Adding carotid total plaque area to the Framingham risk score improves cardiovascular risk classification
| Autor: | Hernan A Perez, Luis J Armando, Néstor H. García, John David Spence |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
hypertension CIENCIAS MÉDICAS Y DE LA SALUD Population Medicina Clínica 030204 cardiovascular system & hematology Lower risk 03 medical and health sciences 0302 clinical medicine Clinical Research Diabetes mellitus Internal medicine CARDIOVASCULAR EVENT purl.org/becyt/ford/3.2 [https] medicine 030212 general & internal medicine education Prospective cohort study education.field_of_study Framingham Risk Score HYPERTENSION business.industry General Medicine medicine.disease cardiovascular event ATHEROSCLEROSIS Plaque area Cardiology purl.org/becyt/ford/3 [https] Medicina Critica y de Emergencia atherosclerosis Risk classification business Body mass index |
| Zdroj: | CONICET Digital (CONICET) Consejo Nacional de Investigaciones Científicas y Técnicas instacron:CONICET Archives of Medical Science : AMS Department of Medicine Publications |
| Popis: | Cardiovascular events (CE) due to atherosclerosis are preventable. Identification of high-risk patients helps to focus resources on those most likely to benefit from expensive therapy. Atherosclerosis is not considered for patient risk categorization, even though a fraction of CE are predicted by Framingham risk factors. Our objective was to assess the incremental value of combining total plaque area (TPA) with the Framingham risk score (FramSc) using post-test probability (Ptp) in order to categorize risk in patients without CE and identify those at high risk and requiring intensive treatment. Material and methods: A descriptive cross-sectional study was performed in the primary care setting in an Argentine population aged 22-90 years without CE. Both FramSc based on body mass index and Ptp-TPA were employed in 2035 patients for risk stratification and the resulting reclassification was compared. Total plaque area was measured with a high-resolution duplex ultrasound scanner. Results: 57% male, 35% hypertensive, 27% hypercholesterolemia, 14% diabetes. 20.1% were low, 28.5% moderate, and 51.5% high risk. When patients were reclassified, 36% of them changed status; 24.1% migrated to a higher and 13.6% to a lower risk level (k index = 0.360, SE k = 0.16, p < 0.05, FramSc vs. Ptp-TPA). With this reclassification, 19.3% were low, 18.9% moderate and 61.8% high risk. Conclusions: Quantification of Ptp-TPA leads to higher risk estimation than FramSc, suggesting that Ptp-TPA may be more sensitive than FramSc as a screening tool. If our observation is confirmed with a prospective study, this reclassification would improve the long-term benefits related to CE prevention. Fil: Perez, Hernan A.. Blossom DMO; Argentina Fil: Garcia, Nestor Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina Fil: Spence, John David. Western University. Robarts Research Institute. Stroke Prevention and Atherosclerosis Research Centre; Canadá Fil: Armando, Luis J.. Blossom DMO; Argentina |
| Databáze: | OpenAIRE |
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