两种模型预测的心血管病发病风险与动脉僵硬度的相关性

目的分别应用汇总队列公式(PCE)和中国人动脉粥样硬化性心血管病(ASCVD)风险预测(China-PAR)模型预测受检者的10年ASCVD风险,比较两种模型预测的心血管病发病风险与动脉僵硬度的相关性。方法本研究为横断面临床研究,选择2016年2月-2018年12月期间行颈股动脉脉搏波传导速度(cfPWV)检查的患者1 090例,所有受检者均来源于福建医科大学附属第一医院全科医学科或老年医学科,年龄30～75岁。根据cfPWV10和≥10 m/s将受检者分为动脉僵硬度正常组和动脉僵硬度增高组。分别应用PCE和China-PAR模型预测受检者的10年ASCVD风险。结果与动脉僵硬度正常组相比,动脉僵硬度增高组中两种模型预测的ASCVD风险均增加[PCE:16.5%(8.6%～28.3%)比6.3%(2.7%～12.3%);China-PAR:8.8%(6.1%～12.4%)比3.9%(2.1%～6.6%),均P0.001]。与PCE相比,China-PAR预测的ASCVD风险与cfPWV的相关性更强(相关系数0.573比0.503,z=5.272,P0.001)。多元线性回归分析显示,PCE预测的ASCVD风险(β=0.475,P0.001)、腰围(β=0.092,P=0.001)是cfPWV的相关因素,但将PCE换成China-PAR,腰围不再是cfPWV的相关因素,只有ASCVD风险(β=0.573,P0.001)是cfPWV的相关因素。受试者工作特征曲线显示:与PCE相比,China-PAR预测的ASCVD风险对动脉僵硬度的识别效能更高(曲线下面积0.814比0.767,z=4.992,P0.001)。分层分析显示,China-PAR识别效能的优势主要来源于男性。结论 China-PAR和PCE预测的10年ASCVD风险均与动脉僵硬度相关。应用China-PAR预测时,两者的相关性更强,在男性中尤为明显。     

两种十年动脉粥样硬化性心血管疾病发病风险评估工具在社区老年人群中的应用效果比较

目的比较10年动脉粥样硬化性心血管疾病(ASCVD)发病危险评估模型和基于中国动脉粥样硬化性心血管疾病风险预测(China-PAR)风险评估模型在社区老年人群中的应用效果。方法采用便利抽样法选取2020年5—8月在江苏省镇江市大市口社区卫生服务中心、健康路社区卫生服务中心和黎明社区卫生服务中心进行健康体检的老年人为调查对象。采用一般资料调查问卷对其进行调查,采用10年ASCVD发病危险评估模型和China-PAR风险评估模型评估其ASCVD风险。结果共发放问卷900份,回收有效问卷864份,有效回收率为96.0%。864例社区老年人中,男359例(41.6%),女505例(58.4%);吸烟169例(19.6%),饮酒130例(15.0%),超重或肥胖473例(54.7%),高血压476例(55.1%),高脂血症293例(33.9%),糖尿病194例(22.5%),代谢综合征(MS)469例(54.3%),心血管疾病主要危险因素个数≥3个242例(28.0%)。两种10年ASCVD发病风险评估工具评估结果的Kappa值为0.401。China-PAR风险评估模型评估的ASCVD高危老年人占比高于10年ASCVD发病危险评估模型评估的ASCVD高危老年人占比(P<0.05)。10年ASCVD发病危险评估模型评估的ASCVD低中危老年人中男性、75~80岁者、有高血压者占比高于China-PAR风险评估模型评估的ASCVD低中危老年人,65~69岁者占比低于China-PAR风险评估模型评估的ASCVD低中危老年人(P<0.05)。10年ASCVD发病危险评估模型评估的ASCVD高危老年人中女性、65~69岁者、有糖尿病者、心血管疾病主要危险因素个数≥3个者占比高于China-PAR风险评估模型评估的ASCVD高危老年人,75~80岁者占比低于China-PAR风险评估模型评估的ASCVD高危老年人(P<0.05)。结论社区老年人群10年ASCVD发病风险中高危者检出率较高,10年ASCVD发病危险评估模型与China-PAR风险评估模型预测结果一致性一般,用于ASCVD风险评估时,应充分考虑两种工具的特点,其中China-PAR风险评估模型可识别出更多的ASCVD高危人群。     

