Uso de modelos de predicción de eventos cardiovasculares para pronóstico de lesión vascular coronaria significativa / Use of cardiovascular events prediction models for the prognosis of a severe coronary artery lesion

Resumen Objetivos: Determinar el mejor punto de corte y el grado de conformidad de las escalas de riesgo, Framingham, PROCAM y Reynolds, para el diagnóstico de lesión vascular coronaria arterioesclerótica severa a través de la comparación de las áreas bajo la curva de acuerdo con las curvas operativas del receptor (COR). Métodos: Estudio de corte transversal en adultos que fueron sometidos a arteriografía coronaria. Se aplicaron las escalas Framingham, PROCAM y Reynolds, las dos primeras ajustadas según estudio de calibración colombiano. Luego se realizó la recolección de los datos de manera concurrente en instituciones de referencia en cardiología y hemodinámica en Bogotá. Resultados: De 200 pacientes estudiados, 66% eran mujeres, 37,5% mayores de 70 años, 53,2% con hipertensión, 52,7% en sobrepeso u obesidad, 61,5% presentaron valores altos de Proteína C Reactiva ultrasensible (PCRus) y 50% tenían al menos una lesión coronaria mayor de 70%. Se encontraron los mejores puntos de corte, de acuerdo con cada curva de características operativas del receptor (COR): Framingham ajustado 5,8% (sensibilidad 80%, especificidad 41%). PROCAM ajustado 1,7% (sensibilidad 78%, especificidad 45%) y Reynolds 3,8% (sensibilidad 68%, especificidad 45%). Adicionalmente, se encontró que las tres escalas presentaron áreas bajo la curva (ABC) de 0,59, 0,59 y 0,57, respectivamente.

Abstract Objectives: To determine the best cut-off point and the level of agreement of the Framingham, PROCAM, and Reynolds risk scales, for the diagnosis of a severe atherosclerotic coronary artery lesion by comparing the areas under the receiver operator characteristics (ROC) curves. Methods: A cross-sectional study was carried out on adults that were subjected to coronary angiography. The Framingham, PROCAM, and Reynolds were applied, with the first two adjusted to a Colombian calibration study. Data were collected concurrently in the institutions of reference in Cardiology and haemodynamics in Bogota. Results: Of the 200 patients study, 66% were female, and 37.5% greater than 70 years-old. Hypertension was recorded in 53.2%, and overweight and obesity in 52.7%. Elevated levels of high sensitivity C-Reactive Protein (hsCRP) were observed in 61.5% of cases and 50% had at least one major coronary lesion greater than 70%. The best cut-off points according to each of the ROC curves: Adjusted Framingham, 5.8% (sensitivity, 80%, specificity, 41%), Adjusted PROCAM, 1.7% (sensitivity, 78%, specificity, 45%) and Reynolds, 3.8% (sensitivity, 68%, specificity, 45%). Additionally, the three areas under the curve (AUC) were 0.59, 0.59, and 0.57, respectively.

Relation between psoriasis features and Framingham cardiovascular risk assessment / 医学研究生学报

Objective Many studies have suggested that cardiovascular risk factors seem to be more common in psoriasis patients than in general population.In this study we aimed to investigate the prevention and treatment of cardiovascular risk in psoriasis patients by Framingham cardiovascular risk assessment in patients with psoriasis vulgaris and normal people using Framingham score.Methods We conducted a prospective study including 90 outpatients with psoriasis vulgaris and 137 controls without psoriasis from October 2015 to October 2016 in our hospital.All psoriasis patients were diagnosed clinically and histopathologically.The severity of psoriasis was assessed according to the psoriasis area and severity index (PASI) score.Along with a thorough medical history and physical examination, serum lipid profile, blood pressure and fasting plasma glucose tests were carried out.The 10-year Framingham risk score (FRS) for general cardiovascular disease included indexes concerning age, gender, total cholesterol, HDL-cholesterol, systolic blood pressure and smoking history.Results We found the 10-year FRS was significantly higher in patients with psoriasis vulgaris than in controls (P0.05).No significance was found in the 10-year FRS of patients with mild and severe psoriasis (P>0.05).FRS was significantly higher in male patients and in patients above 50 years old (P<0.05).Conclusion Psoriasis patients, especially the older male patients, tend to have high risks of cardiovascular disease.Therefore, risk assessment for cardiovascular diseases should be conducted in psoriasis patients, and complications should be actively prevented and treated.

