1
|
Grant JK, Ndumele CE, Martin SS. The Evolving Landscape of Cardiovascular Risk Assessment. JAMA 2024; 332:967-969. [PMID: 39073798 DOI: 10.1001/jama.2024.13247] [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: 07/30/2024]
Affiliation(s)
- Jelani K Grant
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Chiadi E Ndumele
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
2
|
Woolley JJ, Fishman J, Parrinello CM, O'Connell T. Cardiovascular risk in US adults with nonalcoholic steatohepatitis (NASH) vs. matched non-NASH controls, National Health and Nutrition Examination Survey, 2017-2020. PLoS One 2024; 19:e0309617. [PMID: 39190769 DOI: 10.1371/journal.pone.0309617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND NASH is considered a contributor to atherosclerotic cardiovascular disease (ASCVD) risk; however, its contribution beyond traditional risk factors for CVD, particularly diabetes, is less clearly understood. This study aimed to quantify the cardiovascular-event risk associated with NASH, independent of diabetes status. METHODS A cross-sectional analysis was conducted using the 2017-2020 NHANES pre-pandemic cycle. NASH was defined based on presence of steatosis without other causes of liver disease, and FibroScan+AST score from vibration-controlled transient elastography (VCTE). Significant fibrosis (stages F2-F4) was identified by liver stiffness measurement from VCTE. Predicted primary CV-event risk was estimated using both the Pooled Cohort Equations (PCE) and the Framingham Risk Score (FRS). NASH patients were matched with non-NASH controls on age, sex, race/ethnicity, and diabetes status. Weighted logistic regression was conducted, modeling elevated predicted CV risk (binary) as the dependent variable and indicators for NASH / fibrosis stages as independent variables. RESULTS A sample of 125 NASH patients was matched with 2585 controls. NASH with significant fibrosis was associated with elevated predicted 10-year CV risk, although this association was only statistically significant in PCE analyses (odds ratio and 95% CI 2.34 [1.25, 4.36]). Analyses restricting to ages <65 years showed similar results, with associations of greater magnitude. CONCLUSION Independent of diabetes, a significant association was observed between NASH with significant liver fibrosis and predicted primary CV-event risk in US adults, particularly for those <65. These findings suggest the importance of accounting for NASH and liver-fibrosis stage in predicting CV-event risk.
Collapse
Affiliation(s)
| | - Jesse Fishman
- Formerly of Madrigal Pharmaceuticals, Conshohocken, Pennsylvania, United States of America
| | | | - Tom O'Connell
- Medicus Economics, Boston, Massachusetts, United States of America
| |
Collapse
|
3
|
Nwachuku I, Taylor E, Danisa O. The impact of diversity, equity, and inclusion on spinal research - asking different questions. Spine J 2024:S1529-9430(24)00889-1. [PMID: 39053738 DOI: 10.1016/j.spinee.2024.06.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND CONTEXT In recent years, the field of spine surgery has seen significant advancements in surgical techniques alongside a growing emphasis on diversity, equity, and inclusion (DEI). PURPOSE This paper explores the significant impact of DEI on spine surgery, recognizing its potential to drive innovation, improve patient outcomes, and address healthcare disparities. STUDY DESIGN Review. SIGN/SETTING The review focuses on the impact of DEI on spine surgery, examining how diverse perspectives influence research and practice in the field. PATIENT SAMPLE Not applicable. OUTCOME MEASURES Not applicable. METHODS The review analyzes the role of DEI in driving innovation and improving patient outcomes in spine surgery and discusses ongoing challenges such as unconscious biases and systemic barriers. RESULTS Shifting paradigms in research through diverse perspectives is crucial for broadening the scope of inquiry and challenging existing standards. Efforts to promote diversity, including targeted outreach and mentorship initiatives, are essential for cultivating a more inclusive workforce. CONCLUSIONS Embracing diverse perspectives and asking unconventional questions are vital for achieving a comprehensive understanding of spinal health and delivering equitable healthcare. Ongoing challenges highlight the need for continued commitment to DEI principles.
Collapse
Affiliation(s)
- Ikenna Nwachuku
- Department of Orthopaedic Surgery, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA
| | - Erica Taylor
- Department of Orthopaedic Surgery, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710, USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University Health, 25805 Barton Road A106, Loma Linda, CA, 92354, USA.
| |
Collapse
|
4
|
Le A, Peng H, Golinsky D, Di Scipio M, Lali R, Paré G. What Causes Premature Coronary Artery Disease? Curr Atheroscler Rep 2024; 26:189-203. [PMID: 38573470 DOI: 10.1007/s11883-024-01200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW This review provides an overview of genetic and non-genetic causes of premature coronary artery disease (pCAD). RECENT FINDINGS pCAD refers to coronary artery disease (CAD) occurring before the age of 65 years in women and 55 years in men. Both genetic and non-genetic risk factors may contribute to the onset of pCAD. Recent advances in the genetic epidemiology of pCAD have revealed the importance of both monogenic and polygenic contributions to pCAD. Familial hypercholesterolemia (FH) is the most common monogenic disorder associated with atherosclerotic pCAD. However, clinical overreliance on monogenic genes can result in overlooked genetic causes of pCAD, especially polygenic contributions. Non-genetic factors, notably smoking and drug use, are also important contributors to pCAD. Cigarette smoking has been observed in 25.5% of pCAD patients relative to 12.2% of non-pCAD patients. Finally, myocardial infarction (MI) associated with spontaneous coronary artery dissection (SCAD) may result in similar clinical presentations as atherosclerotic pCAD. Recognizing the genetic and non-genetic causes underlying pCAD is important for appropriate prevention and treatment. Despite recent progress, pCAD remains incompletely understood, highlighting the need for both awareness and research.
Collapse
Affiliation(s)
- Ann Le
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Medical Sciences, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Helen Peng
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada
| | - Danielle Golinsky
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada
| | - Matteo Di Scipio
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Medical Sciences, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada
| | - Ricky Lali
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
- Department of Medical Sciences, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Biochemistry and Biomedical Sciences, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
- Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada.
| |
Collapse
|
5
|
Nurmohamed NS, van Rosendael AR, Danad I, Ngo-Metzger Q, Taub PR, Ray KK, Figtree G, Bonaca MP, Hsia J, Rodriguez F, Sandhu AT, Nieman K, Earls JP, Hoffmann U, Bax JJ, Min JK, Maron DJ, Bhatt DL. Atherosclerosis evaluation and cardiovascular risk estimation using coronary computed tomography angiography. Eur Heart J 2024; 45:1783-1800. [PMID: 38606889 PMCID: PMC11129796 DOI: 10.1093/eurheartj/ehae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to atherosclerosis and provide limited accuracy for predicting major adverse cardiovascular events (MACE). Over the past two decades, computed tomography scanners and techniques for coronary computed tomography angiography (CCTA) analysis have substantially improved, enabling more precise atherosclerotic plaque quantification and characterization. The accuracy of CCTA for quantifying stenosis and atherosclerosis has been validated in numerous multicentre studies and has shown consistent incremental prognostic value for MACE over the clinical risk spectrum in different populations. Serial CCTA studies have advanced our understanding of vascular biology and atherosclerotic disease progression. The direct disease visualization of CCTA has the potential to be used synergistically with indirect markers of risk to significantly improve prevention of MACE, pending large-scale randomized evaluation.
Collapse
Affiliation(s)
- Nick S Nurmohamed
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit
Amsterdam, Amsterdam, The
Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of
Amsterdam, Amsterdam, The
Netherlands
- Division of Cardiology, The George Washington University School of
Medicine, Washington, DC, United States
| | | | - Ibrahim Danad
- Department of Cardiology, University Medical Center Utrecht,
Utrecht, The Netherlands
- Department of Cardiology, Radboud University Medical Center,
Nijmegen, The Netherlands
| | - Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson
School of Medicine, Pasadena, CA, United States
| | - Pam R Taub
- Section of Cardiology, Department of Medicine, University of
California, San Diego, CA, United States
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College
London, London, United
Kingdom
| | - Gemma Figtree
- Faculty of Medicine and Health, University of Sydney,
Australia, St Leonards, Australia
| | - Marc P Bonaca
- Department of Medicine, University of Colorado School of
Medicine, Aurora, CO, United States
| | - Judith Hsia
- Department of Medicine, University of Colorado School of
Medicine, Aurora, CO, United States
| | - Fatima Rodriguez
- Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
| | - Alexander T Sandhu
- Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
| | - Koen Nieman
- Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
| | - James P Earls
- Cleerly, Inc., Denver, CO, United States
- Department of Radiology, The George Washington University School of
Medicine, Washington, DC, United States
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center,
Leiden, The Netherlands
| | | | - David J Maron
- Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount
Sinai, 1 Gustave Levy Place, Box 1030, New York, NY
10029, United States
| |
Collapse
|
6
|
Venkatesh KK, Khan SS, Catov J, Wu J, McNeil R, Greenland P, Wu J, Levine LD, Yee LM, Simhan HN, Haas DM, Reddy UM, Saade G, Silver RM, Merz CNB, Grobman WA. Socioeconomic disadvantage in pregnancy and postpartum risk of cardiovascular disease. Am J Obstet Gynecol 2024:S0002-9378(24)00589-1. [PMID: 38759711 DOI: 10.1016/j.ajog.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Pregnancy is an educable and actionable life stage to address social determinants of health (SDOH) and lifelong cardiovascular disease (CVD) prevention. However, the link between a risk score that combines multiple neighborhood-level social determinants in pregnancy and the risk of long-term CVD remains to be evaluated. OBJECTIVE To examine whether neighborhood-level socioeconomic disadvantage measured by the Area Deprivation Index (ADI) in early pregnancy is associated with a higher 30-year predicted risk of CVD postpartum, as measured by the Framingham Risk Score. STUDY DESIGN An analysis of data from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study longitudinal cohort. Participant home addresses during early pregnancy were geocoded at the Census-block level. The exposure was neighborhood-level socioeconomic disadvantage using the 2015 ADI by tertile (least deprived [T1], reference; most deprived [T3]) measured in the first trimester. Outcomes were the predicted 30-year risks of atherosclerotic cardiovascular disease (ASCVD, composite of fatal and nonfatal coronary heart disease and stroke) and total CVD (composite of ASCVD plus coronary insufficiency, angina pectoris, transient ischemic attack, intermittent claudication, and heart failure) using the Framingham Risk Score measured 2 to 7 years after delivery. These outcomes were assessed as continuous measures of absolute estimated risk in increments of 1%, and, secondarily, as categorical measures with high-risk defined as an estimated probability of CVD ≥10%. Multivariable linear regression and modified Poisson regression models adjusted for baseline age and individual-level social determinants, including health insurance, educational attainment, and household poverty. RESULTS Among 4309 nulliparous individuals at baseline, the median age was 27 years (interquartile range [IQR]: 23-31) and the median ADI was 43 (IQR: 22-74). At 2 to 7 years postpartum (median: 3.1 years, IQR: 2.5, 3.7), the median 30-year risk of ASCVD was 2.3% (IQR: 1.5, 3.5) and of total CVD was 5.5% (IQR: 3.7, 7.9); 2.2% and 14.3% of individuals had predicted 30-year risk ≥10%, respectively. Individuals living in the highest ADI tertile had a higher predicted risk of 30-year ASCVD % (adjusted ß: 0.41; 95% confidence interval [CI]: 0.19, 0.63) compared with those in the lowest tertile; and those living in the top 2 ADI tertiles had higher absolute risks of 30-year total CVD % (T2: adj. ß: 0.37; 95% CI: 0.03, 0.72; T3: adj. ß: 0.74; 95% CI: 0.36, 1.13). Similarly, individuals living in neighborhoods in the highest ADI tertile were more likely to have a high 30-year predicted risk of ASCVD (adjusted risk ratio [aRR]: 2.21; 95% CI: 1.21, 4.02) and total CVD ≥10% (aRR: 1.35; 95% CI: 1.08, 1.69). CONCLUSION Neighborhood-level socioeconomic disadvantage in early pregnancy was associated with a higher estimated long-term risk of CVD postpartum. Incorporating aggregated SDOH into existing clinical workflows and future research in pregnancy could reduce disparities in maternal cardiovascular health across the lifespan, and requires further study.
