Discordances among different tools used to estimate cardiovascular risk in postmenopausal women
Pascal Pelletier1, Annie Lapointe, Nathalie Laflamme
1Lipid Research Centre, Centre Hospitalier Universitaire de Québec Research Centre, Quebec, Canada.
Insights
The Framingham risk score (FRS) underestimated cardiovascular disease (CVD) risk in postmenopausal women, missing many with metabolic syndrome (MetS). Integrating high-sensitivity C-reactive protein (hs-CRP) into risk models like the Women's Health Study (WHS) model offers a more accurate CVD risk assessment.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarkers
Background:
- Emerging cardiovascular disease (CVD) risk factors like high-sensitivity C-reactive protein (hs-CRP) and metabolic syndrome (MetS) require integration into risk stratification.
- Current CVD risk classification methods may yield divergent results.
Purpose of the Study:
- To compare CVD risk estimation differences between the Framingham risk score (FRS), hs-CRP, and MetS in postmenopausal women.
- To evaluate the utility of the Women's Health Study (WHS) model incorporating hs-CRP for CVD risk assessment.
Main Methods:
- Determined FRS and MetS presence in 109 postmenopausal women.
- Assessed CVD risk using a scoring system based on FRS covariables and hs-CRP (WHS model).
- Compared CVD risk estimates from hs-CRP alone and the WHS model against the FRS.
Main Results:
- FRS classified 99% of women as low CVD risk.
- MetS was present in 39.4% of women.
- hs-CRP alone classified 28.4% as high risk, while the WHS model identified 1.8% as high risk, with 14.7% moderate risk.
Conclusions:
- FRS failed to identify a significant proportion of postmenopausal women with MetS, who are at elevated CVD risk.
- hs-CRP risk estimation differs substantially based on conventional cutoffs versus its integrated use in the WHS model.
- The WHS model provides a more comprehensive CVD risk profile in this population.
Background:
New cardiovascular disease (CVD) risk factors are being recognized and suggested to be included in CVD risk stratification. High-sensitivity C-reactive protein (hs-CRP) and the metabolic syndrome (MetS) are among these risk factors. However, CVD risk classification may be divergent when using different approaches.
Objectives:
To compare differences in CVD risk estimation using the Framingham risk score (FRS), hs-CRP and the presence of the MetS in a group of 109 postmenopausal women in primary CVD prevention.
Methods:
The FRS and presence of the MetS were determined. CVD risk was evaluated with a cardiovascular point scoring system based on Framingham covariables and hs-CRP values (Women's Health Study [WHS] model). The estimated CVD risks based on hs-CRP levels and the WHS model were compared with the FRS.
Results:
Using the FRS, 99% of women (n=108) were determined to have a low CVD risk. The MetS was identified in 39.4% (n=43) of the women. When hs-CRP was used alone to estimate CVD risk, 37.6% (n=41) of women were classified as being at low, 33.9% (n=37) at moderate and 28.4% (n=31) at high CVD risk. With the WHS model, 83.5% (n=91), 14.7% (n=16) and 1.8 % (n=2) of women were classified as being at low, moderate and high CVD risk, respectively.
Conclusions:
A substantial number of postmenopausal women showing evidence of the MetS were not identified by the FRS, even though women with the MetS are at higher risk of CVD. Estimation of risk by hs-CRP is significantly divergent when using conventional hs-CRP cutoff values compared with an integrated use in the WHS model.
Related Concept Videos
01:23Assessment of blood pressure in brachial artery(two-step method)
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:26Coronary Artery Disease IV: Preventive Measures
01:10Pre-Procedural Guidelines for Assessing Blood Pressure