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6. Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies

Author

Pennells, Lisa, Kaptoge, Stephen, Wood, Angela, Sweeting, Mike, Zhao, Xiaohui, White, Ian, Burgess, Stephen, Willeit, Peter, Bolton, Thomas, Moons, Karel G M, van der Schouw, Yvonne T, Selmer, Randi, Khaw, Kay-Tee, Gudnason, Vilmundur, Assmann, Gerd, Amouyel, Philippe, Salomaa, Veikko, Kivimaki, Mika, Nordestgaard, Børge G, Blaha, Michael J, Kuller, Lewis H, Brenner, Hermann, Gillum, Richard F, Meisinger, Christa, Ford, Ian, Knuiman, Matthew W, Rosengren, Annika, Lawlor, Debbie A, Völzke, Henry, Cooper, Cyrus, Marín Ibañez, Alejandro, Casiglia, Edoardo, Kauhanen, Jussi, Cooper, Jackie A, Rodriguez, Beatriz, Sundström, Johan, Barrett-Connor, Elizabeth, Dankner, Rachel, Nietert, Paul J, Davidson, Karina W, Wallace, Robert B, Blazer, Dan G, Björkelund, Cecilia, Donfrancesco, Chiara, Krumholz, Harlan M, Nissinen, Aulikki, Davis, Barry R, Coady, Sean, Whincup, Peter H, Jørgensen, Torben, Ducimetiere, Pierre, Trevisan, Maurizio, Engström, Gunnar, Crespo, Carlos J, Meade, Tom W, Visser, Marjolein, Kromhout, Daan, Kiechl, Stefan, Daimon, Makoto, Price, Jackie F, Gómez de la Cámara, Agustin, Wouter Jukema, J, Lamarche, Benoît, Onat, Altan, Simons, Leon A, Kavousi, Maryam, Ben-Shlomo, Yoav, Gallacher, John, Dekker, Jacqueline M, Arima, Hisatomi, Shara, Nawar, Tipping, Robert W, Roussel, Ronan, Brunner, Eric J, Koenig, Wolfgang, Sakurai, Masaru, Pavlovic, Jelena, Gansevoort, Ron T, Nagel, Dorothea, Goldbourt, Uri, Barr, Elizabeth L M, Palmieri, Luigi, Njølstad, Inger, Sato, Shinichi, Monique Verschuren, W M, Varghese, Cherian V, Graham, Ian, Onuma, Oyere, Greenland, Philip, Woodward, Mark, Ezzati, Majid, Psaty, Bruce M, Sattar, Naveed, Jackson, Rod, Ridker, Paul M, Cook, Nancy R, D'Agostino, Ralph B, Thompson, Simon G, Danesh, John, Di Angelantonio, Emanuele, Simpson, Lara M, Pressel, Sara L, Couper, David J, Nambi, Vijay, Matsushita, Kunihiro, Folsom, Aaron R, Shaw, Jonathan E, Magliano, Dianna J, Zimmet, Paul Z, Wannamethee, S Goya, Willeit, Johann, Santer, Peter, Egger, Georg, Casas, Juan Pablo, Amuzu, Antointtte, Tikhonoff, Valérie, Sutherland, Susan E, Cushman, Mary, Søgaard, Anne Johanne, Håheim, Lise Lund, Ariansen, Inger, Tybjærg-Hansen, Anne, Jensen, Gorm B, Schnohr, Peter, Giampaoli, Simona, Vanuzzo, Diego, Panico, Salvatore, Balkau, Beverley, Bonnet, Fabrice, Marre, Michel, de la Cámara, Agustin Gómez, Rubio Herrera, Miguel Angel, Friedlander, Yechiel, McCallum, John, McLachlan, Stela, Guralnik, Jack, Phillips, Caroline