Framingham score and LV mass predict events in young adults: CARDIA study

Background

Framingham risk score (FRS) underestimates risk in young adults. Left ventricular mass (LVM) relates to cardiovascular disease (CVD), with unclear value in youth. In a young biracial cohort, we investigate how FRS predicts CVD over 20 years and the incremental value of LVM. We also explore the predictive ability of different cut-points for hypertrophy.

Methods

We assessed FRS and echocardiography-derived LVM (indexed by body surface area or height^2.7) from 3980 African–American and white Coronary Artery Risk Development in Young Adults (CARDIA) participants (1990–1991); and followed over 20 years for a combined endpoint: cardiovascular death; nonfatal myocardial infarction, heart failure, cerebrovascular disease, and peripheral artery disease. We assessed the predictive ability of FRS for CVD and also calibration, discrimination, and net reclassification improvement for adding LVM to FRS.

Results

Mean age was 30 ± 4 years, 46% males, and 52% white. Event incidence (n = 118) across FRS groups was, respectively, 1.3%, 5.4%, and 23.1% (p < 0.001); and was 1.4%, 1.3%, 3.7%, and 5.4% (p < 0.001) across quartiles of LVM (cut-points 117 g, 144 g, and 176 g). LVM predicted CVD independently of FRS, with the best performance in normal weight participants. Adding LVM to FRS modestly increased discrimination and had a statistically significant reclassification. The 85th percentile (≥ 116 g/m² for men; ≥ 96 g/m² for women) showed event prediction more robust than currently recommended cut-points for hypertrophy.

Conclusion

In a biracial cohort of young adults, FRS and LVM are helpful independent predictors of CVD. LVM can modestly improve discrimination and reclassify participants beyond FRS. Currently recommended cut-points for hypertrophy may be too high for young adults.     

Framingham风险评分与遗忘型轻度认知障碍的相关性

目的探讨Framingham风险评分与遗忘型轻度认知障碍（amnestic mild cognitive impairment, aMCI）的相关性,以期为阿尔茨海默症的早期预防提供有意义的临床依据。 方法选取2018年1月至2019年12月浙江医院收治的124老年人,均行神经心理学评估,其中aMCI老年人54例（aMCI组）,认知正常老年人70例（正常组）。比较两组老年人的Framingham风险评分,并分析aMCI老年人Framingham风险评分与认知功能的相关性。计量资料的组间比较采用t检验或非参数Mann-Whitney U检验,计数资料的比较采用χ²检验,Framingham风险评分与认知功能的相关性采用Spearman相关分析。 结果两组对象一般资料（包括Framingham风险评分的组成指标）的差异无统计学意义（P>0.05）。aMCI组Framingham风险评分中位数为24%,四分位数间距为22%;正常组Framingham风险评分中位数为16.7%,四分位数间距为22%;差异有统计学意义（Z=-2.721,P<0.01）。aMCI老年人Framingham风险评分与简易智能状态检查量表及听觉词语学习测验20 min延迟回忆评分均呈显著负相关（r=-0.203、-0.570,P<0.01）。 结论Framingham风险评分与老年人认知功能有关,可作为老年人认知功能障碍的预警参考指标。     

Comparison of original and modified Q risk 2 risk score with Framingham risk score - An Indian perspective

ObjectiveNo study among Indian population has proposed modification of existing cardiovascular disease (CVD) risk scores or novel risk scores as risk estimation using conventional risk calculators can’t be generalized because of epidemiological differences.Material and methodsA single center observational study was performed at a tertiary care center among participants having no evidence of CVD. Prevalence of various cardiac risk factors were analysed and 10-year risk was estimated using Framingham risk score (FRS), Q risk 2 score calculator (QRISK2) and Modified Q risk 2 (mQRISK2) which included smokeless tobacco consumption. QRISK2 and mQRISK2 were compared with FRS and participant’s eligibility for statin therapy as primary preventive measure was assessed.ResultsTotal of 4045 participants were enrolled from August 2016 to July 2019. 3520(87%) had no history of smoking in their lifetime while smokeless tobacco consumption was seen in 1153(28.5%), diabetes in 422(10.4%), hypertension in 1096(27.1%), obesity in 2035(50.3%), and family history of CVD in 353(8.7%) participants. High risk participants were found to be 826(20.4%), 627(15.5%), and 509(12.6%) by using FRS, mQRISK2 and QRISK2, whereas those eligible for statin therapy were maximum by mQRISK2 among 1323(32.7%) participants compared to QRISK2 (n = 1191; 29.4%) and FRS (n = 826; 20.4%) model. Krippendorff’s alpha for mQRISK2 was in better agreement with body mass index (BMI) and lipid FRS CVD scoring system as compared to QRISK2 risk model.ConclusionCVD risk stratification based on smokeless tobacco use is first of its kind from this part of world and should be part of CV risk assessment.     