Collapse
Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH.
| | - Sadiya S Khan
- Departments of Preventive Medicine and Medicine, Northwestern University, Chicago, IL
| | - Janet Catov
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - Jiqiang Wu
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | | | - Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University, Chicago, IL
| | - Jun Wu
- Department of Environmental and Occupational Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Orange, CA
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Hyagriv N Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical College, Norfolk, VA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| |
Collapse
|
7
|
Tan YY, Kang HG, Lee CJ, Kim SS, Park S, Thakur S, Da Soh Z, Cho Y, Peng Q, Lee K, Tham YC, Rim TH, Cheng CY. Prognostic potentials of AI in ophthalmology: systemic disease forecasting via retinal imaging. EYE AND VISION (LONDON, ENGLAND) 2024; 11:17. [PMID: 38711111 PMCID: PMC11071258 DOI: 10.1186/s40662-024-00384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/17/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Artificial intelligence (AI) that utilizes deep learning (DL) has potential for systemic disease prediction using retinal imaging. The retina's unique features enable non-invasive visualization of the central nervous system and microvascular circulation, aiding early detection and personalized treatment plans for personalized care. This review explores the value of retinal assessment, AI-based retinal biomarkers, and the importance of longitudinal prediction models in personalized care. MAIN TEXT This narrative review extensively surveys the literature for relevant studies in PubMed and Google Scholar, investigating the application of AI-based retina biomarkers in predicting systemic diseases using retinal fundus photography. The study settings, sample sizes, utilized AI models and corresponding results were extracted and analysed. This review highlights the substantial potential of AI-based retinal biomarkers in predicting neurodegenerative, cardiovascular, and chronic kidney diseases. Notably, DL algorithms have demonstrated effectiveness in identifying retinal image features associated with cognitive decline, dementia, Parkinson's disease, and cardiovascular risk factors. Furthermore, longitudinal prediction models leveraging retinal images have shown potential in continuous disease risk assessment and early detection. AI-based retinal biomarkers are non-invasive, accurate, and efficient for disease forecasting and personalized care. CONCLUSION AI-based retinal imaging hold promise in transforming primary care and systemic disease management. Together, the retina's unique features and the power of AI enable early detection, risk stratification, and help revolutionizing disease management plans. However, to fully realize the potential of AI in this domain, further research and validation in real-world settings are essential.
Collapse
Affiliation(s)
| | - Hyun Goo Kang
- Division of Retina, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Soo Kim
- Division of Retina, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yunnie Cho
- Mediwhale Inc, Seoul, Republic of Korea
- Department of Education and Human Resource Development, Seoul National University Hospital, Seoul, South Korea
| | - Qingsheng Peng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Kwanghyun Lee
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Singapore, Singapore
| | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Mediwhale Inc, Seoul, Republic of Korea.
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Singapore, Singapore
| |
Collapse
|
8
|
Hippisley-Cox J, Coupland CAC, Bafadhel M, Russell REK, Sheikh A, Brindle P, Channon KM. Development and validation of a new algorithm for improved cardiovascular risk prediction. Nat Med 2024; 30:1440-1447. [PMID: 38637635 PMCID: PMC11108771 DOI: 10.1038/s41591-024-02905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/04/2024] [Indexed: 04/20/2024]
Abstract
QRISK algorithms use data from millions of people to help clinicians identify individuals at high risk of cardiovascular disease (CVD). Here, we derive and externally validate a new algorithm, which we have named QR4, that incorporates novel risk factors to estimate 10-year CVD risk separately for men and women. Health data from 9.98 million and 6.79 million adults from the United Kingdom were used for derivation and validation of the algorithm, respectively. Cause-specific Cox models were used to develop models to predict CVD risk, and the performance of QR4 was compared with version 3 of QRISK, Systematic Coronary Risk Evaluation 2 (SCORE2) and atherosclerotic cardiovascular disease (ASCVD) risk scores. We identified seven novel risk factors in models for both men and women (brain cancer, lung cancer, Down syndrome, blood cancer, chronic obstructive pulmonary disease, oral cancer and learning disability) and two additional novel risk factors in women (pre-eclampsia and postnatal depression). On external validation, QR4 had a higher C statistic than QRISK3 in both women (0.835 (95% confidence interval (CI), 0.833-0.837) and 0.831 (95% CI, 0.829-0.832) for QR4 and QRISK3, respectively) and men (0.814 (95% CI, 0.812-0.816) and 0.812 (95% CI, 0.810-0.814) for QR4 and QRISK3, respectively). QR4 was also more accurate than the ASCVD and SCORE2 risk scores in both men and women. The QR4 risk score identifies new risk groups and provides superior CVD risk prediction in the United Kingdom compared with other international scoring systems for CVD risk.
Collapse
Affiliation(s)
- Julia Hippisley-Cox
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
| | - Carol A C Coupland
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mona Bafadhel
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Richard E K Russell
- King's Centre for Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Aziz Sheikh
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Peter Brindle
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Keith M Channon
- British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
9
|
Muse ED, Topol EJ. Transforming the cardiometabolic disease landscape: Multimodal AI-powered approaches in prevention and management. Cell Metab 2024; 36:670-683. [PMID: 38428435 PMCID: PMC10990799 DOI: 10.1016/j.cmet.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
The rise of artificial intelligence (AI) has revolutionized various scientific fields, particularly in medicine, where it has enabled the modeling of complex relationships from massive datasets. Initially, AI algorithms focused on improved interpretation of diagnostic studies such as chest X-rays and electrocardiograms in addition to predicting patient outcomes and future disease onset. However, AI has evolved with the introduction of transformer models, allowing analysis of the diverse, multimodal data sources existing in medicine today. Multimodal AI holds great promise in more accurate disease risk assessment and stratification as well as optimizing the key driving factors in cardiometabolic disease: blood pressure, sleep, stress, glucose control, weight, nutrition, and physical activity. In this article we outline the current state of medical AI in cardiometabolic disease, highlighting the potential of multimodal AI to augment personalized prevention and treatment strategies in cardiometabolic disease.
Collapse
Affiliation(s)
- Evan D Muse
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA 92037, USA; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA 92037, USA
| | - Eric J Topol
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA 92037, USA; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA 92037, USA.
| |
Collapse
|
10
|
Beaudoin JR, Curran J, Alexander GC. Impact of Race on Classification of Atherosclerotic Risk Using a National Cardiovascular Risk Prediction Tool. AJPM FOCUS 2024; 3:100200. [PMID: 38440670 PMCID: PMC10910235 DOI: 10.1016/j.focus.2024.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Introduction The use of race in clinical risk prediction tools may exacerbate racial disparities in healthcare access and outcomes. This study quantified the number of individuals reclassified for primary prevention of cardiovascular disease owing to a change in their race alone on the basis of a commonly used risk prediction tool. Methods This is a cross-sectional analysis of individuals aged 40-75 years without a history of cardiovascular events, diabetes, or other high-risk features using the 2005-2018 National Health and Nutritional Examination Survey. Authors compared atherosclerotic cardiovascular disease risk scores using the American Heart Association/American College of Cardiology equation recommended for White individuals or individuals of other races with that recommended for Black individuals. Results A total of 2,946 White individuals; 1,361 Black individuals; and 2,495 individuals of other races were included in the analysis. Using the American Heart Association/American College of Cardiology equation, the mean 10-year atherosclerotic cardiovascular disease risk was 5.80% (95% CI=5.54, 6.06) for White individuals, 7.04% (956% CI=6.69, 7.39) for Black individuals, and 4.93% (95% CI=4.61, 5.24) for individuals of other races. When using the American Heart Association/American College of Cardiology equation designated for the opposite race (White/other race versus Black), the mean atherosclerotic cardiovascular disease risk score increased by 1.02% (95% CI=0.90, 1.13) for White individuals, decreased by 1.82% (95% CI= -1.67, -1.96) for Black individuals, and increased by 0.98% (95% CI=0.85, 1.10) for individuals of other races. When using clinical atherosclerotic cardiovascular disease categories of <7.5%, 7.5%-10%, and >10%, 16.93% of all individuals were reclassified when using the American Heart Association/American College of Cardiology's equation designated for the opposite race. Conclusions Changing race within a commonly used cardiovascular risk prediction tool results in significant changes in risk classification among eligible White and Black individuals in the U.S.
Collapse
Affiliation(s)
- Jarett R. Beaudoin
- Department of Family and Community Medicine, University of California, Davis, California
| | - Jill Curran
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| |
Collapse
|
11
|
Navickas P, Lukavičiūtė L, Glaveckaitė S, Baranauskas A, Šatrauskienė A, Badarienė J, Laucevičius A. Navigating the Landscape of Cardiovascular Risk Scores: A Comparative Analysis of Eight Risk Prediction Models in a High-Risk Cohort in Lithuania. J Clin Med 2024; 13:1806. [PMID: 38542029 PMCID: PMC10971708 DOI: 10.3390/jcm13061806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 07/29/2024] Open
Abstract
Background: Numerous cardiovascular risk prediction models (RPM) have been developed, however, agreement studies between these models are scarce. We aimed to assess the inter-model agreement between eight RPMs: assessing cardiovascular risk using SIGN, the Australian CVD risk score (AusCVDRisk), the Framingham Risk Score for Hard Coronary Heart Disease, the Multi-Ethnic Study of Atherosclerosis risk score, the Pooled Cohort Equation (PCE), the QRISK3 cardiovascular risk calculator, the Reynolds Risk Score, and Systematic Coronary Risk Evaluation-2 (SCORE2). Methods: A cross-sectional study was conducted on 11,174 40-65-year-old individuals with diagnosed metabolic syndrome from a single tertiary university hospital in Lithuania. Cardiovascular risk was calculated using the eight RPMs, and the results were categorized into high, intermediate, and low-risk groups. Inter-model agreement was quantified using Cohen's Kappa coefficients. Results: The study revealed significant heterogeneity in risk categorizations with only 1.49% of cases where all models agree on the risk category. SCORE2 predominantly categorized participants as high-risk (67.39%), while the PCE identified the majority as low-risk (62.03%). Cohen's Kappa coefficients ranged from -0.09 to 0.64, indicating varying degrees of inter-model agreement. Conclusions: The choice of RPM can substantially influence clinical decision-making and patient management. The PCE and AusCVDRisk models exhibited the highest degree of agreement while the SCORE2 model consistently exhibited low agreement with other models.
Collapse
Affiliation(s)
- Petras Navickas
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
- State Research Institute Centre for Innovative Medicine, 08410 Vilnius, Lithuania;
| | - Laura Lukavičiūtė
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
| | - Sigita Glaveckaitė
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
| | - Arvydas Baranauskas
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
| | - Agnė Šatrauskienė
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
| | - Jolita Badarienė
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.L.); (S.G.); (A.B.); (A.Š.); (J.B.)
| | | |
Collapse
|
12
|
Wang Z, Yang X, Li L, Zhang X, Zhou W, Chen S. Comparative Analysis of Three Atherosclerotic Cardiovascular Disease Risk Prediction Models in Individuals Aged 75 and Older. Clin Interv Aging 2024; 19:529-538. [PMID: 38525315 PMCID: PMC10961081 DOI: 10.2147/cia.s454060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose To evaluate the performance of the Framingham cardiovascular risk score (FRS)/pooled cohort equations (PCE)/China prediction for atherosclerotic cardiovascular disease (ASCVD) risk (China-PAR model) in a prospective cohort of Chinese older adults. Patients and Methods We assessed 717 older adults aged 75-85 years without ASCVD at the baseline from the Sichuan province of China. The participants were followed annually from 2011 to 2021. We obtained the participants' information through the medical records of physical examination and evaluated their 10-year ASCVD risk using FRS, PCE, and China-PAR. We further evaluated the predictive abilities of three assessment models. Results During the 10-year follow-up, 206 participants developed ASCVD, with an incidence rate of 28.73%. The FRS and China-PAR moderately underestimated the risk of ASCVD (22.1% and 12.4%, respectively), but while PCE overestimated the risk (36.1%). FRS and China-PAR were found to underestimate the risk of ASCVD (26% and 63%, respectively) for men, while PCE overestimated the risk by 8%; For women, FRS and China-PAR were found to underestimate the risk of ASCVD (14% and 35%, respectively), while PCE overestimated the risk by 88%. Conclusion The 10-year ASCVD risk was found to be overestimated by PCE. China-PAR had the most accurate predictions in women, while FRS was particularly well-calibrated in males. All three risk models have good discrimination, with FRS and PCE being well-calibrated in men and all three being well-calibrated in women. Therefore, accurate risk models are warranted to facilitate the prevention of ASCVD at the baseline among Chinese older adults.