广西人群动脉粥样硬化性心血管疾病风险预测研究

目的 探讨广西人群的动脉粥样硬化性心血管疾病(ASCVD)发病风险预测特征和危险因子分布情况。方法 连续纳入2020年1月在广西壮族自治区人民医院体检中心参加体检3 066名研究对象,进行体格检查、问卷调查、血清学检测,应用中国动脉粥样硬化性心血管疾病风险预测模型(China-PAR)对研究对象进行评估,计算10年和终身ASCVD发病风险。结果 相比女性人群,男性的体质指数、腰围、吸烟率、血压、糖尿病患病率和血脂水平均明显升高(均为P0. 05)。男性的10年(2. 8%±3. 9%比1. 3%±2. 5%)和终身(16. 3%±8. 0%比9. 7%±5. 1%) ASCVD发病风险均明显高于女性(均为P0. 05)。在各年龄段比较中,除65～74岁年龄段的终身ASCVD风险男女无差异(P0. 05),其余各年龄段男性的10年和终身ASCVD风险均高于女性(均为P0. 05)。结论血脂水平偏高和男性人群超重、吸烟以及血压水平偏高是广西人群ASCVD发病风险升高的重要因素。     

基于China-PAR模型正常高值血压与心血管病风险相关性研究

目的 基于China-PAR(Prediction for ASCVD Risk in China)模型,探讨正常高值血压水平与未来10年动脉粥样硬化性心血管病(Atherosclerotic cardiovascular disease, ASCVD)风险的相关性。方法 收集2020年9月至2022年12月在广州市某三甲医院全科和广州市某社区医院就诊的694例患者的临床资料,对所有患者进行一般资料调查、体格检查和血液生化检查,使用China-PAR模型评估所有患者未来10年ASCVD发病风险。结果 正常血压、正常高值血压和高血压的检出人数分别为73例(10.52%)、197例(28.39%)和424例(61.09%);正常高值血压患者检出率基本呈现随年龄增高逐渐下降趋势;与正常血压组比较,正常高值血压和高血压组患者年龄、腰围、血压值、FBG、糖尿病患病率和心血管病家族史比例更高,差异有统计学意义(均P<0.05)。二元logistic回归分析显示年龄、腰围是正常高值血压发生的影响因素。未来10年ASCVD风险评估显示,高危人群比例随血压分级和年龄的增高而增高,男性高危人群比例比...     

China-PAR模型与Framingham危险评分对中国绝经后女性健康体检人群心血管疾病风险评估的比较研究

目的:比较美国Framingham危险评分(FRS)和中国动脉粥样硬化性心血管疾病风险预测模型(China-PAR)对中国绝经后女性健康体检人群10年心血管疾病(CVD)发病风险评估的差异,以期找到可更加准确地评估该人群10年CVD发病风险的方法。方法:回顾性选取进行健康体检的绝经后女性4100例,对所有研究对象进行问卷调查、体格检查和血清学检测,同时分别应用FRS与China-PAR模型预测其未来10年患CVD的发病风险,比较这两种评估方法预测结果的一致性。结果:(1)China-PAR模型显示,中国绝经后女性健康体检人群10年CVD绝对风险的均数为7.2%,其中低危比例为40.2%,中危比例为50.9%,高危比例为8.9%;FRS显示,该人群10年CVD绝对风险的均数为9.9%,其中低危比例为32.1%,中危比例为47.8%,高危比例为20.1%。两种方法预测结果相比较,均数、低危及高危比例间差异均有统计学意义(P<0.05)。(2)两种方法预测不同年龄人群中的低危、中危和高危3个危险度评估结果差异均有统计学意义,且不同年龄人群发病风险等级结果一致,年龄越高,CVD 10年发病风险的危险等级越高。(3)两种方法预测结果的一致性较差,一致性检验Kappa=0.139<0.40(P<0.05)。结论:China-PAR模型预测中国绝经后女性健康体检人群未来10年CVD发病风险的平均风险和高危比例均低于美国FRS,这两种方法预测结果的一致性较差,China-PAR可能更适用于中国绝经后女性健康体检人群。     