Paraoxonase 1 (PON1) Q192R genotypes and their interaction with smoking strongly increase atherogenicity and the Framingham risk score

ABSTRACT Objective Paraoxonase 1 (PON1) polymorphisms are associated with an increased susceptibility to cardiovascular disease. PON1 Q192R polymorphism (rs662) partially determine PON1 hydrolytic activity and protect against oxidation of LDL and HDL. This study aimed to delineate the association of PON1 status (functional 192 genotype and plasma activity levels) and atherogenicity in urbans residents aged 40 years or more. Materials and methods Anthropometric data, lipid profiles, the atherogenic index of the plasma (AIP) and Framingham score risk were measured. Three kinetic assays were conducted to assay PON1 status using phenylacetate and 4-(chloromethyl)phenyl acetate as substrates. Results Smoking per se did not significantly impact the AIP but the interaction PON1 genotype by smoking significantly increased the AIP. In subjects with the RR genotype smoking increased the AIP index from (estimated mean ± SEM) -0.038 ± 0.039 to 0.224 ± 0.094. The QR genotype increased the Framingham risk index by around 1.3 points. Smoking by RR genotype carriers significantly increased the Framingham risk score (17.23 ± 2.04) as compared to smoking (13.00 ± 1.06) and non-smoking (7.79 ± 0.70) by QQ+QR genotype carriers. The interaction RR genotype by smoking was a more important predictor (odds ratio = 7.90) of an increased Framingham risk score (> 20) than smoking per se (odds ratio = 2.73). The interaction smoking by RR genotype carriers significantly increased triglycerides and lowered HDL cholesterol. Conclusion Smoking per se has no (AIP) or a mild (Framingham risk score) effect on atherogenicity, while the interaction smoking by PON1 RR genotype has a clinically highly significant impact on atherogenicity.

Determinación de riesgo cardiovascular y edad vascular según el score de Framingham en pacientes del Hospital Nacional Arzobispo Loayza / Determination of cardiovascular risk and vascular age by the Framingham score in patients at the Arzobispo Loayza Hospital

Las enfermedades cardiovasculares ocupan el cuarto lugar de carga de enfermedad en Perú, y en los últimos 7 años, la población de alto riesgo cardiovascular se ha incrementado. OBJETIVO: Determinar el riesgo cardiovascular y edad vascular según el score de Framingham de los pacientes del Hospital Nacional Arzobispo Loayza así como determinar su factor de riesgo más prevalente. Y las características clínicas de los pacientes con mediano y alto riesgo. MATERIAL Y MÉTODOS: Estudio descriptivo, observacional, transversal. Se encuestaron a 238 pacientes hospitalizados en el Servicio de Medicina Interna del hospital. Se consideró: edad, género, diabetes, tabaquismo, IMC y presión arterial. Los datos fueron analizados con el programa SPSS v.21. RESULTADOS: Se encontró que el mayor porcentaje de la población de estudio presentó mediano y alto riesgo, siendo el factor más prevalente la diabetes y la mayoría hombres. La diferencia entre la edad cronológica y la edad vascular fue en promedio 6,9 años. CONCLUSIÓN: La población estudiada tuvo mediano y alto riesgo por lo que se deberían tomar medidas de prevención primaria y secundaria.

Cardiovascular diseases rank fourth place of disease burden in Peru, and in the last 7 years, the population of high cardiovascular risk has increased. OBJECTIVE: Determine the cardiovascular risk and vascular age according to the Framingham score in patients attending the "Hospital Nacional Arzobispo Loayza", as well as to determine the most prevalent factor. Furthermore, to determine the clinical characteristics of patients with mild and high risk. MATERIAL AND METHODS: This is a descriptive, observational, cross-sectional study. 238 hospitalized patients in internal medicine wards were surveyed. Variables such as age, gender, diabetes, smoking, BMI and blood pressure were considered. The data were analyzed using SPSS v.21. RESULTS: The highest percentage of the population was found within the mild and high risk categories, with diabetes being the most prevalent factor. The average difference between chronological age and vascular age was 6.9 years. CONCLUSION: The majority of the population has mild and high risk, thus primary and secondary prevention measures should be taken. (Horiz Med 2015; 15(2): 27-34)