Collapse
Affiliation(s)
- Zhang Wang
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Xue Yang
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Longxin Li
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Xiaobo Zhang
- The Third People’s Hospital of Beichuan Qiang Autonomous County, Mianyang, People’s Republic of China
| | - Wenlin Zhou
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Sixue Chen
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| |
Collapse
|
13
|
Ferreira JP, Vasques-Nóvoa F, Neves JS, Zannad F, Leite-Moreira A. Comparison of interleukin-6 and high-sensitivity C-reactive protein for cardiovascular risk assessment: Findings from the MESA study. Atherosclerosis 2024; 390:117461. [PMID: 38306764 DOI: 10.1016/j.atherosclerosis.2024.117461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND AIMS Inflammation is a risk factor for major adverse cardiovascular events (MACE). Elevated levels of both high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL6) have been associated with MACE. However, few studies have compared IL6 to hsCRP for cardiovascular risk assessment. Using the MESA (Multi-Ethnic Study of Atherosclerosis) study cohort, we aim to compare IL6 to hsCRP. METHODS We divided IL6 and hsCRP by their median values and created 4 groups i.e., low-low, high-low, low-high and high-high. The median follow-up was 14 years. RESULTS 6614 (97 %) participants had complete baseline IL6 and hsCRP data. The correlation between hsCRP and IL6 was modest (Rho = 0.53). IL6 ≥1.2 pg/mL (median) was present in 3309 participants, and hsCRP ≥1.9 mg/L (median) was present in 3339 participants. Compared to participants with low IL6 and low hsCRP, those with high IL6 and high hsCRP were older (64 vs. 60 years), more frequently women (63 % vs. 45 %), and with more cardiovascular co-morbidities. hsCRP outcome associations lost statistical significance when adjusting for IL6: MACE HR (95 %CI) 1.06 (0.93-1.20), p =0.39, whereas IL6 associations remained significant after adjusting for hsCRP: HR (95 %CI) 1.44 (1.25-1.64), p <0.001. The C-index of Framingham score for did not improve with hsCRP but improved with IL6. Compared to participants with low IL6 and low hsCRP, those with high IL6, regardless of hsCRP, experienced an increased risk of MACE, heart failure and mortality. CONCLUSIONS In a diverse and asymptomatic population, IL6 showed a stronger association with atherosclerotic, heart failure and fatal outcomes than hsCRP.
Collapse
Affiliation(s)
- João Pedro Ferreira
- UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Centre d'Investigations Cliniques Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France.
| | - Francisco Vasques-Nóvoa
- UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Sérgio Neves
- UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Adelino Leite-Moreira
- UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| |
Collapse
|
14
|
Lee J, Choi Y, Ko T, Lee K, Shin J, Kim HS. Prediction of Cardiovascular Complication in Patients with Newly Diagnosed Type 2 Diabetes Using an XGBoost/GRU-ODE-Bayes-Based Machine-Learning Algorithm. Endocrinol Metab (Seoul) 2024; 39:176-185. [PMID: 37989268 PMCID: PMC10901655 DOI: 10.3803/enm.2023.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/22/2023] [Accepted: 08/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGRUOUND Cardiovascular disease is life-threatening yet preventable for patients with type 2 diabetes mellitus (T2DM). Because each patient with T2DM has a different risk of developing cardiovascular complications, the accurate stratification of cardiovascular risk is critical. In this study, we proposed cardiovascular risk engines based on machine-learning algorithms for newly diagnosed T2DM patients in Korea. METHODS To develop the machine-learning-based cardiovascular disease engines, we retrospectively analyzed 26,166 newly diagnosed T2DM patients who visited Seoul St. Mary's Hospital between July 2009 and April 2019. To accurately measure diabetes-related cardiovascular events, we designed a buffer (1 year), an observation (1 year), and an outcome period (5 years). The entire dataset was split into training and testing sets in an 8:2 ratio, and this procedure was repeated 100 times. The area under the receiver operating characteristic curve (AUROC) was calculated by 10-fold cross-validation on the training dataset. RESULTS The machine-learning-based risk engines (AUROC XGBoost=0.781±0.014 and AUROC gated recurrent unit [GRU]-ordinary differential equation [ODE]-Bayes=0.812±0.016) outperformed the conventional regression-based model (AUROC=0.723± 0.036). CONCLUSION GRU-ODE-Bayes-based cardiovascular risk engine is highly accurate, easily applicable, and can provide valuable information for the individualized treatment of Korean patients with newly diagnosed T2DM.
Collapse
Affiliation(s)
- Joonyub Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Taehoon Ko
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kanghyuck Lee
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Juyoung Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Health Promotion Center, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Hun-Sung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
15
|
Patel AP. Potential for Bridging Treatment Gaps in Cardiovascular Health in Asia With Inclusive Clinical Trials. JACC. ASIA 2024; 4:135-137. [PMID: 38371288 PMCID: PMC10866730 DOI: 10.1016/j.jacasi.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Affiliation(s)
- Aniruddh P. Patel
- Address for correspondence: Dr Aniruddh P. Patel, Simches Research Center, Massachusetts General Hospital, 185 Cambridge Street, CPZN 3.218, Boston, Massachusetts 02114, USA. @AniruddhPatelMD
| |
Collapse
|
16
|
Mancini GBJ, Ryomoto A, Yeoh E, Brunham LR, Hegele RA. Recommendations for statin management in primary prevention: disparities among international risk scores. Eur Heart J 2024; 45:117-128. [PMID: 37638490 PMCID: PMC10771376 DOI: 10.1093/eurheartj/ehad539] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/18/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND AIMS Statin recommendations in primary prevention depend upon risk algorithms. Moreover, with intermediate risk, risk enhancers and de-enhancers are advocated to aid decisions. The aim of this study was to compare algorithms used in North America and Europe for the identification of patients warranting statin or consideration of risk enhancers and de-enhancers. METHODS A simulated population (n = 7680) equal in males and females, with/without smoking, aged 45-70 years, total cholesterol 3.5-7.0 mmol/L, high-density lipoprotein cholesterol 0.6-2.2 mmol/L, and systolic blood pressure 100-170 mmHg, was evaluated. High, intermediate, and low risks were determined using the Framingham Risk Score (FRS), Pooled Cohort Equation (PCE), four versions of Systematic Coronary Risk Evaluation 2 (SCORE2), and Multi-Ethnic Study of Atherosclerosis (MESA) algorithm (0-1000 Agatston Units). RESULTS Concordance for the three levels of risk varied from 19% to 85%. Both sexes might be considered to have low, intermediate, or high risk depending on the algorithm applied, even with the same burden of risk factors. Only SCORE2 (High Risk and Very High Risk versions) identified equal proportions of males and females with high risk. Excluding MESA, the proportion with moderate risk was 25% (SCORE2, Very High Risk Region), 32% (FRS), 39% (PCE), and 45% (SCORE2, Low Risk Region). CONCLUSION Risk algorithms differ substantially in their estimation of risk, recommendations for statin treatment, and use of ancillary testing, even in identical patients. These results highlight the limitations of currently used risk-based approaches for addressing lipid-specific risk in primary prevention.
Collapse
Affiliation(s)
- G B John Mancini
- Department of Medicine, Division of Cardiology, Centre for Cardiovascular Innovation and Cardiovascular Imaging Research Core Laboratory (CIRCL), University of British Columbia, Rm 9111, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Arnold Ryomoto
- Department of Medicine, Division of Cardiology, Centre for Cardiovascular Innovation and Cardiovascular Imaging Research Core Laboratory (CIRCL), University of British Columbia, Rm 9111, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Eunice Yeoh
- Department of Medicine, Division of Cardiology, Centre for Cardiovascular Innovation and Cardiovascular Imaging Research Core Laboratory (CIRCL), University of British Columbia, Rm 9111, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Liam R Brunham
- Department of Medicine, Division of General Internal Medicine, Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Robert A Hegele
- Departments of Medicine and Biochemistry, Division of Endocrinology, Robarts Research Institute, University of Western Ontario, London, ON, Canada
| |
Collapse
|
17
|
Farmakis D, Richter D, Chronopoulou G, Goumas G, Kountouras D, Mastorakou A, Papingiotis G, Hahalis G, Tsioufis K. High-sensitivity cardiac troponin I for cardiovascular risk stratification in apparently healthy individuals. Hellenic J Cardiol 2024; 75:74-81. [PMID: 37743017 DOI: 10.1016/j.hjc.2023.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
Troponin I and T as cardiac-specific biomarkers are highly useful tools not only in the diagnosis of acute coronary syndromes but also as independent predictors of several other clinical conditions. High-sensitivity cardiac troponin (hs-cTn) assays allow the detection of considerably low concentrations of cardiac troponin in apparently healthy and asymptomatic individuals, being a candidate tool for cardiovascular risk stratification in the general population. A group of Greek experts summarized the bulk of evidence regarding the use of hs-cTnI as a predictor of cardiovascular events and mortality in apparently healthy individuals and its additive value on top of existing risk stratification methods. This document could serve as a guide for the incorporation of hs-cTnI as an additional risk stratification tool in cardiovascular prevention strategies in apparently healthy individuals.
Collapse
Affiliation(s)
- Dimitrios Farmakis
- Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | | | | | | | - Dimitrios Kountouras
- Center for Preventive Medicine & Longevity, Bioiatriki Healthcare Group, Athens, Greece
| | | | | | | | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University Medical School, Athens, Greece
| |
Collapse
|
18
|
Jing J, Wanling L, Maofeng W. A Practical Nomogram for Predicting the Bleeding Risk in Patients with a History of Myocardial Infarction Treating with Aspirin. Clin Appl Thromb Hemost 2024; 30:10760296241262789. [PMID: 38870349 PMCID: PMC11179515 DOI: 10.1177/10760296241262789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/18/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Aspirin is a widely used antiplatelet medication to prevent blood clots, reducing the risk of cardiovascular event. Healthcare providers need to be mindful of the risk of aspirin-induced bleeding and carefully balancing its benefits against potential risks. The objective of this study was to create a practical nomogram for predicting bleeding risk in patients with a history of myocardial infarction treating with aspirin. METHODS A total of 2099 myocardial infarction patients with aspirin were enrolled. The patients were randomly divided into two groups, with a 7:3 ratio, for model development and internal validation. Boruta analysis was utilized to identify clinically significant features associated with bleeding. Logistic regression model based on independent bleeding risk factors was constructed and presented as a nomogram. Model performance was assessed from three aspects: identification, calibration, and clinical utility. RESULTS Boruta analysis identified eight clinical features from 25, and further multivariate logistic regression analysis selected four independent risk factors: hemoglobin, platelet count, previous bleeding, and sex. A visual nomogram was created based on these variables. The model achieved an area under the curve of 0.888 (95% CI: 0.845-0.931) in the training dataset and 0.888 (95% CI: 0.808-0.968) in the test dataset. Calibration curve analysis showed close approximation to the ideal curve. Decision curve analysis demonstrated favorable clinical net benefit for the model. CONCLUSIONS Our study focused on creating and validating a model to evaluate bleeding risk in patients with a history of myocardial infarction treated with aspirin, which demonstrated outstanding performance in discrimination, calibration, and net clinical benefit.