导读

正两种模型预测的心血管病发病风险与动脉僵硬度的相关性(王庭俊,等p736)基于流行病学资料建立起来的心血管病风险评估模型是识别高危人群,开展一级预防的重要措施。美国Framingham风险评分、欧洲SCORE评分是其中应用最为广泛的2种模型。基于我国资料建起的China-PAR对国人冠状动脉粥样硬化性心血管病(atherosclerotic cardiovascular disease,ASCVD)风险也具有良好的预测能力,但临床应用尚不普遍。王庭俊等比较了美国PCE模型与我国China-PAR     

同型半胱氨酸及尿酸水平与社区人群中国动脉粥样硬化性心血管疾病风险预测关系的研究

目的：基于中国动脉粥样硬化性心血管疾病风险预测[prediction for atherosclerotic cardio-vascular disease(ASCVD)risk in China, China-PAR]模型,探讨血同型半胱氨酸（homocysteine,HCY）及UA水平与社区人群心血管病10年风险的关系。方法：以2023年3月至5月,在我中心体检的1 699例50～85岁参检者作为对象,收集年龄、性别等基本临床特征,检测HCY、UA等生化指标,采用China-PAR模型进行心血管10年风险评分。按照血HCY及UA是否升高,分为四组：HCY及UA正常组,单纯高HCY组,单纯高UA组,HCY及UA升高组,比较四组间China-PAR评分的差异。结果：HCY及UA正常组,单纯高HCY组,单纯高UA组,HCY及UA升高组的心血管10年风险值中位数分别为：7.6%,11.1%,9.5%,12.9%;各组心血管10年风险高危分布情况分别为：484例（37.8%）,78例（54.9%）,97例（45.8%）,39例（60.0%）。HCY及UA升高组心血管10年风险值中位数、高危占...     

3种预测工具评估住院高血压患者脑卒中风险

目的采用3种预测工具评估住院高血压患者脑卒中风险。方法选择高血压患者356例,采用脑卒中风险初筛量表、改良Framingham卒中风险评估量表(M-FSP)和汇集队列风险方程(PCE)评估脑卒中风险,并比较M-FSP和PCE在脑卒中风险评估应用中的一致性。结果脑卒中风险初筛量表评估男性脑卒中高危风险明显高于女性(28. 8%vs 17. 2%,P 0. 05);≥60岁脑卒中高危风险明显高于60岁(30. 1%vs 15. 3%,P 0. 01)。M-FSP评估患者10年脑卒中风险(12. 6±7. 1)%,男性脑卒中风险明显高于女性[(14. 5±9. 6)%vs (10. 1±8. 9)%,P 0. 01];≥60岁脑卒中风险明显高于60岁[(18. 8±12. 1)%vs (9. 4±7. 6)%,P 0. 01]。PCE评估患者10年脑卒中风险(13. 3±9. 2)%,男性脑卒中风险明显高于女性[(16. 5±11. 9)%vs (8. 9±7. 8)%,P 0. 01];≥60岁脑卒中风险明显高于60岁[(29. 9±19. 5)%vs (11. 2±9. 3)%,P 0. 01]。相关性分析显示,男性和女性的r值分别为0. 647和0. 609,≥60岁和60岁的r值分别为0. 577和0. 702(P 0. 01)。结论脑卒中风险初筛量表可以对个体脑卒中风险进行初筛和归类,M-FSP和PCE均能预测脑卒中发生风险。     

高血压患者心血管疾病风险及其性别差异分析

目的:分析浙江省奉化区高血压患者心血管疾病危险因素情况,评估未来10年动脉粥样硬化性心血管病(ASCVD)发病风险,并分析其性别差异,为社区早期发现与管理ASCVD高危患者提供依据.方法:对奉化区5个街道参与年度健康体检的35～84岁高血压患者,利用临床决策支持系统自动评估10年ASCVD发病风险.分析各心血管疾病相关...     