Recalibration of the Framingham risk score for predicting 10-year risk of cardiovascular events: A non-concurrent rural cohort study from Tamil Nadu

ObjectiveTo recalibrate the Framingham Risk Score-cardiovascular diseases (FRS-CVD) using 10-year mortality data and baseline risk factor data for a rural cohort and assess the effect of recalibration on proportion categorised as high risk.MethodsParticipants of a cardiovascular risk factor survey aged 30–64 years in 2011–12, from 9 villages of a rural block in Vellore, Tamil Nadu, were followed up for mortality till 2021, as part of an established demographic surveillance system. We calculated both lipid-based and Body Mass Index-based FRS-CVD risk scores, as well as recalibrated scores using risk factor data from the baseline survey and CVD mortality observed over 10 years.ResultsBased on original lipid-based FRS-CVD scores, 8.48% (109) of 1285 males had a 10-year CVD risk ≥30%, compared to 11.60% (149) with recalibrated scores. Among 1737 females, 1.50% (26) had a 10-year CVD risk of ≥30%, using original FRS-CVD scores, and 3.22% (56) using recalibrated scores. Similarly, for BMI based FRS-CVD scores, overall, 3.63% (110/3028) had a 10-year risk of ≥30%, compared to 6.64% (201) using recalibrated scores.The median 10-year FRS-CVD original score in males was 7.57 (IQR: 3.67–15.83), and 2.53 (IQR: 1.28–5.32) in females, compared to 8.95 (IQR: 4.35–18.52) and 3.79 (IQR: 1.92–7.93) respectively, for the recalibrated FRS-CVD risk scores.ConclusionThe recalibrated Framingham models showed a greater proportion of the population at risk of CVDs compared to the original FRS scores, with males having 2–3 times greater CVD risk scores compared to females.     

Dietary patterns explaining variations in blood biomarkers in young adults are associated with the 30-year predicted cardiovascular disease risks in midlife: A follow-up study

Background and aimsTo examine a combined effect of dietary intakes, blood lipid and insulin resistance in young adulthood on the risk of predicted CVD through midlife.Methods and resultsData of young adults from a birth cohort study in Australia were used. Reduced rank regression (RRR) and partial least squares (PLS) methods identified dietary patterns rich in meats, refined grains, processed and fried foods, and high-fat dairy and low in whole grains and low-fat dairy from dietary intakes obtained at 21-years, and blood lipids and measures of insulin resistance measured at 30-years of age. Using standard CVD risk factors measured at 30-years of age, the Framingham Heart Study risk-prediction algorithms were used to calculate the 30-year predicted Framingham CVD risk scores. The scores represent Hard CVD events; coronary death, myocardial infarction and stroke and Full CVD events; Hard CVD plus coronary insufficiency and angina pectoris, transient ischaemic attack, intermittent claudication, and congestive heart failure in midlife. Sex-specific upper quartiles of CVD risk scores were used to define high-risk groups. Modified Poisson regression models were used to estimate relative risks (RRs) with 95% CI. Greater adherence to the diet identified applying RRR in young adulthood was associated with higher risks of predicted Hard CVD (RR: 1.60; 1.14, 2.25) and Full CVD (RR: 1.46; 1.04, 2.05) events in midlife. The diet from PLS showed similar trend of association for the risk of predicted Hard CVD events (RR: 1.49; 1.03, 2.16) in adjusted models.ConclusionDietary patterns associated with variations in blood lipids and insulin resistance in young adulthood are associated with increased risks of predicted CVD events in midlife. The findings suggest that diet induced altered blood lipids and insulin resistance in the life course of young adulthood could increase the risks of CVD events in later life.     

