General Cardiovascular Risk Profile for Use in Primary Care

D’Agostino, Ralph B.; Vasan, Ramachandran S.; Pencina, Michael J.; Wolf, Philip A.; Cobain, Mark; Massaro, Joseph M.; Kannel, William B.

doi:10.1161/circulationaha.107.699579

Cited by 5,974 publications

(4,996 citation statements)

References 55 publications

(63 reference statements)

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“…In the Framingham Heart Study, CVD in previous risk algorithms was defined as CHD (ie, a fatal coronary event, myocardial infarction) or a cerebrovascular event (ie, ischemic stroke, hemorrhagic stroke) 21. For the purpose of this study, major CHD events included recognized myocardial infarction and death from CHD, and major CVD events included major CHD events and ischemic stroke, in accordance with atherosclerotic CVD end points defined in the 2013 American College of Cardiology/American Heart Association risk assessment guidelines 22.…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study

Hoffmann

Massaro

D’Agostino

et al. 2016

JAHA

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167

146

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BackgroundWe determined whether vascular and valvular calcification predicted incident major coronary heart disease, cardiovascular disease (CVD), and all‐cause mortality independent of Framingham risk factors in the community‐based Framingham Heart Study.Methods and ResultsCoronary artery calcium (CAC), thoracic and abdominal aortic calcium, and mitral or aortic valve calcium were measured by cardiac computed tomography in participants free of CVD. Participants were followed for a median of 8 years. Multivariate Cox proportional hazards models were used to determine association of CAC, thoracic and abdominal aortic calcium, and mitral and aortic valve calcium with end points. Improvement in discrimination beyond risk factors was tested via the C‐statistic and net reclassification index. In this cohort of 3486 participants (mean age 50±10 years; 51% female), CAC was most strongly associated with major coronary heart disease, followed by major CVD, and all‐cause mortality independent of Framingham risk factors. Among noncoronary calcifications, mitral valve calcium was associated with major CVD and all‐cause mortality independent of Framingham risk factors and CAC. CAC significantly improved discriminatory value beyond risk factors for coronary heart disease (area under the curve 0.78–0.82; net reclassification index 32%, 95% CI 11–53) but not for CVD. CAC accurately reclassified 85% of the 261 patients who were at intermediate (5–10%) 10‐year risk for coronary heart disease based on Framingham risk factors to either low risk (n=172; no events observed) or high risk (n=53; observed event rate 8%).Conclusions CAC improves discrimination and risk reclassification for major coronary heart disease and CVD beyond risk factors in asymptomatic community‐dwelling persons and accurately reclassifies two‐thirds of the intermediate‐risk population.

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Section: Methodsmentioning

confidence: 99%

Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study

Hoffmann

Massaro

D’Agostino

et al. 2016

JAHA

Self Cite

167

146

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“…One was the Framingham 10‐year risk score, which includes age, total cholesterol, HDL cholesterol, systolic blood pressure, smoking, and diabetes mellitus 28. The second was a new validated 10‐year risk score for CVD from the NHANES (National Health and Nutrition Examination Survey) cohort that uses age and a range of measurements from ECG readings, including positive deflection of the T axis, negative deflection of the T axis, heart rate, and corrected QT interval 29.…”

Section: Methodsmentioning

confidence: 99%

Age at Menarche and Cardiometabolic Health: A Sibling Analysis in the Scottish Family Health Study

Magnus

Lawlor

Iliodromiti

et al. 2018

JAHA

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BackgroundPrevious studies of age at menarche and cardiometabolic health report conflicting findings, and only a few could account for childhood characteristics. We aimed to estimate the associations of age at menarche with cardiovascular risk factors in unrelated women and within sister groups, under the assumption that within‐sibship estimates will be better adjusted for shared genetics and early life environment.Methods and ResultsOur study included 7770 women, from 5984 sibships, participating in the GS:SFHS (Generation Scotland: Scottish Family Health Study). We used fixed‐ and between‐effects linear regression to estimate the associations within sister groups and between unrelated individuals, respectively. Within sibships, the mean difference between sisters with early menarche (≤11 years) and sisters with menarche at 12 to 13 years was 1.73 mm Hg (95% confidence interval [CI], −0.41 to 3.86) for systolic blood pressure, 1.26 mm Hg (95% CI, −0.02 to 2.55) for diastolic blood pressure, −0.06 nmol/L (95% CI, −0.11 to −0.02) for high‐density lipoprotein, 0.20 nmol/L (95% CI, 0.08–0.32) for non–high‐density lipoprotein, −0.34% (95% CI, −1.98 to 1.30) for glucose, 1.60 kg/m2 (95% CI, 0.92–2.28) for body mass index, and 2.75 cm (95% CI, 1.06–4.44) for waist circumference. There was weak evidence of associations between later menarche (14–15 or ≥16 years) and lower body mass index, waist circumference, and blood pressure. We found no strong evidence that estimates from within‐ and between‐sibship analyses differed (all P values >0.1). The associations with other cardiovascular risk factors were attenuated after adjustment for adult body mass index.ConclusionsOur results suggest that confounding by shared familial characteristics is unlikely to be a major driver of the association between early menarche and adverse cardiometabolic health but do not exclude confounding by individual‐level characteristics.

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“…The 10‐ and 30‐year CVD risk by the Framingham score23, 24 was calculated using information on age, systolic blood pressure, antihypertensive treatment, smoking, diabetes, and lipid spectrum (total cholesterol and HDL cholesterol) or BMI (a simpler model of the risk score). Both models, using lipids and using BMI, were applied.…”

Section: Methodsmentioning

confidence: 99%

Increased cardiovascular disease risk in women with a history of recurrent miscarriage

Wagner

Beshay

Rooijakkers

et al. 2018

Acta Obstet Gynecol Scand

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IntroductionCardiovascular disease is the leading cause of death in women. Observational studies suggest that women with a history of recurrent miscarriage have an increased risk of cardiovascular disease.Material and methodsWomen who visited the recurrent miscarriage clinic at Leiden University Medical Center between 2000 and 2010 and who had their third consecutive miscarriage before the age of 31 years, were invited to participate in this follow‐up study (between 2012 and 2014). The reference group consisted of women with at least one uncomplicated pregnancy and no miscarriage, matched by zip code, age, and date of pregnancy. All women were invited for risk factor screening, including physical examination and blood collection. Main outcome measures were the (extrapolated) 10‐ and 30‐year cardiovascular risk scores using the Framingham risk score. A subanalysis was performed for women with idiopathic recurrent miscarriage.ResultsThirty‐six women were included in both groups. Mean follow up was 7.5 years. Women with recurrent miscarriage had a significantly higher extrapolated 10‐year cardiovascular risk score (mean 6.24%, SD 5.44) compared with women with no miscarriage (mean 3.56%, SD 1.82, P = .007) and a significantly higher 30‐year cardiovascular risk score (mean 9.86%, SD 9.10) compared with women with no miscarriage (mean 6.39%, SD 4.20, P = .04). Similar results were found in women with idiopathic recurrent miscarriage (n = 28).ConclusionsWomen with a history of recurrent miscarriage differ in cardiovascular risk profile at a young age compared with women with no miscarriage. The findings support an opportunity to identify women at risk of cardiovascular disease later in life and a possible moment for intervention.

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General Cardiovascular Risk Profile for Use in Primary Care

Cited by 5,974 publications

References 55 publications

Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study

Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study

Age at Menarche and Cardiometabolic Health: A Sibling Analysis in the Scottish Family Health Study

Increased cardiovascular disease risk in women with a history of recurrent miscarriage

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