中国急性心肌梗死患者发病前动脉粥样硬化性心血管疾病危险分层分析

目的:探究急性心肌梗死患者发病前的动脉粥样硬化性心血管疾病(ASCVD)危险分层情况和应用他汀类药物进行预防治疗的现状。方法:纳入2013年1月1日至2016年1月30日入选中国急性心肌梗死注册研究(CAMI)的1型急性心肌梗死患者,依据中国成人血脂异常防治指南(2016年修订版),评估其发病前的ASCVD危险分层情况,并调查不同危险分层患者使用他汀类药物的情况。结果:在30 952例急性心肌梗死患者中,11 950例(38.6%)患者为ASCVD低危人群,5 360例(17.3%)患者为ASCVD中危人群,ASCVD高危、极高危人群分别占25.8%(7 990例)和18.3%(5 652例)。仅5.7%的高危患者服用他汀类药物治疗,低密度脂蛋白胆固醇(LDL-C)达标率为22.4%;极高危患者中仅16.4%应用他汀类药物进行ASCVD二级预防,LDL-C达标率仅18.3%。结论:我国超半数急性心肌梗死患者发病前为ASCVD低中危患者,高危和极高危患者使用他汀类药物进行一级、二级预防的比例均较低。     

Prediction of 10-year atherosclerotic cardiovascular disease risk among community residents in Shanghai,China – a comparative analysis of risk algorithms

Background and aimsThe accuracy of various 10-year atherosclerotic cardiovascular disease (ASCVD) risk models has been debatable. We compared two risk algorithms and explored clustering patterns across different risk stratifications among community residents in Shanghai.Methods and resultsA total of 28,201 residents (aged 40–74 years old) who were free of ASCVD were selected from the Shanghai Survey in China. The 10-year ASCVD risk was estimated by applying the 2013 Pooled Cohort Equations (PCEs) and Prediction for ASCVD Risk in China (China-PAR). The agreement was assessed between PCEs and China-PAR using Cohen's kappa statistics.The mean absolute 10-year ASCVD risk calculated by PCEs and China-PAR was about 10.0% and 6.0%, respectively. PCEs estimated that 44.9% of participants [with a 95% confidence interval (CI):44.0%–45.8%] were at high risk, while China-PAR estimated only 16.7% (95%CI:15.8%–18.0%) were at high risk. In both models, the percentage of high ASCVD risk was higher for participants who were older, men, less educated, current smokers, drinkers and manual workers. Among high-risk individuals, almost all participants (PCEs:90.5%; China-PAR:98.6%) had at least one risk factor; hypertension being the most prevalent. The concordance between PCEs and China-PAR was moderate (kappa:0.428, 95%CI: 0.420–0.434) with a better agreement for women (kappa:0.503,95%CI: 0.493–0.513) than for men (kappa:0.211,95%CI: 0.201–0.221).ConclusionThe proportion of participants with a 10-year ASCVD high risk predicted by China-PAR was lower than the results of the PCEs. The risk stratifications of the two algorithms were inconsistent in terms of demographic and life-behaviour characteristics.     

Association between estimated glomerular filtration rate and 10-year atherosclerotic cardiovascular disease risk among community residents in Shanghai,China

Background and aimsThe association between the estimated glomerular filtration rate (eGFR) and atherosclerotic cardiovascular disease (ASCVD) risk is unknown. We aimed to evaluate whether eGFR can be used as a predictor in ASCVD risk assessment.Methods and resultsUsing baseline data from 28,187 participants from Shanghai Suburban Adult Cohort and Biobank study, we adopted Pooled Cohort Equations (PCEs) and Prediction for ASCVD Risk in China (China-PAR) to estimate 10-year ASCVD risk. Multivariate logistic regression was used to analyze the relationship between 10-year ASCVD risk and eGFR. The receiver operating characteristic (ROC) curve was used to evaluate predictive value of eGFR for 10-year high ASCVD risk. Compared with normal eGFR, both men and women with reduced eGFR had a higher prevalence of ASCVD risk factors. With the decrease of eGFR level, the median of 10-year ASCVD risk gradually increased. For men, the adjusted odds ratios (95% confidence interval (CI)) of 10-year high ASCVD risk by PCEs associated with eGFR (60–74 and <60 mL/min/1.73 m²) were 1.52 (95%CI:1.17–1.99) and 2.51 (95%CI:1.27–4.97). The corresponding result was significant only for eGFR < 60 mL/min/1.73 m², OR of 1.57 (1.14–2.18) for women. Using China-PAR, the adjusted OR of 10-year high risk associated with eGFR < 60 mL/min/1.73 m² was 1.82 (1.40–2.38) in men. ROC indicated that eGFR has a good predictive value for 10-year high ASCVD risk.ConclusioneGFR may be an important risk factor in predicting and stratifying ASCVD risk. Consideration should be given to integrating eGFR into existing risk assessment tools to improve predictive performance.     