Dietary patterns and predicted 10-year cardiovascular disease risk in a multiethnic Asian population

Background and aimsStudies examining associations between dietary patterns and Framingham risk score (FRS) and predicted 10-year cardiovascular diseases (CVD) risk in an Asian population are lacking. This study aimed to identify a posteriori dietary patterns across three major ethnic groups in Singapore and ascertain their associations with locally modified FRS and predicted 10-year CVD risk.Methods and resultsThis cross-sectional study included 8594 Singapore residents (aged 21–75 years) from the Singapore Multi-Ethnic Cohort. Data on sociodemographic and lifestyle factors were collected via questionnaires. Food consumption was assessed using a validated Food Frequency Questionnaire. Dietary patterns were identified using principal component analysis and associations with CVD risk factors, FRS and predicted CVD risk (%) were analysed using multiple linear and logistic regression. Four dietary patterns emerged that explained 25.6% of variance. The ‘processed food and sugar-sweetened beverages’ pattern was significantly associated with higher FRS (β: 0.13; 95% CI: 0.04, 0.23), while the ‘ethnic breads, legumes and nuts’ (β: 0.13; 95% CI: 0.22, ?0.04) and ‘whole grains, fruit and dairy’ (β: 0.17; 95% CI: 0.24, ?0.10) patterns were significantly associated with lower FRS. The ‘meat and vegetables’ pattern was not significantly associated with FRS. Increased adherence to the ‘whole grains, fruit and dairy’ pattern was associated with lower odds of having predicted CVD risk of ≥10% (p-trend: 0.03).ConclusionAdherence to the ‘ethnic breads, legumes and nuts’ and ‘whole grains, fruit and dairy’ patterns was associated with a lower predicted CVD risk, and an inverse association for the ‘processed food and sugar-sweetened beverages’ pattern in an Asian population. These findings can inform the development of culturally sensitive dietary interventions to prevent CVD.     

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...     

Borderline high serum calcium levels are associated with arterial stiffness and 10‐year cardiovascular disease risk determined by Framingham risk score

Recent epidemiological data indicate that the concentration of circulating calcium is related to cardiovascular disease (CVD) mortality. We determined whether serum calcium level is related to arterial stiffness and 10‐year CVD risk calculated by Framingham risk score (FRS). We examined the association of normal‐range serum calcium level with arterial stiffness and FRS in 565 Korean adults participating at the Health Promotion Center of Gangnam Severance Hospital between March 2016 and May 2017. High brachial‐ankle pulse wave velocity (baPWV) was defined as >1460 cm/s, and high FRS was defined as ≥10 percent for 10‐year CVD risk. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for high baPWV and high FRS were calculated using multiple logistic regression analysis after adjusting for confounding variables. The OR (95% CI) for high baPWV was 3.91 (1.15‐7.36) per 1 mg/dL increment of serum calcium after adjusting for age, sex, body mass index, smoking status, exercise regularity, alcohol consumption, mean blood pressure, fasting plasma glucose, triglyceride, HDL‐cholesterol, C‐reactive protein, γ‐glutamyltransferase, uric acid level, phosphate level, potassium level, and presence of hypertension, diabetes and dyslipidemia medications (P = 0.024). A positive association between serum calcium level and high FRS was also observed after adjusting for the same covariables (OR, 3.54 [95% CI, 1.01‐12.44], P = 0.048). Serum calcium level was independently and positively associated with baPWV and 10‐year CVD risk estimates. Early detection of higher serum calcium level may be important for the assessment of arterial stiffness and future risk of a cardiovascular event.     

Correlation of hyper-homocysteinemia with coronary artery disease in absence of conventional risk factors among young adults

Objective

Coronary artery disease is major cause of mortality and morbidity. Homocysteine has long been postulated as an underlying factor for atherosclerosis leading to coronary artery disease, yet its role in young patients is uncertain. This study was aimed to analyze the correlation between plasma homocysteine and coronary artery disease among young adults in the absence of conventional risk factors.