The association between insulin resistance and Framingham risk score among type 2 diabetes / 한국역학회지

BACKGROUND AND PURPOSE: Insulin resistance has been known to be associated with the risk of cardiovascular diseases. However, the relationship with Framingham risk score among type 2 diabetes has not been well known. We investigated the relationship between insulin resistance (IR) and the Framingham risk score(FRS) among type 2 diabetes in Korea. METHODS: We estimated the 5-year risk of ischemic heart disease(IHD) based on Framingham equation among 1,941 diabetes patients(1,294 men and 647 women), who visited Huh's clinic, enrolled from January 2003 to June 2006. IR, which was measured by insulin tolerance test (ITT), was divided into five groups(Q1 to Q5). High risk of IHD was defined as upper 10 percentile of FRS. Multivariate regression and logistic regression models were used to see independent association of higher quintiles of IR level, compared with lowest quintile(Q1) for the risk of IHD. RESULTS: Mean (+/-standard deviation) 5-year FRS of study subjects were 8.40%(+/-6.89) for men and 5.92%(+/-5.23) for women. There were significant correlation between IR, body mass index, HbA1C, fasting glucose, triglyceride, LDL-cholesterol, C-peptide and FRS in both men and women. After adjusting for triglyceride, LDL-cholesterol, C-peptide, multivariate regression model analysis showed that IR was independently associated with the FRS. A positive association between IR and high risk of IHD was observed in men: highest versus lowest quintile of IR (odds ratio 5.45 in men and 4.71 in women). CONCLUSION: Increased IR level was independently associated with risk of IHD measured by FRS among type 2 diabetes in Korea.

Correlations of C-reactive protein levels and Framingham coronary risk score / 대한내과학회지

BACKGROUND: The Framingham coronary risk score is a simplified coronary prediction tool developed to enable clinicians to estimate cardiovascular risk. C-reactive protein (CRP), a marker of low-grade inflammation, has been extensively studied in several large, prospective, epidemiological studies. However, few studies are available that have directly compared CRP levels with the Framingham coronary risk score. METHODS: A total of 13,052 individuals that visited our hospital for comprehensive medical tests between January 2002 and June 2003, were enrolled in the study (7,978 men, 5,074 women, mean age 44.8+/-11.0 years). Plasma samples were assayed for determination of CRP level by using a clinically validated high-sensitive assay. The Framingham coronary risk score was calculated by using previously published algorithms that used baseline cardiac risk factors including age, HDL cholesterol level, total cholesterol level, smoking status, blood pressure, and history of diabetes. Pearson correlation coefficients relating these individual risk factor scores and a total score were calculated. The CRP levels were divided into different categories; into 4 groups based on the quartiles of the CRP levels and 3 groups based on the baseline CRP levels of 0.3 mg/dL. The CRP levels were compared with the Framingham coronary risk score and the Framingham 10-year coronary heart disease risk according to each group. RESULTS: CRP levels significantly correlated with the Framingham coronary risk score (rtotal=0.373, p<0.01; rmen=0.351, p<0.01; rwomen=0.378, p<0.01). The CRP levels also correlated with individual components of the Framingham coronary risk score, which included age (rtotal=0.302, p<0.01; rmen=0.330, p<0.01; rwomen=0.287, p<0.01), blood pressure (rtotal=0.275, p<0.01; rmen=0.214, p<0.01; rwomen=0.270, p<0.01) and HDL-cholesterol level (rtotal=0.221, p<0.01; rmen=0.198, p<0.01; rwomen=0.221, p<0.01). Furthermore CRP levels correlated with calculated the Framingham 10-year coronary heart disease risk (rtotal=0.366, p<0.01, rmen=0.301, p<0.01, rwomen=0.420, p<0.01). The Framingham coronary risk score and calculated Framingham 10-year coronary heart disease risk increased with each increasing CRP level category(quartiles and risk, p<0.01). CONCLUSIONS: The CRP level correlated well with the Framingham coronary risk score and is a useful factor for predicting cardiovascular risk in Korean patients.