L, Wareham, Nick, Schöttker, Ben, Saum, Kai-Uwe, Holleczek, Bernd, Tolonen, Hanna, Vartiainen, Erkki, Jousilahti, Pekka, Harald, Kennet, D’Agostino, Ralph B, Massaro, Joseph M, Pencina, Michael, Vasan, Ramachandran, Kayama, Takamasa, Kato, Takeo, Oizumi, Toshihide, Jespersen, Jørgen, Møller, Lars, Bladbjerg, Else Marie, Chetrit, A, Wilhelmsen, Lars, Lissner, Lauren, Dennison, Elaine, Kiyohara, Yutaka, Ninomiya, Toshiharu, Doi, Yasufumi, Nijpels, Giel, Stehouwer, Coen D A, Kazumasa, Yamagishi, Iso, Hiroyasu, Kurl, Sudhir, Tuomainen, Tomi-Pekka, Salonen, Jukka T, Deeg, Dorly J H, Nilsson, Peter M, Hedblad, Bo, Melander, Olle, De Boer, Ian H, DeFilippis, Andrew Paul, Verschuren, W M Monique, Watt, Graham, Tverdal, Aage, Kirkland, Susan, Shimbo, Daichi, Shaffer, Jonathan, Bakker, Stephan J L, van der Harst, Pim, Hillege, Hans L, Dallongeville, Jean, Schulte, Helmut, Trompet, Stella, Smit, Roelof A J, Stott, David J, Després, Jean-Pierre, Cantin, Bernard, Dagenais, Gilles R, Laughlin, Gail, Wingard, Deborah, Aspelund, Thor, Eiriksdottir, Gudny, Gudmundsson, Elias Freyr, Ikram, Arfan, van Rooij, Frank J A, Franco, Oscar H, Rueda-Ochoa, Oscar L, Muka, Taulant, Glisic, Marija, Tunstall-Pedoe, Hugh, Howard, Barbara V, Zhang, Ying, Jolly, Stacey, Davey-Smith, George, Can, Günay, Yüksel, Hüsniye, Nakagawa, Hideaki, Morikawa, Yuko, Miura, Katsuyuki, Ingelsson, Martin, Giedraitis, Vilmantas, Gaziano, J Michael, Shipley, Martin, Arndt, Volker, Cook, Nancy, Ibañez, Alejandro Marín, Geleijnse, Johanna M, Epidemiology, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland, Pennells, Lisa [0000-0002-8594-3061], Kaptoge, Stephen [0000-0002-1155-4872], Wood, Angela [0000-0002-7937-304X], Sweeting, Michael [0000-0003-0980-8965], Zhao, Xiaohui [0000-0001-9922-2815], Burgess, Stephen [0000-0001-5365-8760], Danesh, John [0000-0003-1158-6791], Di Angelantonio, Emanuele [0000-0001-8776-6719], Apollo - University of Cambridge Repository, Nutrition and Health, APH - Aging & Later Life, APH - Societal Participation & Health, APH - Health Behaviors & Chronic Diseases, Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Groningen Institute for Organ Transplantation (GIOT), Lifestyle Medicine (LM), Life Course Epidemiology (LCE), AGEM - Endocrinology, metabolism and nutrition, Internal medicine, Epidemiology and Data Science, İÜC, Lisa, Pennell, Stephen, Kaptoge, Angela, Wood, Mike, Sweeting, Xiaohui, Zhao, Ian, White, Stephen, Burge, Peter, Willeit, Thomas, Bolton, Karel G M, Moon, Yvonne T, van der Schouw, Randi, Selmer, Kay-Tee, Khaw, Vilmundur, Gudnason, Gerd, Assmann, Philippe, Amouyel, Veikko, Salomaa, Mika, Kivimaki, Børge G, Nordestgaard, Michael J, Blaha, Lewis H, Kuller, Hermann, Brenner, Richard