Visceral/epicardial adiposity in nonobese and apparently healthy young adults: Association with the cardiometabolic profile

Objective

We investigate associations of regional adipose tissues with cardiometabolic profile of nonobese and apparently healthy young adults.

Methods

Four hundred twenty-five nonobese and apparently healthy individuals were assessed for blood pressure and fasting lipid profile, blood glucose and adiponectin. Subcutaneous abdominal adipose tissue (SAT) and ectopic fat depots (visceral abdominal adipose tissue [VAT], epicardial adipose tissue [EAT] and hepatic fat fraction [HFF]) were quantified by magnetic resonance imaging.

Results

According to anthropometric measurements, blood pressure and blood markers, the population (18–35 years, 54% women) had a low cardiometabolic risk. Compared to women, men had more VAT, EAT and HFF, but less SAT. Regional adipose tissues were positively correlated with each other. VAT and EAT carried significant correlations with all markers of cardiometabolic risk, while SAT and HFF correlated variably with these markers. While taking into account age and gender, SAT, VAT and EAT were associated with most cardiometabolic markers, while HFF was only associated with total cholesterol/high-density lipoprotein ratio (TC/HDL-C) and triglycerides (TG). When comparing SAT, VAT and EAT head-to-head, VAT was the only adipose tissue location maintaining significant association with most markers of cardiometabolic risk. Greater VAT (≥50th percentile) was associated with a worse cardiometabolic profile, whether individuals were overweight or normal weight.

Conclusion

Even in nonobese and apparently healthy young women and men, accumulation of ectopic visceral adiposity in general, and of VAT in particular, is associated with a worse cardiometabolic profile whether individuals were overweight or normal weight.     

Gender difference in the association between Framingham Risk Score with cardio-metabolic risk factors and psychological distress in patients with metabolic syndrome

BackgroundIn the current study we aimed to evaluate the gender-specific associations between metabolic and psychological risk factors of cardiovascular disease (CVD) and Framingham Risk Score (FRS) in patients with metabolic syndrome.MethodsIn a cross-sectional study of 256 patients with metabolic syndrome (157 men, 99 women), the cardiovascular disease risk was evaluated using the FRS scoring system by a pre-defined computerized algorithm. Psychological distress was also assessed by general health questionnaire (GHQ)-12. Evaluation of the biochemical parameters including fasting serum glucose (FSG), lipid profile, liver enzymes and adiponectin concentrations were also performed using the enzymatic methods.ResultsThe prevalence of low, intermediate and high risk of CVD in men was significantly higher than women (P < 0.05). Both genders in high risk of CVD had significantly higher age, systolic blood pressure (SBP) and FSG concentrations compared with male and females in intermediate and low risk of CVD (P < 0.05). In multiple logistic regression, being single was in the highest relationship with high psychological distress values compared with married or divorced/separated marital status. Moreover, high SBP and low high density lipoprotein (HDL) concentrations were also potent determinants of high psychological distress (P < 0.05).ConclusionsIn the current study, the prevalence of CVD risk factors were higher in men compared with women. Moreover, higher age, SBP and FSG were potent determinants of FRS in both genders. Marital status and serum HDL were in relation with psychological distress among patients with metabolic syndrome.     

Coronary heart disease risk assessment in diabetes mellitus--a comparison of PROCAM and Framingham risk assessment functions.

AIMS: To assess any differences between coronary heart disease (CHD) risks calculated by the Framingham equation and those calculated by the PROCAM equation in men with and without diabetes mellitus, and whether any such differences are associated with the hypertriglyceridaemia of diabetes mellitus. METHODS: Clinical and biochemical data collected from 1774 men seen in either general practice, a hospital diabetes or lipid clinic. CHD risks were calculated by both the Framingham and PROCAM functions and comparisons made between those patients with and those without diabetes. RESULTS: Of the 1774 men only 996 fulfilled the criteria for assessment by the PROCAM equation and thus further analysis. Patients with diabetes mellitus had significantly higher serum triglyceride levels than those without (1.9 mmol/l vs. 1.7 mmol/l). Median annual CHD risks calculated by the Framingham function were 1.7% in the patients with and 1.32% in the patients without diabetes mellitus, whereas those calculated by the PROCAM function were 0.77% and 0.6%, respectively. Bland-Altman difference plots showed that in both groups of patients the PROCAM equation systematically underestimated risk in comparison with the Framingham equation at low levels of risk but overestimated at higher levels of risk. The shape of the plots in each group of patients was, however, similar. CONCLUSION: There were no systematic differences between CHD risks calculated by the two different equations in patients with diabetes compared with those without, despite the higher serum triglyceride levels associated with diabetes. Restrictions in the use of the PROCAM function meant that only 56% of the original cohort could be assessed in this way. Thus the Framingham equation remains the most suitable method of CHD risk prediction for UK patients with and without diabetes mellitus.     