Collapse
Affiliation(s)
- Jin Jing
- Department of Gynecology, Dongyang Women & Children Hospital, Dongyang, China
| | - Lei Wanling
- Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital, Wenzhou Medical University, Dongyang, China
| | - Wang Maofeng
- Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital, Wenzhou Medical University, Dongyang, China
| |
Collapse
|
19
|
Ding J, Luo Y, Shi H, Chen R, Luo S, Yang X, Xiao Z, Liang B, Yan Q, Xu J, Ji L. Machine learning for the prediction of atherosclerotic cardiovascular disease during 3-year follow up in Chinese type 2 diabetes mellitus patients. J Diabetes Investig 2023; 14:1289-1302. [PMID: 37605871 PMCID: PMC10583655 DOI: 10.1111/jdi.14069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
AIMS/INTRODUCTION Clinical guidelines for the management of individuals with type 2 diabetes mellitus endorse the systematic assessment of atherosclerotic cardiovascular disease risk for early interventions. In this study, we aimed to develop machine learning models to predict 3-year atherosclerotic cardiovascular disease risk in Chinese type 2 diabetes mellitus patients. MATERIALS AND METHODS Clinical records of 4,722 individuals with type 2 diabetes mellitus admitted to 94 hospitals were used. The features included demographic information, disease histories, laboratory tests and physical examinations. Logistic regression, support vector machine, gradient boosting decision tree, random forest and adaptive boosting were applied for model construction. The performance of these models was evaluated using the area under the receiver operating characteristic curve. Additionally, we applied SHapley Additive exPlanation values to explain the prediction model. RESULTS All five models achieved good performance in both internal and external test sets (area under the receiver operating characteristic curve >0.8). Random forest showed the highest discrimination ability, with sensitivity and specificity being 0.838 and 0.814, respectively. The SHapley Additive exPlanation analyses showed that previous history of diabetic peripheral vascular disease, older populations and longer diabetes duration were the three most influential predictors. CONCLUSIONS The prediction models offer opportunities to personalize treatment and maximize the benefits of these medical interventions.
Collapse
Affiliation(s)
| | - Yingying Luo
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | | | | | | | | | | | | | | | - Jie Xu
- Shanghai AI LaboratoryShanghaiChina
| | - Linong Ji
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| |
Collapse
|
20
|
Medina-Inojosa JR, Somers VK, Garcia M, Thomas RJ, Allison T, Chaudry R, Wood-Wentz CM, Bailey KR, Mulvagh SL, Lopez-Jimenez F. Performance of the ACC/AHA Pooled Cohort Cardiovascular Risk Equations in Clinical Practice. J Am Coll Cardiol 2023; 82:1499-1508. [PMID: 37793746 DOI: 10.1016/j.jacc.2023.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/11/2023] [Accepted: 07/19/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The performance of the American College of Cardiology/American Heart Association pooled cohort equation (PCE) for atherosclerotic cardiovascular disease (ASCVD) in real-world clinical practice has not been evaluated extensively. OBJECTIVES The goal of this study was to test the performance of PCE to predict ASCVD risk in the community, and determine if including individuals with values outside the PCE range (ie, age, blood pressure, cholesterol) or statin therapy initiation over follow-up would significantly affect PCE predictive capabilities. METHODS The PCE was validated in a community-based cohort of consecutive patients who sought primary care in Olmsted County, Minnesota, between 1997 and 2000, followed-up through 2016. Inclusion criteria were similar to those of PCE derivation. Patient information was ascertained by using the record linkage system of the Rochester Epidemiology Project. ASCVD events (nonfatal and fatal myocardial infarction and ischemic stroke) were validated in duplicate. Calculated and observed ASCVD risk and c-statistics were compared across predefined groups. RESULTS This study included 30,042 adults, with a mean age of 48.5 ± 12.2 years; 46% were male. Median follow-up was 16.5 years, truncated at 10 years for this analysis. Mean ASCVD risk was 5.6% ± 8.73%. There were 1,555 ASCVD events (5.2%). The PCE revealed good performance overall (c-statistic 0.78) and in sex and race subgroups; it was highest among non-White female subjects (c-statistic 0.81) and lowest in White male subjects (c-statistic 0.77). Out-of-range values and initiation of statin medication did not affect model performance. CONCLUSIONS The PCE performed well in a community cohort representing real-world clinical practice. Values outside PCE ranges and initiation of statin medication did not affect performance. These results have implications for the applicability of current strategies for the prevention of ASCVD.
Collapse
Affiliation(s)
- Jose R Medina-Inojosa
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA; Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Mariana Garcia
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Randal J Thomas
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Thomas Allison
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Rajeev Chaudry
- Department of Medicine and Division of Preventive Cardiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Christina M Wood-Wentz
- Department of Medicine and Division of Preventive Cardiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Kent R Bailey
- Department of Medicine and Division of Preventive Cardiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Sharon L Mulvagh
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA; Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | |
Collapse
|
21
|
Suwannasom P, Phinyo P, Leemasawat K, Chichareon P, Nantsupawat T, Osataphan N, Thonghong T, Suwanugsorn S, Wongvipaporn C, Phrommintikul A. Prognostic Value of Ankle-Brachial Index in Prediction of Cardiovascular Events in an Asian Population with Multiple Atherosclerotic Risk Factors. Angiology 2023; 74:848-858. [PMID: 36062408 DOI: 10.1177/00033197221124772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to evaluate the incremental prognostic value after incorporation of the ankle-brachial index (ABI) into the 10-year pool cohort equation (PCE) risk model in patients with multiple risk factors (MRFs). A total of 4332 MRFs patients were divided into 2 groups as ABI ≤.9 or >.9. The primary outcome was hard cardiovascular events (hCVE: including cardiovascular death, myocardial infarction, or ischemic stroke) over a median follow-up of 36 months. The Cox proportional hazards survival model, C-statistic, and net reclassification indices (NRI) were used. The occurrence of the primary outcome in the ABI ≤.9 group (3.7%) was significantly greater than in the ABI > .9 group (1.3%), P < .001. ABI is an independent predictor of hCVE in addition to the variables in the standard risk model (age, gender, and smoking status). ABI modestly improved the C-index when added to the PCE risk model (PCE .70 vs ABI+PCE .74). The addition of ABI to the PCE risk model did not significantly improve the classification of patients (NRI -.029; 95% CI: -.215 to .130). Despite ABI being one of the independent predictors of hCVE, integration of ABI into the PCE model did not improve the efficacy of risk reclassification in patients with MRFs.
Collapse
Affiliation(s)
- Pannipa Suwannasom
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Krit Leemasawat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ply Chichareon
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Teerapat Nantsupawat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nichanan Osataphan
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tasalak Thonghong
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Saranyou Suwanugsorn
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
22
|
Brown S, Banks E, Woodward M, Raffoul N, Jennings G, Paige E. Evidence supporting the choice of a new cardiovascular risk equation for Australia. Med J Aust 2023; 219:173-186. [PMID: 37496296 PMCID: PMC10952164 DOI: 10.5694/mja2.52052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/06/2023] [Accepted: 04/21/2023] [Indexed: 07/28/2023]
Abstract
This article reviews the risk equations recommended for use in international cardiovascular disease (CVD) primary prevention guidelines and assesses their suitability for use in Australia against a set of a priori defined selection criteria. The review and assessment were commissioned by the National Heart Foundation of Australia on behalf of the Australian Chronic Disease Prevention Alliance to inform recommendations on CVD risk estimation as part of the 2023 update of the Australian CVD risk assessment and management guidelines. Selected international risk equations were assessed against eight selection criteria: development using contemporary data; inclusion of established cardiovascular risk factors; inclusion of ethnicity and deprivation measures; prediction of a broad selection of fatal and non-fatal CVD outcomes; population representativeness; model performance; external validation in an Australian dataset; and the ability to be recalibrated or modified. Of the ten risk prediction equations reviewed, the New Zealand PREDICT equation met seven of the eight selection criteria, and met additional usability criteria aimed at assessing the ability to apply the risk equation in practice in Australia.
Collapse
Affiliation(s)
- Sinan Brown
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraACT
| | - Emily Banks
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraACT
| | - Mark Woodward
- The George Institute for Global HealthUniversity of New South WalesSydneyNSW
- The George Institute for Global HealthImperial College LondonLondonUnited Kingdom
| | | | - Garry Jennings
- National Heart Foundation of AustraliaSydneyNSW
- University of New South WalesSydneyNSW
| | - Ellie Paige
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraACT
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| |
Collapse
|
23
|
Alabduljabbar K, Alkhalifah M, Aldheshe A, Shihah AB, Abu-Zaid A, DeVol EB, Albedah N, Aldakhil H, Alzayed B, Mahmoud A, Alkhenizan A. Development of a Cardiovascular Disease Risk Prediction Model: A Preliminary Retrospective Cohort Study of a Patient Sample in Saudi Arabia. J Clin Med 2023; 12:5115. [PMID: 37568517 PMCID: PMC10419869 DOI: 10.3390/jcm12155115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/22/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Saudi Arabia has an alarmingly high incidence of cardiovascular disease (CVD) and its associated risk factors. To effectively assess CVD risk, it is essential to develop tailored models for diverse regions and ethnicities using local population variables. No CVD risk prediction model has been locally developed. This study aims to develop the first 10-year CVD risk prediction model for Saudi adults aged 18 to 75 years. The electronic health records of Saudi male and female patients aged 18 to 75 years, who were seen in primary care settings between 2002 and 2019, were reviewed retrospectively via the Integrated Clinical Information System (ICIS) database (from January 2002 to February 2019). The Cox regression model was used to identify the risk factors and develop the CVD risk prediction model. Overall, 451 patients were included in this study, with a mean follow-up of 12.05 years. Thirty-five (7.7%) patients developed a CVD event. The following risk factors were included: fasting blood sugar (FBS) and high-density lipoprotein cholesterol (HDL-c), heart failure, antihyperlipidemic therapy, antithrombotic therapy, and antihypertension therapy. The Bayesian information criterion (BIC) score was 314.4. This is the first prediction model developed in Saudi Arabia and the second in any Arab country after the Omani study. We assume that our CVD predication model will have the potential to be used widely after the validation study.
Collapse
Affiliation(s)
- Khaled Alabduljabbar
- Department of Family Medicine & Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.); (A.A.); (A.B.S.); (A.M.)
| | - Mohammed Alkhalifah
- Department of Family Medicine & Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.); (A.A.); (A.B.S.); (A.M.)
| | - Abdulaziz Aldheshe
- Department of Family Medicine & Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.); (A.A.); (A.B.S.); (A.M.)
| | - Abdulelah Bin Shihah
- Department of Family Medicine & Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.); (A.A.); (A.B.S.); (A.M.)
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia;
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Edward B. DeVol
- Department of Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (E.B.D.); (N.A.); (H.A.); (B.A.)
| | - Norah Albedah
- Department of Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (E.B.D.); (N.A.); (H.A.); (B.A.)
| | - Haifa Aldakhil
- Department of Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (E.B.D.); (N.A.); (H.A.); (B.A.)
| | - Balqees Alzayed
- Department of Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (E.B.D.); (N.A.); (H.A.); (B.A.)
| | - Ahmed Mahmoud
- Department of Family Medicine & Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.); (A.A.); (A.B.S.); (A.M.)
| | - Abdullah Alkhenizan
- Department of Family Medicine & Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.); (A.A.); (A.B.S.); (A.M.)
