Utility of established cardiovascular disease risk score models for the 10-year prediction of disease outcomes in women

Goh, Louise Gek Huang; Dhaliwal, Satvinder S.; Lee, Andy H.; Bertolatti, Dean; Della, Phillip

doi:10.1586/erc.13.26

Cited by 9 publications

(10 citation statements)

References 81 publications

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“…BMI is the only measure of obesity currently included in CVD risk score models such as the simplified general CVD risk score model, as an alternative to total and HDL cholesterol level for ease of measurement and calculation,20 and in the QRISK score model 29…”

Section: Discussionmentioning

confidence: 99%

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study

et al. 2014

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ObjectivesIt is important to ascertain which anthropometric measurements of obesity, general or central, are better predictors of cardiovascular disease (CVD) risk in women. 10-year CVD risk was calculated from the Framingham risk score model, SCORE risk chart for high-risk regions, general CVD and simplified general CVD risk score models. Increase in CVD risk associated with 1 SD increment in each anthropometric measurement above the mean was calculated, and the diagnostic utility of obesity measures in identifying participants with increased likelihood of being above the treatment threshold was assessed.DesignCross-sectional data from the National Heart Foundation Risk Factor Prevalence Study.SettingPopulation-based survey in Australia.Participants4487 women aged 20–69 years without heart disease, diabetes or stroke.Outcome measuresAnthropometric obesity measures that demonstrated the greatest increase in CVD risk as a result of incremental change, 1 SD above the mean, and obesity measures that had the greatest diagnostic utility in identifying participants above the respective treatment thresholds of various risk score models.ResultsWaist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio had larger effects on increased CVD risk compared with body mass index (BMI). These central obesity measures also had higher sensitivity and specificity in identifying women above and below the 20% treatment threshold than BMI. Central obesity measures also recorded better correlations with CVD risk compared with general obesity measures. WC and WHR were found to be significant and independent predictors of CVD risk, as indicated by the high area under the receiver operating characteristic curves (>0.76), after controlling for BMI in the simplified general CVD risk score model.ConclusionsCentral obesity measures are better predictors of CVD risk compared with general obesity measures in women. It is equally important to maintain a healthy weight and to prevent central obesity concurrently.

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Section: Discussionmentioning

confidence: 99%

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study

et al. 2014

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“…Risk variables used to calculate the 10-year risk include: age, sex, systolic blood pressure (SBP), diastolic blood pressure, total cholesterol level, high-density lipoprotein (HDL) cholesterol level, smoking status, diabetes status and ECG-left ventricular hypertrophy (ECG-LVH) 16. The most commonly used treatment threshold for the Framingham model was 20%17; this denotes that an individual who has a risk score of more than 20% is considered to be at increased risk of experiencing a CVD event within the next 10 years and should be targeted for treatment.…”

Section: Methodsmentioning

confidence: 99%

Ethnicity and the association between anthropometric indices of obesity and cardiovascular risk in women: a cross-sectional study

et al. 2014

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ObjectivesThe objectives of this study were to determine whether the cross-sectional associations between anthropometric obesity measures, body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR), and calculated 10-year cardiovascular disease (CVD) risk using the Framingham and general CVD risk score models, are the same for women of Australian, UK and Ireland, North European, South European and Asian descent. This study would investigate which anthropometric obesity measure is most predictive at identifying women at increased CVD risk in each ethnic group.DesignCross-sectional data from the National Heart Foundation Risk Factor Prevalence Study.SettingPopulation-based survey in Australia.Participants4354 women aged 20–69 years with no history of heart disease, diabetes or stroke. Most participants were of Australian, UK and Ireland, North European, South European or Asian descent (97%).Outcome measuresAnthropometric obesity measures that demonstrated stronger predictive ability of identifying women at increased CVD risk and likelihood of being above the promulgated treatment thresholds of various risk score models.ResultsCentral obesity measures, WC and WHR, were better predictors of cardiovascular risk. WHR reported a stronger predictive ability than WC and BMI in Caucasian women. In Northern European women, BMI was a better indicator of risk using the general CVD (10% threshold) and Framingham (20% threshold) risk score models. WC was the most predictive of cardiovascular risk among Asian women.ConclusionsEthnicity should be incorporated into CVD assessment. The same anthropometric obesity measure cannot be used across all ethnic groups. Ethnic-specific CVD prevention and treatment strategies need to be further developed.

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“…Whereas risk factors such as tobacco abuse, hyperlipidemia, and diabetes mellitus are currently used to calculate global CVD risk, 1 they are not equally predictive in all subgroups of race 2 and sex, 3 and they are even less reliable predictors of noncoronary vascular disease, which is more prevalent in nonwhite populations. 2 This might be particularly relevant among Latinos, who are among the fastest-growing minority groups, expanding at 4 times the rate of the rest of the United States' population.…”

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Longitudinal Changes in Vascular Risk Markers and Mortality Rates among a Latino Population with Hypertension

Pflederer¹,

Long²,

Beaty³

et al. 2016

Texas Heart Institute Journal

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T he search for novel clinical markers in order to improve the prediction of cardiovascular disease (CVD) beyond traditional risk factors is an ongoing area of research. Whereas risk factors such as tobacco abuse, hyperlipidemia, and diabetes mellitus are currently used to calculate global CVD risk, 1 they are not equally predictive in all subgroups of race 2 and sex, 3 and they are even less reliable predictors of noncoronary vascular disease, which is more prevalent in nonwhite populations.2 This might be particularly relevant among Latinos, who are among the fastest-growing minority groups, expanding at 4 times the rate of the rest of the United States' population. 4 Although circulating inflammatory biomarkers such as high-sensitivity C-reactive protein (hs-CRP) have been shown to improve CVD risk discrimination, validation cohorts have included just 1% Latino subjects. 5 In addition, elevation in these circulating biomarkers varies significantly with race and ethnicity, 6 so their diagnostic usefulness in the Latino population remains unknown. Recently, the use of physiologic tools such as pulse-wave velocity (PWV) for estimating vascular stiffness has been shown to improve the accuracy of risk stratification. Specifically, a meta-analysis of more than 17,000 patients suggests that the addition of arterial PWV to traditional 10-year CVD risk calculation improves the net reclassification index.7 Notably, the results of this study showed improved risk categorization to the greatest degree among younger individuals and those labeled as having intermediate global risk. Reclassifying intermediate-risk patients as high-or low-risk, when measures of arterial stiffness are taken into account, therefore has potentially important implications for initiating or withholding therapeutic interventions. The role of arterial stiffness in improving CVD prediction is promising; however, to date, it has not been adequately evaluated among populations of lower socioeconomic status.

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Utility of established cardiovascular disease risk score models for the 10-year prediction of disease outcomes in women

Cited by 9 publications

References 81 publications

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study

Ethnicity and the association between anthropometric indices of obesity and cardiovascular risk in women: a cross-sectional study

Longitudinal Changes in Vascular Risk Markers and Mortality Rates among a Latino Population with Hypertension

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