Performance of Framingham cardiovascular disease (CVD) predictions in the Rotterdam Study taking into account competing risks and disentangling CVD into coronary heart disease (CHD) and stroke

Background

To evaluate the performance of Framingham predictions of cardiovascular disease (CVD) risk corrected for the competing risk of non-CVD death, in an independent European cohort of older individuals and subsequently extend the predictions by disentangling CVD into coronary heart disease (CHD) and stroke separately.

Methods

We used the Rotterdam Study data, a prospective cohort study of individuals aged 55 years and older (N = 6004), to validate the Framingham predictions of CVD, defined as first occurrence of myocardial infarction, coronary death or stroke during 15 years of follow-up, corrected for the competing risk of non-CVD death. We subsequently estimated the risks of CHD and stroke separately, and used the sum as a predictor for the total CVD risk. Calibration plots and c-statistics were used to evaluate the performance of the models.

Results

Performance of the Framingham predictions was good in the low- to intermediate risk (≤ 30%, 15-year CVD risk) (17.5% observed vs. 16.6% expected) but poorer in the higher risk (> 30%) categories (36.3% observed vs. 44.1% expected). The c-statistic increased from 0.66 to 0.69 after refitting. Separately estimating CHD and stroke revealed considerable heterogeneity with regard to the contribution of CHD and stroke to total CVD risk.

Conclusions

Framingham CVD risk predictions perform well in the low- to intermediate risk categories in the Rotterdam Study. Disentangling CVD into CHD and stroke separately provides additional information about the individual contribution of CHD and stroke to total individual CVD risk.     

Cardiovascular risk prediction in the general population with use of suPAR,CRP, and Framingham Risk Score

Background

The inflammatory biomarkers soluble urokinase plasminogen activator receptor (suPAR) and C-reactive protein (CRP) independently predict cardiovascular disease (CVD). The prognostic implications of suPAR and CRP combined with Framingham Risk Score (FRS) have not been determined.

Methods

From 1993 to 1994, baseline levels of suPAR and CRP were obtained from 2315 generally healthy Danish individuals (mean [SD] age: 53.9 [10.6] years) who were followed for the composite outcome of ischemic heart disease, stroke and CVD mortality.

Results

During a median follow-up of 12.7 years, 302 events were recorded. After adjusting for FRS, women with suPAR levels in the highest tertile had a 1.74-fold (95% confidence interval [CI]: 1.08–2.81, p = 0.027) and men a 2.09-fold (95% CI: 1.37–3.18, p < 0.001) increase in risk compared to the lowest tertile. Including suPAR and CRP together resulted in stronger risk prediction with a 3.30-fold (95% CI: 1.36–7.99, p < 0.01) increase for women and a 3.53-fold (1.78–7.02, p < 0.001) increase for men when both biomarkers were in the highest compared to the lowest tertile. The combined extreme tertiles of suPAR and CRP reallocated individuals predicted to an intermediate 10-year risk of CVD of 10–20% based on FRS, to low (< 10%) or high (> 20%) risk categories, respectively. This was reflected in a significant improvement of C statistics for men (p = 0.034) and borderline significant for women (p = 0.054), while the integrated discrimination improvement was highly significant (P ≤ 0.001) for both genders.

Conclusions

suPAR provides prognostic information of CVD risk beyond FRS and improves risk prediction substantially when combined with CRP in this setting.     