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia;
| |
Collapse
|
24
|
Kott KA, Genetzakis E, Gray MP, Hansen P, McGuire HM, Yang JY, Grieve SM, Vernon ST, Figtree GA. Serum Soluble Lectin-like Oxidized Low-Density Lipoprotein Receptor-1 (sLOX-1) Is Associated with Atherosclerosis Severity in Coronary Artery Disease. Biomolecules 2023; 13:1187. [PMID: 37627252 PMCID: PMC10452248 DOI: 10.3390/biom13081187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
Risk-factor-based scoring systems for atherosclerotic coronary artery disease (CAD) remain concerningly inaccurate at the level of the individual and would benefit from the addition of biomarkers that correlate with atherosclerosis burden directly. We hypothesized that serum soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) would be independently associated with CAD and investigated this in the BioHEART study using 968 participants with CT coronary angiograms, which were scored for disease burden in the form of coronary artery calcium scores (CACS), Gensini scores, and a semi-quantitative soft-plaque score (SPS). Serum sLOX-1 was assessed by ELISA and was incorporated into regression models for disease severity and incidence. We demonstrate that sLOX-1 is associated with an improvement in the prediction of CAD severity when scored by Gensini or SPS, but not CACS. sLOX-1 also significantly improved the prediction of the incidence of obstructive CAD, defined as stenosis in any vessel >75%. The predictive value of sLOX-1 was significantly greater in the subgroup of patients who did not have any of the standard modifiable cardiovascular risk factors (SMuRFs). sLOX-1 is associated with CAD severity and is the first biomarker shown to have utility for risk prediction in the SMuRFless population.
Collapse
Affiliation(s)
- Katharine A. Kott
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW 2065, Australia; (K.A.K.)
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Elijah Genetzakis
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW 2065, Australia; (K.A.K.)
| | - Michael P. Gray
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW 2065, Australia; (K.A.K.)
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Peter Hansen
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Helen M. McGuire
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Ramaciotti Facility for Human Systems Biology, University of Sydney, Camperdown, NSW 2006, Australia
| | - Jean Y. Yang
- School of Mathematics and Statistics, University of Sydney, Camperdown, NSW 2006, Australia
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW 2006, Australia
| | - Stephen T. Vernon
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW 2065, Australia; (K.A.K.)
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Gemma A. Figtree
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW 2065, Australia; (K.A.K.)
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| |
Collapse
|
25
|
Colantonio LD, Goonewardena SN, Wang Z, Jackson EA, Farkouh ME, Li M, Malick W, Kent ST, López JAG, Muntner P, Bittner V, Rosenson RS. Incident CHD and ischemic stroke associated with lipoprotein(a) by levels of Factor VIII and inflammation. J Clin Lipidol 2023; 17:529-537. [PMID: 37331900 DOI: 10.1016/j.jacl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Inflammation and coagulation may contribute to the increased risk for atherosclerotic cardiovascular disease (ASCVD) associated with high lipoprotein(a). The association of lipoprotein(a) with ASCVD is stronger in individuals with high versus low high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation. OBJECTIVES Determine the association of lipoprotein(a) with incident ASCVD by levels of coagulation Factor VIII controlling for hs-CRP. METHODS We analyzed data from 6,495 men and women 45 to 84 years of age in the Multi-Ethnic Study of Atherosclerosis (MESA) without prevalent ASCVD at baseline (2000-2002). Lipoprotein(a) mass concentration, Factor VIII coagulant activity, and hs-CRP were measured at baseline and categorized as high or low (≥75th or <75th percentile of the distribution). Participants were followed for incident coronary heart disease (CHD) and ischemic stroke through 2015. RESULTS Over a median follow-up of 13.9 years, there were 390 CHD and 247 ischemic stroke events. The hazard ratio (95%CI) for CHD associated with high lipoprotein(a) (≥40.1 versus <40.1 mg/dL) including adjustment for hs-CRP among participants with low and high Factor VIII was 1.07 (0.80-1.44) and 2.00 (1.33-3.01), respectively (p-value for interaction 0.016). The hazard ratio (95%CI) for CHD associated with high lipoprotein(a) including adjustment for Factor VIII was 1.16 (0.87-1.54) and 2.00 (1.29-3.09) among participants with low and high hs-CRP, respectively (p-value for interaction 0.042). Lp(a) was not associated with ischemic stroke regardless of Factor VIII or hs-CRP levels. CONCLUSION High lipoprotein(a) is a risk factor for CHD in adults with high levels of hemostatic or inflammatory markers.
Collapse
Affiliation(s)
- Lisandro D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Colantonio, Wang, Li, Muntner, Rosenson).
| | - Sascha N Goonewardena
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA (Dr Goonewardena)
| | - Zhixin Wang
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Colantonio, Wang, Li, Muntner, Rosenson)
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Jackson, Bittner)
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto and Heart and Stroke Richard Lewar Centre of Excellence, Toronto, ON, Canada (Dr Farkouh)
| | - Mei Li
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Colantonio, Wang, Li, Muntner, Rosenson)
| | - Waqas Malick
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Drs Malick, Rosenson)
| | - Shia T Kent
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA (Dr Kent)
| | | | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Colantonio, Wang, Li, Muntner, Rosenson)
| | - Vera Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA (Drs Jackson, Bittner)
| | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA (Drs Malick, Rosenson)
| |
Collapse
|
26
|
Patel AP, Wang M, Ruan Y, Koyama S, Clarke SL, Yang X, Tcheandjieu C, Agrawal S, Fahed AC, Ellinor PT, Tsao PS, Sun YV, Cho K, Wilson PWF, Assimes TL, van Heel DA, Butterworth AS, Aragam KG, Natarajan P, Khera AV. A multi-ancestry polygenic risk score improves risk prediction for coronary artery disease. Nat Med 2023; 29:1793-1803. [PMID: 37414900 PMCID: PMC10353935 DOI: 10.1038/s41591-023-02429-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 05/30/2023] [Indexed: 07/08/2023]
Abstract
Identification of individuals at highest risk of coronary artery disease (CAD)-ideally before onset-remains an important public health need. Prior studies have developed genome-wide polygenic scores to enable risk stratification, reflecting the substantial inherited component to CAD risk. Here we develop a new and significantly improved polygenic score for CAD, termed GPSMult, that incorporates genome-wide association data across five ancestries for CAD (>269,000 cases and >1,178,000 controls) and ten CAD risk factors. GPSMult strongly associated with prevalent CAD (odds ratio per standard deviation 2.14, 95% confidence interval 2.10-2.19, P < 0.001) in UK Biobank participants of European ancestry, identifying 20.0% of the population with 3-fold increased risk and conversely 13.9% with 3-fold decreased risk as compared with those in the middle quintile. GPSMult was also associated with incident CAD events (hazard ratio per standard deviation 1.73, 95% confidence interval 1.70-1.76, P < 0.001), identifying 3% of healthy individuals with risk of future CAD events equivalent to those with existing disease and significantly improving risk discrimination and reclassification. Across multiethnic, external validation datasets inclusive of 33,096, 124,467, 16,433 and 16,874 participants of African, European, Hispanic and South Asian ancestry, respectively, GPSMult demonstrated increased strength of associations across all ancestries and outperformed all available previously published CAD polygenic scores. These data contribute a new GPSMult for CAD to the field and provide a generalizable framework for how large-scale integration of genetic association data for CAD and related traits from diverse populations can meaningfully improve polygenic risk prediction.
Collapse
Affiliation(s)
- Aniruddh P Patel
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Minxian Wang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, China.
| | - Yunfeng Ruan
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Satoshi Koyama
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Veteran Affairs Boston Healthcare System, Boston, MA, USA
| | - Shoa L Clarke
- Stanford University School of Medicine, Palo Alto, CA, USA
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Xiong Yang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, China
| | | | - Saaket Agrawal
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Akl C Fahed
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick T Ellinor
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Philip S Tsao
- Stanford University School of Medicine, Palo Alto, CA, USA
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Yan V Sun
- Veteran Affairs Atlanta Healthcare System, Decatur, GA, USA
| | - Kelly Cho
- Veteran Affairs Boston Healthcare System, Boston, MA, USA
| | | | - Themistocles L Assimes
- Stanford University School of Medicine, Palo Alto, CA, USA
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
| | - David A van Heel
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, and Centre of Research Excellence, University of Cambridge, Cambridge, UK
| | - Krishna G Aragam
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Pradeep Natarajan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Amit V Khera
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Verve Therapeutics, Boston, MA, USA.
| |
Collapse
|
27
|
Ullah A, Sajid S, Qureshi M, Kamran M, Anwaar MA, Naseem MA, Zaman MU, Mahmood F, Rehman A, Shehryar A, Nadeem MA. Novel Biomarkers and the Multiple-Marker Approach in Early Detection, Prognosis, and Risk Stratification of Cardiac Diseases: A Narrative Review. Cureus 2023; 15:e42081. [PMID: 37602073 PMCID: PMC10434821 DOI: 10.7759/cureus.42081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Cardiac diseases are a primary cause of mortality worldwide, underscoring the importance of early identification and risk stratification to enhance patient outcomes. Biomarkers have become important tools for the risk assessment of cardiovascular disease and monitoring disease progression. This narrative review focuses on the multiple-marker approach, which involves simultaneously evaluating several biomarkers for the early detection and risk stratification of heart diseases. The review covers the clinical applications of novel biomarkers, such as high-sensitivity troponin, galectin-3, source of tumorigenicity 2, B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide, growth differentiation factor 15, myeloperoxidase, fatty acid-binding protein, C-reactive protein, lipoprotein-associated phospholipase A2, microRNAs, circulating endothelial cells, and ischemia-modified albumin. These biomarkers have demonstrated potential in identifying people who are at high risk for developing heart disease and in providing prognostic data. Given the complexity of cardiac illnesses, the multiple-marker approach to risk assessment is extremely beneficial. Implementing the multiple-marker strategy can improve risk stratification, diagnostic accuracy, and patient care in heart disease patients.
Collapse
Affiliation(s)
| | - Samar Sajid
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Maria Qureshi
- Family Medicine, Ayub Medical College, Abbottabad, PAK
| | | | - Mohammad Ahsan Anwaar
- Internal Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | | | | | - Fizza Mahmood
- Cardiology/Cardiac Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| | | | | | - Muhammad A Nadeem
- Medicine and Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| |
Collapse
|
28
|
Danilov A, Aronow WS. Artificial Intelligence in Cardiology: Applications and Obstacles. Curr Probl Cardiol 2023; 48:101750. [PMID: 37088174 DOI: 10.1016/j.cpcardiol.2023.101750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
Artificial intelligence (AI) technology is poised to alter the flow of daily life, and in particular, medicine, where it may eventually complement the physician's work in diagnosing and treating disease. Despite the recent frenzy and uptick in AI research over the past decade, the integration of AI into medical practice is in its early stages. Cardiology stands to benefit due to its many diagnostic modalities and diverse treatments. AI methods have been applied to various domains within cardiology: imaging, electrocardiography, wearable devices, risk prediction, and disease classification. While many AI-based approaches have been developed that perform equal to or better than the state-of-the-art, few prospective randomized studies have evaluated their use. Furthermore, obstacles at the intersection of medicine and AI remain unsolved, including model understanding, bias, model evaluation, relevance and reproducibility, and legal and ethical dilemmas. We summarize recent and current applications of AI in cardiology, followed by a discussion of the aforementioned complications.
Collapse
Affiliation(s)
| | - Wilbert S Aronow
- New York Medical College, School of Medicine, Valhalla, New York; Department of Cardiology, Westchester Medical Center, Valhalla, NY
| |
Collapse
|
29
|
Chahine Y, Magoon MJ, Maidu B, del Álamo JC, Boyle PM, Akoum N. Machine Learning and the Conundrum of Stroke Risk Prediction. Arrhythm Electrophysiol Rev 2023; 12:e07. [PMID: 37427297 PMCID: PMC10326666 DOI: 10.15420/aer.2022.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/07/2023] [Indexed: 07/11/2023] Open
Abstract
Stroke is a leading cause of death worldwide. With escalating healthcare costs, early non-invasive stroke risk stratification is vital. The current paradigm of stroke risk assessment and mitigation is focused on clinical risk factors and comorbidities. Standard algorithms predict risk using regression-based statistical associations, which, while useful and easy to use, have moderate predictive accuracy. This review summarises recent efforts to deploy machine learning (ML) to predict stroke risk and enrich the understanding of the mechanisms underlying stroke. The surveyed body of literature includes studies comparing ML algorithms with conventional statistical models for predicting cardiovascular disease and, in particular, different stroke subtypes. Another avenue of research explored is ML as a means of enriching multiscale computational modelling, which holds great promise for revealing thrombogenesis mechanisms. Overall, ML offers a new approach to stroke risk stratification that accounts for subtle physiologic variants between patients, potentially leading to more reliable and personalised predictions than standard regression-based statistical associations.
