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Sheikh A, Nurmatov U, Al-Katheeri HA, Ali Al Huneiti R. Risk prediction models for atherosclerotic cardiovascular disease: A systematic assessment with particular reference to Qatar. Qatar Med J 2021; 2021:42. [PMID: 34604019 PMCID: PMC8475266 DOI: 10.5339/qmj.2021.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Atherosclerotic cardiovascular disease (ASCVD) is a common disease in the State of Qatar and results in considerable morbidity, impairment of quality of life and mortality. The American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE) is currently used in Qatar to identify those at high risk of ASCVD. However, it is unclear if this is the optimal ASCVD risk prediction model for use in Qatar's ethnically diverse population. Aims: This systematic review aimed to identify, assess the methodological quality of and compare the properties of established ASCVD risk prediction models for the Qatari population. Methods: Two reviewers performed head-to-head comparisons of established ASCVD risk calculators systematically. Studies were independently screened according to predefined eligibility criteria and critically appraised using Prediction Model Risk Of Bias Assessment Tool. Data were descriptively summarized and narratively synthesized with reporting of key statistical properties of the models. Results: We identified 20,487 studies, of which 41 studies met our eligibility criteria. We identified 16 unique risk prediction models. Overall, 50% (n = 8) of the risk prediction models were judged to be at low risk of bias. Only 13% of the studies (n = 2) were judged at low risk of bias for applicability, namely, PREDICT and QRISK3.Only the PREDICT risk calculator scored low risk in both domains. Conclusions: There is no existing ASCVD risk calculator particularly well suited for use in Qatar's ethnically diverse population. Of the available models, PREDICT and QRISK3 appear most appropriate because of their inclusion of ethnicity. In the absence of a locally derived ASCVD for Qatar, there is merit in a formal head-to-head comparison between PCE, which is currently in use, and PREDICT and QRISK3.
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Affiliation(s)
- Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK E-mail:
| | | | - Huda Amer Al-Katheeri
- Strategic Planning and Performance Department, Ministry of Public Health, State of Qatar
| | - Rasmeh Ali Al Huneiti
- Healthcare Quality and Patient Safety, Strategic Planning and Performance Department, Ministry of Public Health, State of Qatar
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Ferrario MM, Martire G, Gianfagna F, Lasalvia P, Cremonesi F, Tozzi M, Franchin M, Campana F, Roncaioli M, Cavicchiolo M, Borchini R, Iacoviello L, Veronesi G. Occupational class differences in ankle-brachial index and pulse wave velocity measurements to detect subclinical vascular disease. LA MEDICINA DEL LAVORO 2021; 112:268-278. [PMID: 34446685 PMCID: PMC8436821 DOI: 10.23749/mdl.v112i4.11415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND High pulse wave velocity (PWV) and low ankle brachial index (ABI) have been proposed as surrogate end-points for cardiovascular disease (CVD). OBJECTIVES In a cross-sectional setting, we aimed at assessing the distributions of PWV and ABI among occupational classes (OC) in a population-based ever-employed salaried sample. METHODS We enrolled 1388 salaried CVD-free workers attending a CVD population-based survey, the RoCAV study, and classified them into four OC, based on current or last job title: manager/director (MD), non-manual (NMW), skilled-manual (SMW) and (UMW) unskilled-manual workers. We derived brachial-ankle PWV and ABI from four-limb blood pressures measurements, then carotid-femoral PWV (cfPWV) was estimated. We estimated the OC gradients in cfPWV and ABI using linear and logistic regression models. RESULTS Compared to MD (reference category), UMW had higher age- and BMI-adjusted cfPWV mean values both in men (0.63 m/s; 95%CI:0.11-1.16) and women (1.60 m/s; 0.43-2.77), only marginally reduced when adjusting for CVD risk factors. Decreased ABI mean values were also detected in lower OC. The overall detection rate of abnormal cfPWV (≥12 m/s) or ABI (≤0.9) values was 28%. Compared to MD, the prevalence of abnormal cfPWV or ABI was higher in NMW (OR=1.77; 95%CI:1.12-2.79), SMW (1.71; 1.05-2.78) and UMW (2.72; 1.65-4.50). Adjustment for CVD risk factors used in risk score equations did not change the results. DISCUSSION We found a higher prevalence of abnormal values of arterial stiffness measures in lower OC, and these differences were not explained by traditional CVD risk factors. These may be presumably determined by additional work- and environmental-related risk factors.