青年与中老年主动脉夹层患者的临床资料对比分析

目的:分析对比青年与中老年主动脉夹层患者的临床资料,了解青年主动脉夹层患者的临床特点。方法:回顾性分析542例主动脉夹层患者的临床资料,根据年龄将其分为青年组(年龄≤44岁)及中老年组(年龄>44岁),其中青年组126例,中老年组416例。结果:2组在起病是否有诱因、入院是否有疼痛方面无明显统计学差异。与中老年组相比,青年组中高血压患者比例低(X2=15.22,P<0.001),吸烟者比例低(X2=10.67,P=0.001),饮酒者比例低(X2=4.58,P=0.038),Marfan综合征者比例高(X2=108.56,P<0.001),既往有糖尿病病史、冠心病病史者2组无明显统计学差异,青年组入院时平均心率较快(P=0.001),甘油三酯(TG)水平较高(P=0.001),入院后血压控制至达标水平(<120/80mmHg)所需的时间较长(P=0.042),青年组行介入及外科手术治疗者的比例较高(X2=27.04,P<0.001),入院时收缩压(SBP)、舒张压(DBP)、胆固醇(TC)、低密度脂蛋白(LDL)、肌酐(Cr)、尿素氮(BUN)、住院期间病死率等方面2组之间均无明显统计学差异。结论:与中老年主动脉夹层患者相比,青年主动脉夹层患者有其自身的临床特点,青年主动脉夹层患者采取介入及外科手术比例较高。     

Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: Insights from the National Health and Nutrition Examination Survey-III

Background

Neutrophil lymphocyte ratio (NLR) has been shown to predict cardiovascular events in several studies. We sought to study if NLR predicts coronary heart disease (CHD) in a healthy US cohort and if it reclassifies the traditional Framingham risk score (FRS) model.

Methods

We performed post hoc analysis of National Health and Nutrition Examination Survey-III (1998–94) including subjects aged 30–79 years free from CHD or CHD equivalent at baseline. Primary endpoint was death from ischemic heart disease. NLR was divided into four categories: < 1.5, ≥ 1.5 to < 3.0, 3.0–4.5 and > 4.5. Statistical analyses involved multivariate Cox proportional hazards models as well as discrimination, calibration and reclassification.

Results

We included 7363 subjects with a mean follow up of 14.1 years. There were 231 (3.1%) CHD deaths, more in those with NLR > 4.5 (11%) compared to NLR < 1.5 (2.4%), p < 0.001. Adjusted hazard ratio of NLR > 4.5 was 2.68 (95% CI 1.07–6.72, p = 0.035). There was no significant improvement in C-index (0.8709 to 0.8713) or area under curve (0.8520 to 0.8531) with addition of NLR to FRS model. Model with NLR was well calibrated with Hosmer–Lemeshow chi-square of 8.57 (p = 0.38). Overall net reclassification index (NRI) was 6.6% (p = 0.003) with intermediate NRI of 10.1% (p < 0.001) and net upward reclassification of 5.6%. Absolute integrated discrimination index (IDI) was 0.003 (p = 0.039) with relative IDI of 4.3%.

Conclusions

NLR can independently predict CHD mortality in an asymptomatic general population cohort. It reclassifies intermediate risk category of FRS, with significant upward reclassification. NLR should be considered as an inflammatory biomarker of CHD.     

Dietary patterns and the risk of abnormal blood lipids among young adults: A prospective cohort study