Collapse
Affiliation(s)
- Yaacoub Chahine
- Division of Cardiology, University of Washington, Seattle, WA, US
| | - Matthew J Magoon
- Department of Bioengineering, University of Washington, Seattle, WA, US
| | - Bahetihazi Maidu
- Department of Mechanical Engineering, University of Washington, Seattle, WA, US
| | - Juan C del Álamo
- Department of Mechanical Engineering, University of Washington, Seattle, WA, US
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, US
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, US
| | - Patrick M Boyle
- Department of Bioengineering, University of Washington, Seattle, WA, US
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, US
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, US
| | - Nazem Akoum
- Division of Cardiology, University of Washington, Seattle, WA, US
- Department of Bioengineering, University of Washington, Seattle, WA, US
| |
Collapse
|
30
|
Abovich A, Florido R. Aortic Inflammation: A Predictor of Cardiovascular Disease Risk in Lymphoma Patients? JACC. ADVANCES 2023; 2:100283. [PMID: 38938301 PMCID: PMC11198326 DOI: 10.1016/j.jacadv.2023.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Arielle Abovich
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roberta Florido
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
31
|
Henson JB, Budoff MJ, Muir AJ. Performance of the Pooled Cohort Equations in non-alcoholic fatty liver disease: The Multi-Ethnic Study of Atherosclerosis. Liver Int 2023; 43:599-607. [PMID: 36401810 PMCID: PMC9974541 DOI: 10.1111/liv.15480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/31/2022] [Accepted: 11/16/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Non-alcoholic fatty liver disease (NAFLD) is associated with a high risk of cardiovascular disease. Whether risk scores developed in the general population accurately assess cardiovascular risk in the NAFLD population is unknown. This study aimed to evaluate the performance of the Pooled Cohort Equations (PCE) in NAFLD. METHODS Individuals in the Multi-Ethnic Study of Atherosclerosis with baseline non-contrast cardiac computed tomography scans with sufficient data to determine the presence of hepatic steatosis were identified and assessed for the development of incident 10-year atherosclerotic cardiovascular disease. The discrimination and calibration of the PCE were evaluated, and the observed and expected events by risk category (<5%, 5-<7.5%, 7.5-<20%, ≥20%) were determined. Risk reclassification with the addition of NAFLD to the PCE was assessed. RESULTS Of 4014 participants included, 698 (17.4%) with NAFLD were identified, including 247 (35.3%) with moderate-to-severe steatosis. Discrimination of the PCE was suboptimal in NAFLD (c-statistic 0.69), particularly moderate-to-severe steatosis (0.65), and calibration was overall poor. While risk was overestimated in non-NAFLD, it was underestimated in NAFLD in lower/intermediate risk categories, predominantly in women (5-<7.5% observed/expected ratio = 1.67). The addition of NAFLD to the PCE improved risk classification in women. CONCLUSIONS The PCE overall performed suboptimally in cardiovascular risk assessment in NAFLD, particularly in women and individuals with moderate-to-severe steatosis in clinically relevant risk categories. Primary prevention may need to be considered at a lower risk threshold in these groups, and further work is needed to improve risk stratification in this growing high-risk population.
Collapse
Affiliation(s)
- Jacqueline B Henson
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center and Lundquist Institute for Biomedical Innovation, Torrance, California, USA
| | - Andrew J Muir
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| |
Collapse
|
32
|
An international perspective on low-dose aspirin for the primary prevention of myocardial infarction. Int J Cardiol 2023; 373:17-22. [PMID: 36442672 DOI: 10.1016/j.ijcard.2022.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022]
|
33
|
The Role of Imaging in Preventive Cardiology in Women. Curr Cardiol Rep 2023; 25:29-40. [PMID: 36576679 DOI: 10.1007/s11886-022-01828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The prevalence of CVD in women is increasing and is due to the increased prevalence of CV risk factors. Traditional CV risk assessment tools for prevention have failed to accurately determine CVD risk in women. CAC has shown to more precisely determine CV risk and is a better predictor of CV outcomes. Coronary CTA provides an opportunity to determine the presence of CAD and initiate prevention in women presenting with angina. Identifying women with INOCA due to CMD with use of cPET or cMRI with MBFR is vital in managing these patients. This review article outlines the role of imaging in preventive cardiology for women and will include the latest evidence supporting the use of these imaging tests for this purpose. RECENT FINDINGS CV mortality is higher in women who have more extensive CAC burden. Women have a greater prevalence of INOCA which is associated with higher MACE. INOCA is due to CMD in most cases which is associated with traditional CVD risk factors. Over half of these women are untreated or undertreated. Recent study showed that stratified medical therapy, tailored to the specific INOCA endotype, is feasible and improves angina in women. Coronary CTA is useful in the setting of women presenting with acute chest pain to identify CAD and initiate preventive therapy. CAC confers greater relative risk for CV mortality in women versus (vs.) men. cMRI or cPET is useful to assess MBFR to diagnose CMD and is another useful imaging tool in women for CV prevention.
Collapse
|
34
|
Langenbach MC, Sandstede J, Sieren MM, Barkhausen J, Gutberlet M, Bamberg F, Lehmkuhl L, Maintz D, Naehle CP. German Radiological Society and the Professional Association of German Radiologists Position Paper on Coronary computed tomography: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome. ROFO-FORTSCHR RONTG 2023; 195:115-134. [PMID: 36634682 DOI: 10.1055/a-1973-9687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This position paper is a joint statement of the German Radiological Society (DRG) and the Professional Association of German Radiologists (BDR), which reflects the current state of knowledge about coronary computed tomography. It is based on preclinical and clinical studies that have investigated the clinical relevance as well as the technical requirements and fundamentals of cardiac computed tomography. CITATION FORMAT: · Langenbach MC, Sandstede J, Sieren M et al. DRG and BDR Position Paper on Coronary CT: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome. Fortschr Röntgenstr 2023; 195: 115 - 133.
Collapse
Affiliation(s)
- Marcel C Langenbach
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Koln, Germany.,Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jörn Sandstede
- Radiologische Allianz, Hamburg, Germany.,Berufsverband der deutschen Radiologen e. V. (BDR), München, Deutschland
| | - Malte M Sieren
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Luebeck, Lübeck, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Luebeck, Lübeck, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Lehmkuhl
- Department for Diagnostic and Interventional Radiology, RHÖN Clinic, Campus Bad Neustadt, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Koln, Germany
| | - Claas P Naehle
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Koln, Germany.,Radiologische Allianz, Hamburg, Germany
| |
Collapse
|
35
|
Langenbach MC, Sandstede J, Sieren MM, Barkhausen J, Gutberlet M, Bamberg F, Lehmkuhl L, Maintz D, Nähle CP. [German Radiological Society and the Professional Association of German Radiologists position paper on coronary computed tomography: clinical evidence and quality of patient care in chronic coronary syndrome]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:1-19. [PMID: 36633613 PMCID: PMC9838426 DOI: 10.1007/s00117-022-01096-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/13/2023]
Abstract
This position paper is a joint statement of the German Radiological Society (DRG) and the Professional Association of German Radiologists (BDR), which reflects the current state of knowledge about coronary computed tomography (CT). It is based on preclinical and clinical studies that have investigated the clinical relevance as well as the technical requirements and fundamentals of cardiac computed tomography.
Collapse
Affiliation(s)
- M C Langenbach
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Köln, Deutschland.
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - J Sandstede
- Radiologische Allianz, Hamburg, Deutschland
- Berufsverband der deutschen Radiologen e. V. (BDR), München, Deutschland
| | - M M Sieren
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - J Barkhausen
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - M Gutberlet
- Abteilung für Diagnostische und Interventionelle Radiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Deutschland
| | - F Bamberg
- Medizinische Fakultät, Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - L Lehmkuhl
- Abteilung für Diagnostische und Interventionelle Radiologie, RHÖN Klinik, Campus Bad Neustadt, Bad Neustadt, Deutschland
| | - D Maintz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Köln, Deutschland
| | - C P Nähle
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Köln, Deutschland
- Radiologische Allianz, Hamburg, Deutschland
| |
Collapse
|
36
|
Souza V, Valadares V, Dias T, Brites C. High Concordance between D:A:Dr and the Framingham Risk Score in Brazilians Living with HIV. Viruses 2023; 15:348. [PMID: 36851562 PMCID: PMC9960260 DOI: 10.3390/v15020348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
People living with HIV (PLHIV) have twice the risk of developing cardiovascular diseases, making it essential to identify high cardiovascular risk (CVR). However, there is no validated CVR calculator for PLHIV in Brazil. We performed a cross-sectional study with 265 individuals living with HIV, aged 40 to 74 years, to assess the agreement between three CVR scores: Framingham Risk Score (FRS), Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score, and a specific for PLHIV, Reduced Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:Dr). We assessed agreement using the weighted Kappa coefficient and the Bland-Altman plot. The median age was 52 years (47-58), 58.9% were men, 34% were hypertensive and 8.3% had a detectable viral load. There was an almost perfect agreement between D:A:Dr x FRS (k = 0.82; 95% CI 0.77-0.87; p < 0.001), and substantial agreement between FRS vs. ASCVD (k = 0.74; 95% CI 0.69-0.79; p < 0.001) and between D:A:Dr vs. ASCVD (k = 0.70; 95% CI 0.64-0.76; p < 0.001). The Bland-Altman plot revealed greater discordance between scores as the CVR increased. Our results suggest that the FRS and the D:A:Dr are adequate to classify the CVR in this population, and the D:A:Dr score can be used as an alternative to the FRS in Brazil, as other international guidelines have already advocated.
Collapse
Affiliation(s)
- Vitor Souza
- Department of Medicine, Medical School, Federal University of Bahia, Salvador 40110-060, BA, Brazil
| | - Victória Valadares
- Department of Medicine, Medical School, Federal University of Bahia, Salvador 40110-060, BA, Brazil
| | - Thais Dias
- Department of Medicine, Medical School, Federal University of Bahia, Salvador 40110-060, BA, Brazil
| | - Carlos Brites
- Department of Medicine, Medical School, Federal University of Bahia, Salvador 40110-060, BA, Brazil
- Hospital Universitário Professor Edgard Santos, UFBA-EBSEHR, Salvador 40110-060, BA, Brazil
| |
Collapse
|
37
|
Baskaran L, Lee JK, Ko MSM, Al’Aref SJ, Neo YP, Ho JS, Huang W, Yoon YE, Han D, Nakanishi R, Tan SY, Al-Mallah M, Budoff MJ, Shaw LJ. Comparing the pooled cohort equations and coronary artery calcium scores in a symptomatic mixed Asian cohort. Front Cardiovasc Med 2023; 10:1059839. [PMID: 36733301 PMCID: PMC9887040 DOI: 10.3389/fcvm.2023.1059839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
Background The value of pooled cohort equations (PCE) as a predictor of major adverse cardiovascular events (MACE) is poorly established among symptomatic patients. Coronary artery calcium (CAC) assessment further improves risk prediction, but non-Western studies are lacking. This study aims to compare PCE and CAC scores within a symptomatic mixed Asian cohort, and to evaluate the incremental value of CAC in predicting MACE, as well as in subgroups based on statin use. Methods Consecutive patients with stable chest pain who underwent cardiac computed tomography were recruited. Logistic regression was performed to determine the association between risk factors and MACE. Cohort and statin-use subgroup comparisons were done for PCE against Agatston score in predicting MACE. Results Of 501 patients included, mean (SD) age was 53.7 (10.8) years, mean follow-up period was 4.64 (0.66) years, 43.5% were female, 48.3% used statins, and 50.0% had no CAC. MI occurred in 8 subjects while 9 subjects underwent revascularization. In the general cohort, age, presence of CAC, and ln(Volume) (OR = 1.05, 7.95, and 1.44, respectively) as well as age and PCE score for the CAC = 0 subgroup (OR = 1.16 and 2.24, respectively), were significantly associated with MACE. None of the risk factors were significantly associated with MACE in the CAC > 0 subgroup. Overall, the PCE, Agatston, and their combination obtained an area under the receiver operating characteristic curve (AUC) of 0.501, 0.662, and 0.661, respectively. Separately, the AUC of PCE, Agatston, and their combination for statin non-users were 0.679, 0.753, and 0.734, while that for statin-users were 0.585, 0.615, and 0.631, respectively. Only the performance of PCE alone was statistically significant (p = 0.025) when compared between statin-users (0.507) and non-users (0.783). Conclusion In a symptomatic mixed Asian cohort, age, presence of CAC, and ln(Volume) were independently associated with MACE for the overall subgroup, age and PCE score for the CAC = 0 subgroup, and no risk factor for the CAC > 0 subgroup. Whilst the PCE performance deteriorated in statin versus non-statin users, the Agatston score performed consistently in both groups.