阵发性室上性心动过速ST段压低患者冠脉造影结果分析

目的 探讨阵发性室上性心动过速（PSVT）发作时ST段压低患者冠状动脉造影结果的影响因素及与ST段压低形态的关系。方法 选取PSVT发作时伴ST段压低，且已行腔内电生理检查及冠状动脉造影术的患者74例，根据冠状动脉造影结果分为造影阴性组（n=47）与造影阳性组（n=27）。比较两组患者临床资料、血液生化指标、PSVT类型、10年动脉粥样硬化性心血管疾病（ASCVD）风险及ST段压低形态，分析冠状动脉造影结果的影响因素。结果 与冠状动脉造影阴性组相比较，造影阳性组患者年龄更大（63±10 vs. 55.2±9）岁, P<0.01，合并高血压的比例更高（48%vs. 15%）,P<0.01，出现胸闷/胸痛症状的比例更高（96%vs. 66%）, P<0.05，但出现心悸症状的比例显著降低（82%vs. 98%）, P<0.05，而10年ASCVD风险显著增高（P<0.01）。两组患者ST段压低形态无显著差异。单因素分析中，年龄、心悸症状、胸闷/胸痛症状、高血压、10年ASCVD风险对冠状动脉造影结果有影响。多因素Logistic回归分析表明胸闷/胸痛症状（OR...     

Prevalence and outcomes of low ankle brachial index by atherosclerotic cardiovascular disease risk level: Insights from the National Health and Nutrition Examination Survey (NHANES)

BackgroundAnkle brachial index (ABI) as a risk-enhancing factor in addition to the pooled cohort equation (PCE) in assessing cardiovascular risk for primary prevention of atherosclerotic cardiovascular disease (ASCVD) is uncertain.MethodsWe analyzed data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES), for 5130 participants, aged 40 and older, without known cardiovascular disease or diabetes, with available data on standard ASCVD risk and ABI. Prevalence of low ABI (ABI<0.9) and all-cause mortality in persons with low, borderline and intermediate ASCVD risk categories using PCE was assessed.ResultsThe overall prevalence of low ABI was 3.1%. The participants with low ABI were predominantly clustered in the intermediate (33%) and high (33%) ASCVD risk categories while most participants with a normal ABI were in the low (56%) and intermediate (23%) risk categories. All-cause mortality was higher among participants with low ABI compared to those with a normal ABI in both the intermediate/borderline and high-risk categories, p<0.001 but not in the low-risk ASCVD category, p = 0.323.ConclusionsUsing the PCE, two-third of the participants with low ABI were classified as having a low, borderline or intermediate risk of ASCVD. Low ABI was associated with an increased all-cause mortality in the overall cohort and specifically among those with a borderline/intermediate or high risk of ASCVD but not in those with a low risk of ASCVD. Our study supports consideration of ABI as a risk enhancer for primary prevention among patients classified as borderline or intermediate risk of ASCVD.     