Background and aimsThe extent to which dietary patterns influence the risk of abnormal blood lipids throughout young adulthood remains unclear. The aim was to investigate whether early young adulthood dietary patterns predict the risk of abnormal blood lipids during later young adulthood.Methods and resultsWe used data from a long running birth cohort study in Australia. Western dietary pattern rich in meats, processed foods and high-fat dairy products and prudent pattern rich in fruit, vegetables, fish, nuts, whole grains and low-fat dairy products were derived using principal component analysis at the 21-year follow-up from dietary data obtained using a food frequency questionnaire. After 9-years, fasting blood samples of all participants were collected and their total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterols and triglyceride (TG) levels were measured. Abnormal blood lipids were based on clinical cut-offs for total, LDL and HDL cholesterols, and TG and relative distributions for total:HDL and TG:HDL cholesterols ratios. Log-binomial models were used to estimate risk of each outcome in relation to dietary patterns. Greater adherence to the Western pattern predicted increased risks of high LDL (RR: 1.47; 95%CI: 1.06, 2.03) and TG (1.90; 1.25, 2.86), and high ratios of total:HDL (1.48; 1.00, 2.19) and TG:HDL (1.78; 1.18, 2.70) cholesterols in fully adjusted models. Conversely, a prudent pattern predicted reduced risks of low HDL (0.58; 0.42, 0.78) and high TG (0.66; 0.47, 0.92) and high total:HDL (0.71; 0.51, 0.98) and TG:HDL (0.61; 0.45, 0.84) cholesterols ratios.ConclusionThis is the first prospective study to show greater adherence to unhealthy Western diet predicted increased risks of abnormal blood lipids, whereas healthy prudent diet predicted lower such risks in young adults. Addressing diets in early course may improve cardiovascular health of young adults.     

Metabolic syndrome and Framingham risk score for prediction of cardiovascular events in Caribbean Indian patients with blood glucose abnormalities

OBJECTIVE: To evaluate the metabolic syndrome (MS) and Framingham risk score (FRS) as predictors of cardiovascular (CV) events in Caribbean Indian patients who have type 2 diabetes (T2D) or impaired glucose tolerance (IGT). METHOD: A longitudinal and retrospective study was conducted involving patients classified as T2D or IGT in a first study in 1997 who responded for a second examination in 2006. Nonparametric tests and Cox's proportional hazards model were used. Hazard ratios (HRs) and their confidence intervals (95% CI) for risk of a first CV event, according to the presence of MS or a high FRS, were estimated. For MS, the models were adjusted for age, gender and smoking status. RESULTS: A total of 148 patients were included in the present study. The mean time without a CV event was 7.5 years (range 0.38-8.45 years). We noted 31 (25 nonfatal) first hospitalizations, for stroke (n=15), angina pectoris (n=8), acute coronary heart disease (n=7) and acute peripheral vascular disease (n=1). Ten (6.8%) patients died and six deaths were related to CV events. The HRs of CV events associated with metabolic syndrome, defined by the National Cholesterol Education Program's Adult Treatment Program III, were not significant. Conversely, HRs of CV events associated with the FRS were 4.78 (95% CI 1.65-13.5) and 2.94 (95% CI 1.42-6.06) for a risk score superior or equal to 10% and superior or equal to 20%, respectively. For coronary heart disease alone, the HRs associated with the FRS were 9.92 (95% CI 1.31-75.2) and 2.88 (95% CI 1.05-7.93), respectively. In these Caribbean Indian patients with blood glucose abnormalities, unlike the FRS, MS failed to identify subgroups at high cardiovascular risk in the short term (8.5 years). Nevertheless, the long-term risk-predictive value of these tools needs to be evaluated.     

Prediction of coronary heart disease: a comparison between the Copenhagen risk score and the Framingham risk score applied to a Dutch population

OBJECTIVES: To compare the estimation of coronary heart disease (CHD) risk by the Framingham risk score (FRS) and the Copenhagen risk score (CRS) using Dutch population data. DESIGN: Comparison of CHD risk estimates from FRS and CRS. CHD risk-estimations for each separate risk factor. SETTING: Urk, the Netherlands. SUBJECTS: A total of 408 fishermen from Urk, aged 30-65 years, without pre-existing cardiovascular disease. MAIN OUTCOME MEASURES: Absolute CHD risk estimates. RESULTS: The average 10-year risk for CHD was significantly different between the FRS (4.6%, SD 5.0) and the CRS (3.2%, SD 4.1). The correlation between the two estimates was 0.94 (P < 0.001). The Bland-Altman figure shows a large proportion of agreement, but with an increasing difference with increasing average risk. When examining the separate risk factors age, total cholesterol, HDL cholesterol and systolic blood pressure and smoking, there appear differences between the two risk functions. CONCLUSION: Using Dutch population data, differences were found for the calculation of CHD risk with the FRS and the CRS. Further research must be carried out to examine the validity of these risk functions in the Dutch population.