Collapse
Affiliation(s)
- Lohendran Baskaran
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore,*Correspondence: Lohendran Baskaran,
| | - Jing Kai Lee
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Michelle Shi Min Ko
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Subhi J. Al’Aref
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Yu Pei Neo
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jien Sze Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Weiting Huang
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Swee Yaw Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Mouaz Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Leslee J. Shaw
- Icahn School of Medicine at Mount Sinai, Blavatnik Family Women’s Health Research Institute, New York, NY, United States
| |
Collapse
|
38
|
Kassam N, Surani S, Hameed K, Aghan E, Mayenga R, Matei I, Jengo G, Bakshi F, Mbithe H, Orwa J, Udeani G, Somji S. Magnitude, Distribution and Contextual Risk Enhancing Predictors of High 10-Year Cardiovascular Risk Among Diabetic Patients in Tanzania. Patient Relat Outcome Meas 2023; 14:87-96. [PMID: 37152069 PMCID: PMC10162395 DOI: 10.2147/prom.s405392] [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: 01/26/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Atherosclerotic Cardiovascular Disease (ASCVD) is the leading cause of death worldwide. In Diabetics, ASCVD is associated with poor prognosis and a higher case fatality rate compared with the general population. Sub-Saharan Africa is facing an epidemiological transition with ASCVD being prevalent among young adults. To date, over 20 million people have been living with DM in Africa, Tanzania being one of the five countries in the continent reported to have a higher prevalence. This study aimed to identify an individual's 10-year ASCVD absolute risk among a diabetic cohort in Tanzania and define contextual risk enhancing factors. Methods A prospective observational study was conducted at the Aga Khan hospital, Mwanza, for a period of 8 months. The hospital is a 42-bed district-level hospital in Tanzania. Individuals 10-year risk was calculated based on the ASCVD 2013 risk calculator by ACC/AHA. Pearson's chi-square or Fischer's exact test was used to compare categorical and continuous variables. Multivariable analysis was applied to determine contextual factors for those who had a high 10-year risk of developing ASCVD. Results The overall cohort included 573 patients. Majority of the individuals were found to be hypertensive (n = 371, 64.7%) and obese (n = 331, 58%) having a high 10-year absolute risk (n = 343, 60%) of suffering ASCVD. The study identified duration of Diabetes Mellitus (>10 years) (OR 8.15, 95% CI 5.25-14.42), concomitant hypertension (OR 1.82 95% CI 1.06-3.06), Diabetic Dyslipidemia (OR 1.44, 95% CI 1.08-1.92) and deranged serum creatinine (OR 1.03, 95% CI 1.02-1.03) to be the risk enhancing factors amongst our population. Conclusion The study confirms the majority of diabetic individuals in the lake region of Tanzania to have a high 10-year ASCVD risk. The high prevalence of obesity, hypertension and dyslipidemia augments ASCVD risk but provides interventional targets for health-care workers to decrease these alarming projections.
Collapse
Affiliation(s)
- Nadeem Kassam
- Department of Internal Medicine, Aga Khan Hospital, Mwanza, Tanzania
- Correspondence: Nadeem Kassam, Email
| | - Salim Surani
- Department of Pharmacy, A&M University, College Station, TX, USA
| | - Kamran Hameed
- Department of Internal Medicine, Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Eric Aghan
- Department of Family Medicine Aga Khan University Medical College, Dar es Salaam, Tanzania
| | - Robert Mayenga
- Department of Internal Medicine, Aga Khan Hospital, Mwanza, Tanzania
| | - Iris Matei
- Department of Internal Medicine, Aga Khan Hospital, Mwanza, Tanzania
| | - Gijsberta Jengo
- Department of Internal Medicine, Aga Khan Hospital, Mwanza, Tanzania
| | - Fatma Bakshi
- Department of Internal Medicine, Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Hanifa Mbithe
- Department of Internal Medicine, Aga Khan Hospital, Dar es Salaam, Tanzania
| | - James Orwa
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - George Udeani
- Department of Pharmacy, A&M University, College Station, TX, USA
| | - Samina Somji
- Department of Internal Medicine, Aga Khan Hospital, Dar es Salaam, Tanzania
| |
Collapse
|
39
|
Sasikumar M, Oommen AM, Mohan VR, Gupta P, Rebekah G, Abraham VJ, George K. Recalibration of the Framingham risk score for predicting 10-year risk of cardiovascular events: A non-concurrent rural cohort study from Tamil Nadu. Indian Heart J 2023; 75:47-52. [PMID: 36638887 PMCID: PMC9986738 DOI: 10.1016/j.ihj.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To recalibrate the Framingham Risk Score-cardiovascular diseases (FRS-CVD) using 10-year mortality data and baseline risk factor data for a rural cohort and assess the effect of recalibration on proportion categorised as high risk. METHODS Participants of a cardiovascular risk factor survey aged 30-64 years in 2011-12, from 9 villages of a rural block in Vellore, Tamil Nadu, were followed up for mortality till 2021, as part of an established demographic surveillance system. We calculated both lipid-based and Body Mass Index-based FRS-CVD risk scores, as well as recalibrated scores using risk factor data from the baseline survey and CVD mortality observed over 10 years. RESULTS Based on original lipid-based FRS-CVD scores, 8.48% (109) of 1285 males had a 10-year CVD risk ≥30%, compared to 11.60% (149) with recalibrated scores. Among 1737 females, 1.50% (26) had a 10-year CVD risk of ≥30%, using original FRS-CVD scores, and 3.22% (56) using recalibrated scores. Similarly, for BMI based FRS-CVD scores, overall, 3.63% (110/3028) had a 10-year risk of ≥30%, compared to 6.64% (201) using recalibrated scores. The median 10-year FRS-CVD original score in males was 7.57 (IQR: 3.67-15.83), and 2.53 (IQR: 1.28-5.32) in females, compared to 8.95 (IQR: 4.35-18.52) and 3.79 (IQR: 1.92-7.93) respectively, for the recalibrated FRS-CVD risk scores. CONCLUSION The recalibrated Framingham models showed a greater proportion of the population at risk of CVDs compared to the original FRS scores, with males having 2-3 times greater CVD risk scores compared to females.
Collapse
Affiliation(s)
- Midhun Sasikumar
- Community Health Department, Christian Medical College Vellore, Tamil Nadu, 632002, India
| | - Anu Mary Oommen
- Community Health Department, Christian Medical College Vellore, Tamil Nadu, 632002, India.
| | - Venkata Raghava Mohan
- Community Health Department, Christian Medical College Vellore, Tamil Nadu, 632002, India
| | - Priti Gupta
- Centre for Chronic Disease Control, New Delhi, 110016, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College Vellore, Tamil Nadu, 632002, India
| | - Vinod Joseph Abraham
- Community Health Department, Christian Medical College Vellore, Tamil Nadu, 632002, India
| | - Kuryan George
- Community Health Department, Christian Medical College Vellore, Tamil Nadu, 632002, India
| |
Collapse
|
40
|
Ren Y, Li Y, Pan W, Yin D, Du J. Predictive value of CAC score combined with clinical features for obstructive coronary heart disease on coronary computed tomography angiography: a machine learning method. BMC Cardiovasc Disord 2022; 22:569. [PMID: 36572879 PMCID: PMC9793556 DOI: 10.1186/s12872-022-03022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE We investigated the predictive value of clinical factors combined with coronary artery calcium (CAC) score based on a machine learning method for obstructive coronary heart disease (CAD) on coronary computed tomography angiography (CCTA) in individuals with atypical chest pain. METHODS The study included data from 1,906 individuals undergoing CCTA and CAC scanning because of atypical chest pain and without evidence for the previous CAD. A total of 63 variables including traditional cardiovascular risk factors, CAC score, laboratory results, and imaging parameters were used to build the Random forests (RF) model. Among all the participants, 70% were randomly selected to train the models on which fivefold cross-validation was done and the remaining 30% were regarded as a validation set. The prediction performance of the RF model was compared with two traditional logistic regression (LR) models. RESULTS The incidence of obstructive CAD was 16.4%. The area under the receiver operator characteristic (ROC) for obstructive CAD of the RF model was 0.841 (95% CI 0.820-0.860), the CACS model was 0.746 (95% CI 0.722-0.769), and the clinical model was 0.810 (95% CI 0.788-0.831). The RF model was significantly superior to the other two models (p < 0.05). Furthermore, the calibration curve and Hosmer-Lemeshow test showed that the RF model had good classification performance (p = 0.556). CAC score, age, glucose, homocysteine, and neutrophil were the top five important variables in the RF model. CONCLUSION RF model was superior to the traditional models in the prediction of obstructive CAD. In clinical practice, the RF model may improve risk stratification and optimize individual management.
Collapse
Affiliation(s)
- Yongkui Ren
- grid.24696.3f0000 0004 0369 153XBeijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China ,grid.411971.b0000 0000 9558 1426Department of Cardiology, 1st Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yulin Li
- grid.24696.3f0000 0004 0369 153XBeijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China ,grid.411606.40000 0004 1761 5917Beijing Institute of Heart, Lung, and Blood Vessel Disease, Beijing, China
| | - Weili Pan
- grid.411971.b0000 0000 9558 1426Department of Cardiology, 1st Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Da Yin
- grid.440218.b0000 0004 1759 7210Department of Cardiology, Shenzhen People’s Hospital, 2nd Clinical Medical College of JINAN University, 1st Affiliated Hospital of Southern University of Science and Technology, ShenZhen, China
| | - Jie Du
- grid.24696.3f0000 0004 0369 153XBeijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China ,grid.411606.40000 0004 1761 5917Beijing Institute of Heart, Lung, and Blood Vessel Disease, Beijing, China
| |
Collapse
|
41
|
Mantri NM, Merchant M, Rana JS, Go AS, Pursnani SK. Performance of the pooled cohort equation in South Asians: insights from a large integrated healthcare delivery system. BMC Cardiovasc Disord 2022; 22:566. [PMID: 36564709 PMCID: PMC9789536 DOI: 10.1186/s12872-022-02993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
South Asian ethnicity is associated with increased atherosclerotic cardiovascular disease (ASCVD) risk and has been identified as a "risk enhancer" in the 2018 American College of Cardiology/American Heart Association Guidelines. Risk estimation and statin eligibility in South Asians is not well understood; we studied the accuracy of 10-years ASCVD risk prediction by the pooled cohort equation (PCE), based on statin use, in a South Asian cohort. This is a retrospective cohort study of Kaiser Permanente Northern California South Asian members without existing ASCVD, age range 30-70, and 10-years follow up. ASCVD events were defined as myocardial infarction, ischemic stroke, and cardiovascular death. The cohort was stratified by statin use during the study period: never; at baseline and during follow-up; and only during follow-up. Predicted probability of ASCVD, using the PCE was calculated and compared to observed ASCVD events for low < 5.0%, borderline 5.0 to < 7.5%, intermediate 7.5 to < 20.0%, and high ≥ 20.0% risk groups. A total of 1835 South Asian members were included: 773 never on statin, 374 on statins at baseline and follow-up, and 688 on statins during follow-up only. ASCVD risk was underestimated by the PCE in low-risk groups: entire cohort: 1.8 versus 4.9%, p < 0.0001; on statin at baseline and follow-up: 2.58 versus 8.43%, p < 0.0001; on statin during follow-up only: 2.18 versus 7.77%, p < 0.0001; and never on statin: 1.37 versus 2.09%, p = 0.12. In this South Asian cohort, the PCE underestimated risk in South Asians, regardless of statin use, in the low risk ASCVD risk category.