动脉粥样硬化性心血管疾病风险评估对中国高血压防治的启示

高血压是心脑血管疾病最为重要的危险因素之一。对高血压患者进行动脉粥样硬化性心血管疾病（ASCVD）风险评估是临床工作中不可忽视的重要环节。目前我国常用的风险评估模型主要有美国心脏病学会（ACC）/美国心脏协会（AHA）制定的动脉粥样硬化性心血管疾病风险评估模型（PCE模型）、Framingham心血管疾病风险评估模型（FRS模型）以及中国缺血性心血管疾病（ICVD）风险评估模型（China-PAR模型）。三者在纳入人群、终点事件、计算方法等方面既有相似又有不同，各自之间既有优势又有不足。文章对三种模型的特点以及临床应用进行了综述。     

Coronary Artery Calcium Scores and Atherosclerotic Cardiovascular Disease Risk Stratification in Smokers

ObjectivesThis study assessed the utility of the pooled cohort equation (PCE) and/or coronary artery calcium (CAC) for atherosclerotic cardiovascular disease (ASCVD) risk assessment in smokers, especially those who were lung cancer screening eligible (LCSE).BackgroundThe U.S. Preventive Services Task Force recommended and the Centers for Medicare & Medicaid Services currently pays for annual screening for lung cancer with low-dose computed tomography scans in a specified group of cigarette smokers. CAC can be obtained from these low-dose scans. The incremental utility of CAC for ASCVD risk stratification remains unclear in this high-risk group.MethodsOf 6,814 MESA (Multi-Ethnic Study of Atherosclerosis) participants, 3,356 (49.2% of total cohort) were smokers (2,476 former and 880 current), and 14.3% were LCSE. Kaplan-Meier, Cox proportional hazards, area under the curve, and net reclassification improvement (NRI) analyses were used to assess the association between PCE and/or CAC and incident ASCVD. Incident ASCVD was defined as coronary death, nonfatal myocardial infarction, or fatal or nonfatal stroke.ResultsSmokers had a mean age of 62.1 years, 43.5% were female, and all had a mean of 23.0 pack-years of smoking. The LCSE sample had a mean age of 65.3 years, 39.1% were female, and all had a mean of 56.7 pack-years of smoking. After a mean of 11.1 years of follow-up 13.4% of all smokers and 20.8% of LCSE smokers had ASCVD events; 6.7% of all smokers and 14.2% of LCSE smokers with CAC = 0 had an ASCVD event during the follow-up. One SD increase in the PCE 10-year risk was associated with a 68% increase risk for ASCVD events in all smokers (hazard ratio: 1.68; 95% confidence interval: 1.57 to 1.80) and a 22% increase in risk for ASCVD events in the LCSE smokers (hazard ratio: 1.22; 95% confidence interval: 1.00 to 1.47). CAC was associated with increased ASCVD risk in all smokers and in LCSE smokers in all the Cox models. The C-statistic of the PCE for ASCVD was higher in all smokers compared with LCSE smokers (0.693 vs. 0.545). CAC significantly improved the C-statistics of the PCE in all smokers but not in LCSE smokers. The event and nonevent net reclassification improvements for all smokers and LCSE smokers were 0.018 and ?0.126 versus 0.16 and ?0.196, respectively.ConclusionsIn this well-characterized, multiethnic U.S. cohort, CAC was predictive of ASCVD in all smokers and in LCSE smokers but modestly improved discrimination over and beyond the PCE. However, 6.7% of all smokers and 14.2% of LCSE smokers with CAC = 0 had an ASCVD event during follow-up.     

Predicted risk of coronary heart disease among persons with type 2 diabetes

BACKGROUND: Diabetes is an independent risk factor for the development of coronary heart disease (CHD). We evaluated whether there are racial/ethnic differences in predicted probability of CHD among persons with type 2 diabetes from the 1999-2002 National Health and Nutrition Examination Survey. METHODS: Adults with type 2 diabetes without cardiovascular disease (n=585) were evaluated; the United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine was used to develop estimates of CHD and Framingham Risk Score (FRS) was used to assess the 10-year CHD risk. Chi-square tests and analysis of variance were used to assess differences between racial/ethnic groups in risk factors and predicted probability for CHD. RESULTS: Risk factors for CHD differed significantly amongst the three racial/ethnic groups. Whites had lower mean A1C concentrations (7.3%+/-0.2) than blacks (8.1%+/-0.2, P<0.05) or Mexican Americans (8.1%+/-0.2, P<0.05). Systolic blood pressure was higher in blacks compared with whites (P<0.05) and in Mexican American men compared with white men (P<0.05). Total cholesterol differed insignificantly by race/ethnicity whereas high-density lipoprotein cholesterol was higher in blacks compared with whites and Mexican Americans. Blacks had the greatest 5, 10, 15, and 20-year predicted risks of CHD among men, whereas whites had the greatest predicted risks among women. When evaluated by the FRS, the 10-year predicted risk of CHD was estimated to be 22.5% by UKPDS and 17% using FRS. CONCLUSIONS: UKPDS estimates of probability of CHD were similar across race/ethnicities, indicating that the risk factors tended to balance out. Despite differences in individual risk factors, the estimated risk for CHD was similar for all persons with diabetes.     

