, 3508, GA, Utrecht, The Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Str. 6.131, 3508, GA, Utrecht, The Netherlands
| | - Thomas P A Debray
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Str. 6.131, 3508, GA, Utrecht, The Netherlands
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Domenech M, Casas R, Ruiz-León AM, Sobrino J, Ros E, Estruch R. Effects of a Novel Nutraceutical Combination (Aquilea Colesterol ®) on the Lipid Profile and Inflammatory Biomarkers: A Randomized Control Trial. Nutrients 2019; 11:E949. [PMID: 31035469 PMCID: PMC6566177 DOI: 10.3390/nu11050949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/20/2019] [Accepted: 04/24/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cholesterol-lowering nutraceuticals are useful in the management of moderate hypercholesterolemia. METHODS In a parallel-group, randomized, placebo-controlled double-blind trial we evaluated the effects on plasma total cholesterol, low-density lipoprotein cholesterol (LDL-c), and inflammatory biomarkers of a nutraceutical combination (Aquilea Colesterol®) containing phytosterols (1.5 g), red yeast rice providing monacolin K (10 mg), hydroxytyrosol (5 mg), and plasma cholesterol values >5.17 mmol/L (>200 mg/dL) and LDL-c >2.97 mmol/L (>115 mg/dL). At baseline and at one and three months we recorded dietary habits; anthropometric parameters; blood pressure; lipid profile; fasting glucose; liver, renal, and muscle function tests, C-reactive protein (hs-CRP); and interleukin-6. RESULTS 13 men and 27 women (mean age 61.8 years) completed the trial; 20 participants received the nutraceutical and 20 received placebo. No adverse effects were noted. Compared to placebo, at one and three months the nutraceutical reduced total cholesterol by 11.4% and 14.1%, LDL-c by 19.8% and 19.7%, and apolipoprotein B by 12.4% and 13.5%, respectively (p < 0.001; all). hs-CRP decreased significantly (p = 0.021) in the nutraceutical group. CONCLUSION The nutraceutical Aquilea Colesterol® is useful for reducing total cholesterol, LDL-c, and inflammation in individuals with moderate hypercholesterolemia.
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Affiliation(s)
- Mònica Domenech
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
| | - Rosa Casas
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
| | - Ana Maria Ruiz-León
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain.
- Mediterranean Diet Foundation, 08021 Barcelona, Spain.
| | - Javier Sobrino
- Department of Internal Medicine, Fundació Hospital Esperit Sant, University of Barcelona, 08923 Barcelona, Spain.
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
- Lipid Clinic, Endocrinology and Nutrition Service, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain.
| | - Ramon Estruch
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
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Sanchez-Santos R, Padin EM, Adam D, Borisenko O, Fernandez SE, Dacosta EC, Fernández SG, Vazquez JT, de Adana JCR, de la Cruz Vigo F. Bariatric surgery versus conservative management for morbidly obese patients in Spain: a cost-effectiveness analysis. Expert Rev Pharmacoecon Outcomes Res 2017; 18:305-314. [PMID: 29188745 DOI: 10.1080/14737167.2018.1407649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND We assessed the cost-effectiveness of bariatric surgery (BS) versus conservative management (CM) for treating morbid obesity in Spain. METHODS We developed a probabilistic Markov model to estimate health outcomes, quality-adjusted life years (QALY), life years gained (LYG), and costs over lifetime and 10-year horizons. Combined common BS procedures were compared with CM. Clinical and utility inputs were obtained from the literature and resource use and costs from local sources (€2017). RESULTS Over the 10-year horizon, BS led to a cost increment of €9,386 and 1.6 additional QALY (€5,966/QALY). Leading to 0.6 LYG and 4.4 QALY gains and €300/patient average cost savings over lifetime, BS could potentially significantly reduce diabetes and cardiovascular disease risk over the considered horizons. Despite short-term cost reductions, surgery delay may lead to significant clinical benefits loss. CONCLUSIONS Compared to CM, BS is a more effective and less costly alternative for treating morbid obesity in Spain.
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Affiliation(s)
- Raquel Sanchez-Santos
- a General and Digestive Surgery Department , Complejo Hospitalario de Pontevedra, Instituto de Investigación Galicia Sur , Pontevedra , Spain
| | - Esther Mariño Padin
- b General and Digestive Surgery Department , Complejo Hospitalario de Pontevedra , Pontevedra , Spain
| | - Daniel Adam
- c Health Economics Department , Synergus AB , Danderyd , Sweden
| | - Oleg Borisenko
- c Health Economics Department , Synergus AB , Danderyd , Sweden
| | - Sergio Estevez Fernandez
- d General and Digestive Surgery Department , Complejo Hospitalario Universitario de Pontevedra , Pontevedra , Spain
| | - Ester Carrera Dacosta
- d General and Digestive Surgery Department , Complejo Hospitalario Universitario de Pontevedra , Pontevedra , Spain
| | - Sonia González Fernández
- b General and Digestive Surgery Department , Complejo Hospitalario de Pontevedra , Pontevedra , Spain
| | - Juan Turnes Vazquez
- e Digestive System Department , Instituo de investigación Galicia Sur , Pontevedra , Spain
| | | | - Felipe de la Cruz Vigo
- g General and Digestive Surgery Department , Hospital Universitario 12 de Octubre , Madrid , Spain
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Majed B, Tafflet M, Kee F, Haas B, Ferrieres J, Montaye M, Ruidavets JB, Arveiler D, Yarnell J, Amouyel P, Ducimetiere P, Empana JP. External validation of the 2008 Framingham cardiovascular risk equation for CHD and stroke events in a European population of middle-aged men. The PRIME study. Prev Med 2013; 57:49-54. [PMID: 23603213 DOI: 10.1016/j.ypmed.2013.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/05/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To test the applicability of the sex-specific 2008 Framingham general cardiovascular risk equation for coronary heart disease (CHD) and stroke in European middle-aged men from Ireland and France. METHODS In the PRIME study, 9638 healthy middle-aged men recruited in France and Ireland were surveyed for 10 years for the occurrence of first CHD and stroke events. The original Framingham equation, the partially calibrated Framingham equation (using the PRIME baseline survival at 10 years), and the completely calibrated Framingham equation (additionally using risk factor means calculated in PRIME) were assessed. Model fit (expected versus observed events) and discrimination ability were assessed using a modified Hosmer-Lemeshow Chi-square statistic and Harrell's c-index respectively. RESULTS The original (uncalibrated) Framingham equation overestimated by 1.94-fold the risk of CHD and stroke combined in PRIME, and by 2.23 and 1.42-fold in PRIME-France and PRIME-Ireland respectively. Adequate fit was found after complete calibration. However, discrimination ability of the Framingham equation was poor as shown by Harrell's c-index lower than 0.70. CONCLUSION The (completely) calibrated 2008 Framingham equation predicted accurate number of CHD and stroke events but discriminated poorly individuals at higher from those at lower event risk in a European population of middle-aged men.
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Affiliation(s)
- Bilal Majed
- Paris Cardiovascular Research Centre (PARCC), University Paris Descartes, Sorbonne Paris Cité, UMR-S970 Paris, France.
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Gotler RS, Stange KC. In this issue: from apprehension to action. Ann Fam Med 2011; 9:386-7. [PMID: 22013617 PMCID: PMC3185484 DOI: 10.1370/afm.1252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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