Collapse
Affiliation(s)
- Neha M. Mantri
- Department of Cardiology, Palo Alto Veterans Health Care System, Palo Alto, CA USA ,grid.168010.e0000000419368956Department of Medicine, Stanford University, Palo Alto, CA USA
| | - Maqdooda Merchant
- grid.280062.e0000 0000 9957 7758Division of Research, Kaiser Permanente, Oakland, CA USA
| | - Jamal S. Rana
- grid.280062.e0000 0000 9957 7758Division of Research, Kaiser Permanente, Oakland, CA USA
| | - Alan S. Go
- grid.280062.e0000 0000 9957 7758Division of Research, Kaiser Permanente, Oakland, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, CA USA ,grid.168010.e0000000419368956Department of Medicine, Stanford University, Palo Alto, CA USA
| | - Seema K. Pursnani
- grid.414888.90000 0004 0445 0711Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, 710 Lawrence Expressway, Dept 348, Santa Clara, CA 95051 USA
| |
Collapse
|
42
|
Estimated versus observed 10-year atherosclerotic cardiovascular event rates in a rural population-based health initiative: The Heart of New Ulm Project. Am J Prev Cardiol 2022; 13:100449. [PMID: 36636122 PMCID: PMC9830107 DOI: 10.1016/j.ajpc.2022.100449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Assess discrepancy between estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk and observed 10-year event rates in a rural population participating in cardiovascular health initiative. Methods The study included a rural sample of individuals participating in the Heart of New Ulm (HONU), a population-based health initiative aimed at reducing ASCVD risk in a rural community. HONU conducted over 100 baseline screening events with 5221 individuals participating in 2009. For this analysis, we included participants who were aged 40-79 years, free of ASCVD at baseline, and had adequate data to calculate 10-year ASCVD risk. Electronic health record data and state death records were used to determine rates of non-fatal myocardial infarction and stroke, and ASCVD death from 2010-2019. ASCVD event rates were compared to estimated 10-year risks calculated using the Pooled Cohort Equations, stratified by sex and clinically relevant risk categories. Results The sample (n = 2819, mean ± SD age 56.1 ± 9.9 years, 59.6% female) had a low prevalence of tobacco use (8.1% current smokers) and diabetes (6.5%) and a high prevalence of hypertension (44.4%) and hyperlipidemia (56.6%). The median estimated 10-year ASCVD risk for the entire sample was 5.7% (IQR 2.3-13.5%) with an observed 10-year ASCVD event rate of 3.4%. The largest gap between observed and estimated risk was in those at intermediate/high (≥7.5%) ASCVD risk (median 10-year risk 15.8% [IQR 10.4-29.0], observed ASCVD event rate 6.4%). Conclusio In a sample of rural participants exposed to a multifaceted ASCVD prevention initiative, observed rates of ASCVD were substantially lower compared to estimated ASCVD risk. The potential for significantly lower than predicted ASCVD event rates in certain populations should be included in the clinician-patient risk discussion.
Collapse
|
43
|
Ho JC, Staimez LR, Narayan KMV, Ohno-Machado L, Simpson RL, Hertzberg VS. Evaluation of available risk scores to predict multiple cardiovascular complications for patients with type 2 diabetes mellitus using electronic health records. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE UPDATE 2022; 3:100087. [PMID: 37332899 PMCID: PMC10274317 DOI: 10.1016/j.cmpbup.2022.100087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Aims Various cardiovascular risk prediction models have been developed for patients with type 2 diabetes mellitus. Yet few models have been validated externally. We perform a comprehensive validation of existing risk models on a heterogeneous population of patients with type 2 diabetes using secondary analysis of electronic health record data. Methods Electronic health records of 47,988 patients with type 2 diabetes between 2013 and 2017 were used to validate 16 cardiovascular risk models, including 5 that had not been compared previously, to estimate the 1-year risk of various cardiovascular outcomes. Discrimination and calibration were assessed by the c-statistic and the Hosmer-Lemeshow goodness-of-fit statistic, respectively. Each model was also evaluated based on the missing measurement rate. Sub-analysis was performed to determine the impact of race on discrimination performance. Results There was limited discrimination (c-statistics ranged from 0.51 to 0.67) across the cardiovascular risk models. Discrimination generally improved when the model was tailored towards the individual outcome. After recalibration of the models, the Hosmer-Lemeshow statistic yielded p-values above 0.05. However, several of the models with the best discrimination relied on measurements that were often imputed (up to 39% missing). Conclusion No single prediction model achieved the best performance on a full range of cardiovascular endpoints. Moreover, several of the highest-scoring models relied on variables with high missingness frequencies such as HbA1c and cholesterol that necessitated data imputation and may not be as useful in practice. An open-source version of our developed Python package, cvdm, is available for comparisons using other data sources.
Collapse
Affiliation(s)
- Joyce C Ho
- Department of Computer Science, Emory University, 400 Dowman Drive, Atlanta, GA 30322, United States
| | - Lisa R Staimez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, United States
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, United States
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, School of Medicine, University of California San Diego, United States
| | - Roy L Simpson
- Center for Data Science, Nell Hodgson Woodruff School of Nursing, Emory University, United States
| | - Vicki Stover Hertzberg
- Center for Data Science, Nell Hodgson Woodruff School of Nursing, Emory University, United States
| |
Collapse
|
44
|
Development of Prediction Models for Acute Myocardial Infarction at Prehospital Stage with Machine Learning Based on a Nationwide Database. J Cardiovasc Dev Dis 2022; 9:jcdd9120430. [PMID: 36547427 PMCID: PMC9784963 DOI: 10.3390/jcdd9120430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Models for predicting acute myocardial infarction (AMI) at the prehospital stage were developed and their efficacy compared, based on variables identified from a nationwide systematic emergency medical service (EMS) registry using conventional statistical methods and machine learning algorithms. Patients in the EMS cardiovascular registry aged >15 years who were transferred from the public EMS to emergency departments in Korea from January 2016 to December 2018 were enrolled. Two datasets were constructed according to the hierarchical structure of the registry. A total of 184,577 patients (Dataset 1) were included in the final analysis. Among them, 72,439 patients (Dataset 2) were suspected to have AMI at prehospital stage. Between the models derived using the conventional logistic regression method, the B-type model incorporated AMI-specific variables from the A-type model and exhibited a superior discriminative ability (p = 0.02). The models that used extreme gradient boosting and a multilayer perceptron yielded a higher predictive performance than the conventional logistic regression-based models for analyses that used both datasets. Each machine learning algorithm yielded different classification lists of the 10 most important features. Therefore, prediction models that use nationwide prehospital data and are developed with appropriate structures can improve the identification of patients who require timely AMI management.
Collapse
|
45
|
Al-Kindi S, Tashtish N, Rashid I, Sullivan C, Neeland IJ, Robinson M, Gross EM, Shaw L, Cainzos-Achirica M, Nasir K, Kreatsoulas C, Gilkeson R, Simon DI, Rajagopalan S. Impact of low/no-charge coronary artery calcium scoring on statin eligibility and outcomes in women: The CLARIFY study. Am J Prev Cardiol 2022; 12:100392. [PMID: 36157553 PMCID: PMC9493055 DOI: 10.1016/j.ajpc.2022.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/01/2022] [Accepted: 09/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Methods Results Conclusion
Collapse
|
46
|
Mendez K, Rane M, Orkaby AR, Gaziano JM. A tool to help patients visualize ASCVD risk and the potential impact of risk-lowering interventions. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 15:200159. [PMID: 36573190 PMCID: PMC9789346 DOI: 10.1016/j.ijcrp.2022.200159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/13/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
Abstract
Risk assessment is a fundamental step in the current approach to primary prevention of atherosclerotic cardiovascular disease (ASCVD). When considering pharmacotherapy for primary prevention of ASCVD, current prevention guidelines in the United States recommend the use of the pooled cohort equations (PCE) to assess 10-year ASCVD risk and begin the important process of shared decision-making between patients and clinicians. Clinicians should support patients in the decisionmaking process by turning raw data into information that is easily understood and more effectively utilized for decisions around the treatment plan. In this work, we present a tool to help patients visualize ASCVD risk and the projected impact of risk-lowering interventions. We believe this visual tool can facilitate communication of ASCVD risk to patients, and improve patient understanding of risk and the potential impact of risklowering interventions, which we believe may help patients make more informed, empowered decisions that achieve greater risk reduction.
Collapse
Affiliation(s)
- Keegan Mendez
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
- Corresponding author. MIT E25-319 400 Main Street Cambridge, MA 02142, USA
| | - Manas Rane
- VA Boston Healthcare System, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ariela R. Orkaby
- New England GRECC (Geriatric Research Education and Clinical Center) VA Boston Healthcare System, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - J. Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| |
Collapse
|
47
|
Mortensen MB. Recalibrating 10-Year Risk Models Using Population-Based Data: Not Without Caveats. J Am Coll Cardiol 2022; 80:1343-1345. [PMID: 36175053 DOI: 10.1016/j.jacc.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Ciccarone Center for Cardiovascular Disease Prevention, Johns Hopkins, Baltimore, Maryland, USA.
| |
Collapse
|
48
|
Population-Based Recalibration of the Framingham Risk Score and Pooled Cohort Equations. J Am Coll Cardiol 2022; 80:1330-1342. [PMID: 36175052 DOI: 10.1016/j.jacc.2022.07.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Framingham Risk Score (FRS) and Pooled Cohort Equations (PCEs) overestimate risk in many contemporary cohorts. OBJECTIVES This study sought to determine if recalibration of these scores using contemporary population-level data improves risk stratification for statin therapy. METHODS Five-year FRS and PCEs were recalibrated using a cohort of Ontario residents alive January 1, 2011, who were 30 to 79 years of age without cardiovascular disease. Scores were externally validated in a primary care cohort of routinely collected electronic medical record data from January 1, 2010, to December 31, 2014. The relative difference in mean predicted and observed risk, number of statins avoided, and number needed to treat with statins to reduce a cardiovascular event at 5 years were reported. RESULTS The FRS was recalibrated in 6,938,971 Ontario residents (51.6% women, mean age 48 years) and validated in 71,450 individuals (56.1% women, mean age 52 years). Recalibration reduced overestimation from 109% to 49% for women and 131% to 32% for men. The recalibrated FRS was estimated to reduce statin prescriptions in up to 26 per 1,000 low-risk women and 80 per 1,000 low-risk men, as well as reduce the number needed to treat from 61 to 47 in women and from 53 to 41 in men. In contrast, after recalibration of the PCEs, risk remained overestimated by 217% in women and 128% in men. CONCLUSIONS Recalibration is a feasible solution to improve risk prediction but is dependent on the model being used. Recalibration of the FRS but not the PCEs reduced overestimation and may improve utilization of statins.
Collapse
|
49
|
Habib AR, Katz MH, Redberg RF. Statins for Primary Cardiovascular Disease Prevention: Time to Curb Our Enthusiasm. JAMA Intern Med 2022; 182:1021-1024. [PMID: 35997985 DOI: 10.1001/jamainternmed.2022.3204] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anand R Habib
- Department of Medicine, University of California, San Francisco.,Editorial Fellow, JAMA Internal Medicine
| | - Mitchell H Katz
- NYC Health + Hospitals, New York, New York.,Deputy Editor, JAMA Internal Medicine
| | - Rita F Redberg
- Division of Cardiology, Department of Medicine, University of California, San Francisco.,Editor, JAMA Internal Medicine
| |
Collapse
|
50
|
Impact of psychological status on cardiovascular diseases: Is it time for upgrading risk score charts? Atherosclerosis 2022; 359:42-43. [PMID: 36127169 DOI: 10.1016/j.atherosclerosis.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022]
|