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Association Between Predicting Risk of Cardiovascular Disease Events (PREVENT) Risk Scores and Subclinical
Gracia Fahed1,2, Diona Gjermeni1,3, Nicholas Cauwenberghs4
1Division of Cardiovascular Medicine, Department of Medicine Stanford University School of Medicine Stanford CA.
Insights
The American Heart Association cardiovascular disease (CVD) risk scores accurately identify subclinical heart failure (HF) and atherosclerotic CVD (ASCVD) in asymptomatic individuals. Higher predicted risk strongly correlates with the presence of underlying subclinical CVD.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- The American Heart Association (AHA) Predicting Risk of Cardiovascular Disease Events scores are used to estimate future heart failure (HF) and atherosclerotic cardiovascular disease (ASCVD) events.
- The association between these risk scores and subclinical CVD in asymptomatic populations has not been previously established.
Purpose of the Study:
- To investigate the relationship between AHA 10-year risk scores for HF and ASCVD and the presence of subclinical CVD in an asymptomatic community cohort.
- To determine if higher predicted cardiovascular disease risk is associated with subclinical indicators of HF and coronary artery disease.
Main Methods:
- Analysis of 1138 participants from the Project Baseline Health Study (PBHS) cohort, all free of known CVD.
- Subclinical CVD was defined using echocardiography (left ventricular diastolic dysfunction, hypertrophy, or low ejection fraction) and coronary artery calcium scoring.
- Logistic regression and ROC curve analysis were employed to assess the association between 10-year risk scores and subclinical CVD.
Main Results:
- Subclinical HF, primarily diastolic dysfunction, was identified in 16% of participants, with prevalence increasing significantly with higher HF risk scores.
- Subclinical coronary artery disease (coronary artery calcium >0) was present in 41% of participants, rising sharply with elevated ASCVD risk scores.
- Each unit increase in 10-year HF risk score showed a 2.67-fold increased odds of diastolic dysfunction (AUC 0.81).
- Each unit increase in 10-year ASCVD risk score correlated with a 2.91-fold increased odds of any coronary calcification (AUC 0.80), with stronger associations for higher calcium scores.
Conclusions:
- In an asymptomatic, CVD-free population, higher predicted 10-year risks for HF and ASCVD are significantly associated with the presence of subclinical CVD.
- The AHA Predicting Risk of CVD Events equations demonstrate utility in identifying individuals with underlying subclinical cardiovascular disease, even in the absence of diagnosed conditions.
Background:
The American Heart Association Predicting Risk of Cardiovascular Disease Events risk scores estimate cardiovascular disease (CVD) risk, including heart failure (HF) and atherosclerotic CVD (ASCVD) events. Whether they associate with subclinical CVD in an asymptomatic community population is unknown.
Methods:
We analyzed 1138 participants from the multicenter PBHS (Project Baseline Health Study) cohort, who underwent echocardiography and coronary artery calcium scoring and were free of known CVD. Subclinical CVD was defined as the presence of subclinical HF or subclinical coronary artery disease. Subclinical HF included left ventricular diastolic dysfunction, left ventricular hypertrophy, or low ejection fraction (<50%). Subclinical coronary artery disease was defined as coronary artery calcium >0. Predicting Risk of CVD Events 10-year risk score associations with subclinical CVD were assessed using logistic regression and area under the receiver operating characteristic curve analysis.
Results:
Median age was 52 (41-64) years; 64% were White; and 57% were women. Subclinical HF was found in 182 (16%) participants, predominantly with left ventricular diastolic dysfunction (14%). Diastolic dysfunction prevalence increased from 5.8% in low-risk HF groups to 44.1% in intermediate-/high-risk HF groups. Each unit increase in 10-year HF risk corresponded to 2.67-fold higher odds of diastolic dysfunction (95% CI, 2.25-3.18; area under the curve, 0.81). Subclinical coronary artery disease was present in 466 (41%) participants, with prevalence increasing from 28.5% in low-risk ASCVD groups to 79.3% in intermediate-/high-risk ASCVD groups. Each unit increase in 10-year ASCVD risk was associated with 2.91-fold higher odds of any coronary calcification (95% CI, 2.54-3.35; area under the curve, 0.80), increasing to 4.76-fold for coronary artery calcium >100 (95% CI, 3.70-6.12; area under the curve, 0.86) and 5.60-fold for coronary artery calcium >300 (95% CI, 3.89-8.05; area under the curve, 0.87).
Conclusions:
In an asymptomatic CVD-free community sample, subclinical CVD was increasingly associated with higher 10-year HF and ASCVD risks calculated by the Predicting Risk of CVD Events equations.
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