Early cardiovascular structural and functional abnormalities as a guide to future morbid events

Area of Science:

• Cardiology
• Preventive Medicine
• Biomedical Engineering

Background:

• Cardiovascular disease remains a leading cause of morbidity and mortality.
• Accurate prediction of cardiovascular events in asymptomatic individuals is crucial for timely intervention.
• Current risk assessment tools may not fully capture the underlying biological disease process.

Purpose of the Study:

• To evaluate the predictive capability of a composite score derived from 10 non-invasive cardiovascular tests.
• To assess the utility of this disease score (DS) in identifying future cardiovascular morbid events.
• To compare the predictive performance of the DS with the established Framingham risk score (FRS).

Main Methods:

• 1900 asymptomatic adults underwent 10 non-invasive tests assessing cardiovascular structure and function.
• A disease score (DS) was computed for each participant based on the test results.
• Follow-up data for cardiovascular morbidity and mortality were collected for 1442 participants over a mean of 9.2 years.

Main Results:

• Participants in the highest DS tertile had a significantly higher rate of cardiovascular events (1.3 per 100 patient-years) compared to the lowest tertile (0.16 per 100 patient-years).
• The DS demonstrated improved risk reclassification when added to the Framingham risk score (net reclassification index = 0.11, p=0.01).
• The DS identified individuals at high risk more effectively than the FRS alone.

Conclusions:

• Non-invasive assessment of cardiovascular structure and function, quantified by the DS, effectively predicts future cardiovascular events in asymptomatic adults.
• The DS offers a valuable tool for risk stratification and may guide clinical decision-making for preventive interventions.
• Further research is needed to determine optimal strategies for risk assessment and intervention based on biological disease burden.