Incidence of Atherosclerotic Cardiovascular Disease in Young Adults at Low Short-Term But High Long-Term Risk

BackgroundYoung adults may have high long-term atherosclerotic cardiovascular disease (ASCVD) risk despite low short-term risk.ObjectivesIn this study, we sought to compare the performance of short-term and long-term ASCVD risk prediction tools in young adults and evaluate ASCVD incidence associated with predicted short-term and long-term risk.MethodsWe included adults aged 18 to 39 years, from 2008 to 2009 in a U.S. integrated health care system, and followed them through 2019. We calculated 10-year and 30-year ASCVD predicted risk and assessed ASCVD incidence.ResultsAmong 414,260 young adults, 813 had an incident ASCVD event during a median of 4 years (maximum 11 years). Compared with 10-year predicted risk, 30-year predicted risk improved reclassification (net reclassification index: 16%) despite having similar discrimination (Harrell’s C: 0.749 vs 0.726). Overall, 1.0% and 2.2% of young adults were categorized as having elevated 10-year (≥7.5%) and elevated 30-year (≥20%) predicted risk, respectively, and 1.6% as having low 10-year (<7.5%) but elevated 30-year predicted risk. The ASCVD incidence rate per 1,000 person-years was 2.60 (95% CI: 1.92-3.52) for those with elevated 10-year predicted risk, 1.87 (95% CI: 1.42-2.46) for those with low 10-year but elevated 30-year predicted risk, and 0.32 (95% CI: 0.30-0.35) for those with low 10-year and 30-year predicted risk. The age- and sex-adjusted incidence rate ratio was 3.04 (95% CI: 2.25-4.10) comparing those with low 10-year but elevated 30-year predicted risk and those with low 10-year and 30-year predicted risk.ConclusionsLong-term ASCVD risk prediction tools further discriminate a subgroup of young adults with elevated observed risk despite low estimated short-term risk.     

Cardiorespiratory Fitness and Atherosclerotic Cardiovascular Outcomes by Levels of Baseline-Predicted Cardiovascular Risk: The Look AHEAD Study

BackgroundWe evaluated the associations of cardiorespiratory fitness with atherosclerotic cardiovascular disease (ASCVD) by levels of baseline-predicted ASCVD risk among adults with type 2 diabetes.MethodsWe analyzed data from 4203 adults with type 2 diabetes in the Look AHEAD (Action for Health in Diabetes) study. Cardiorespiratory fitness was assessed using maximal exercise testing and categorized into low, moderate, and high; baseline-predicted. ASCVD risk was calculated using the American College of Cardiology/American Heart Association Pooled Cohort Equation. We used Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for ASCVD events (fatal and nonfatal myocardial infarction and stroke).ResultsOver a median of 9.6 years, there were 295 ASCVD events. The effect of fitness on outcomes was different across levels of 10-year predicted ASCVD risk (P for interaction < .001). Among participants with a baseline-predicted risk of 7.5% to 20%, the HR of low (vs high) fitness group was 1.94 (95% CI, 1.12-3.35) for ASCVD events. Fitness was not significantly associated with ASCVD events in the groups with baseline-predicted risk <7.5% (HR 1.53; 95% CI, 0.49-4.76) or ≥20% (HR 1.40; 95% CI, 0.88-2.24). A similar pattern was observed for myocardial infarction and stroke separately.ConclusionsIn a large sample of type 2 diabetes individuals, the association of low fitness with incident ASCVD was modified by the baseline-predicted 10-year ASCVD risk. Our findings suggest the utility of assessing fitness in ASCVD risk stratification in type 2 diabetes, especially among those with intermediate predicted 10-year risk of ASCVD.