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Affiliation(s)
- Marco Mario Ferrario
- EPIMED Research Centre, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy; and Occupational Medicine Unit, University Hospital of Varese, Varese, Italy .
| | - Giulia Martire
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy.
| | - Francesco Gianfagna
- EPIMED Research Centre, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy; and Mediterranea Cardiocentro, Napoli, Italy.
| | - Paolo Lasalvia
- EPIMED Research Centre, Department of Medicine and Surgery, School of Medicine, University .
| | - Federico Cremonesi
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy; .
| | - Matteo Tozzi
- Vascular Surgery Unit, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy.
| | - Marco Franchin
- Vascular Surgery Unit, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy.
| | - Francesca Campana
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy; .
| | - Mattia Roncaioli
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy; .
| | - Marco Cavicchiolo
- School of Specialization in Occupational Medicine, University of Insubria, Varese, Italy; .
| | | | - Licia Iacoviello
- EPIMED Research Centre, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy; and Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
| | - Giovanni Veronesi
- EPIMED Research Centre, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy; .
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Santos-Ferreira C, Baptista R, Oliveira-Santos M, Moura JP, Gonçalves L. A 10- and 15-year performance analysis of ESC/EAS and ACC/AHA cardiovascular risk scores in a Southern European cohort. BMC Cardiovasc Disord 2020; 20:301. [PMID: 32560700 PMCID: PMC7304198 DOI: 10.1186/s12872-020-01574-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
Background A key strategy for the primary prevention of cardiovascular disease (CVD) is the use of risk prediction algorithms. We aimed to investigate the predictive ability of SCORE (Systematic COronary Risk Estimation) and PCE (Pooled Cohort Equations) systems for atherosclerotic CVD (ASCVD) risk in Portugal, a low CVD risk country, at the 10-year landmark and at a longer, 15-year follow-up. Methods The SCORE and PCE 10-year risk estimates were calculated for 455 and 448 patients, respectively. Discrimination was assessed by Harrell’s C-statistic. Calibration was analyzed by standardized incidence ratios (SIR). Results During the 10-year follow-up, 7 fatal ASCVD events (the SCORE outcome) and 32 any ASCVD events (the PCE outcome) occurred. The SCORE system showed good discrimination (C-statistic 0.83), while the PCE showed poor discrimination (C-statistic 0.62). Calibration was similar for both systems, according to SIR: SCORE, 0.3 (95% CI 0.1–0.7); PCE, 0.5 (95% CI 0.4–0.7). Globally, both 10-year fatal ASCVD risk and any ASCVD risk were overestimated in the overall population and men. However, the risk was underestimated by both systems in women. Despite an overestimation of 15-year fatal ASCVD by SCORE, the 15-year any ASCVD observed incidence was 1.8 times the 10-year incidence among men and 1.4 times among women. This acceleration of CVD risk was more relevant in the lowest classes of ASCVD risk. Conclusion In this prospective, contemporary, Portuguese cohort, the SCORE had better discriminatory power and similar calibration compared to PCE. However, both risk scores underestimated 10-year ASCVD risk in women.
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Affiliation(s)
| | - Rui Baptista
- Cardiology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - José Pereira Moura
- Internal Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Veronesi G, Maresca AM. Cardiovascular disease in the youngest: is it time for precision prevention? ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S74. [PMID: 30613649 DOI: 10.21037/atm.2018.10.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giovanni Veronesi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea M Maresca
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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