F, Gillum, Christa, Meisinger, Ian, Ford, Matthew W, Knuiman, Annika, Rosengren, Debbie A, Lawlor, Henry, Völzke, Cyrus, Cooper, Alejandro, Marín Ibañez, Edoardo, Casiglia, Jussi, Kauhanen, Jackie A, Cooper, Beatriz, Rodriguez, Johan, Sundström, Elizabeth, Barrett-Connor, Rachel, Dankner, Paul J, Nietert, Karina W, Davidson, Robert B, Wallace, Dan G, Blazer, Cecilia, Björkelund, Chiara, Donfrancesco, Harlan M, Krumholz, Aulikki, Nissinen, Barry R, Davi, Sean, Coady, Peter H, Whincup, Torben, Jørgensen, Pierre, Ducimetiere, Maurizio, Trevisan, Gunnar, Engström, Carlos J, Crespo, Tom W, Meade, Marjolein, Visser, Daan, Kromhout, Stefan, Kiechl, Makoto, Daimon, Jackie F, Price, Agustin, Gómez de la Cámara, J, Wouter Jukema, Benoît, Lamarche, Altan, Onat, Leon A, Simon, Maryam, Kavousi, Yoav, Ben-Shlomo, John, Gallacher, Jacqueline M, Dekker, Hisatomi, Arima, Nawar, Shara, Robert W, Tipping, Ronan, Roussel, Eric J, Brunner, Wolfgang, Koenig, Masaru, Sakurai, Jelena, Pavlovic, Ron T, Gansevoort, Dorothea, Nagel, Uri, Goldbourt, Elizabeth L M, Barr, Luigi, Palmieri, Inger, Njølstad, Shinichi, Sato, W M, Monique Verschuren, Cherian V, Varghese, Ian, Graham, Oyere, Onuma, Philip, Greenland, Mark, Woodward, Majid, Ezzati, Bruce M, Psaty, Sattar, W Tipping, Naveerobert, M Simpson, Lara, L Pressel, Sara, J Couper, David, Nambi, Vijay, Matsushita, Kunihiro, R Folsom, Aaron, E Shaw, Jonathan, J Magliano, Dianna, Z Zimmet, Paul, W Knuiman, Matthew, H Whincup, Peter, Goya Wannamethee, S, Willeit, Johann, Santer, Peter, Egger, Georg, Pablo Casas, Juan, Amuzu, Antoinette, Ben-Shlomo, Yoav, Gallacher, John, Tikhonoff, Valérie, Casiglia, Edoardo, E Sutherland, Susan, J Nietert, Paul, Cushman, Mary, M Psaty, Bruce, Johanne Søgaard, Anne, Lund Håheim, Lise, Ariansen, Inger, Tybjærg-Hansen, Anne, B Jensen, Gorm, Schnohr, Peter, Giampaoli, Simona, Vanuzzo, Diego, Panico, Salvatore, Palmieri, Luigi, Balkau, Beverley, Bonnet, Fabrice, Marre, Michel, Gómez de la Cámara, Agustin, Angel Rubio Herrera, Miguel, Friedlander, Yechiel, Mccallum, John, Mclachlan, Stela, Guralnik, Jack, L Phillips, Caroline, Khaw, Kay-Tee, Wareham, Nick, Schöttker, Ben, Saum, Kai-Uwe, Holleczek, Bernd, Nissinen, Aulikki, Tolonen, Hanna, Donfrancesco, Chiara, Vartiainen, Erkki, Jousilahti, Pekka, Harald, Kennet, B D’Agostino, Ralph, M Massaro, Joseph, Pencina, Michael, Vasan, Ramachandran, Kayama, Takamasa, Kato, Takeo, Oizumi, Toshihide, Jespersen, Jørgen, Møller, Lar, Marie Bladbjerg, Else, Chetrit, A, Rosengren, Annika, Wilhelmsen, Lar, Björkelund, Cecilia, Lissner, Lauren, Nagel, Dorothea, Dennison, Elaine, Kiyohara, Yutaka, Ninomiya, Toshiharu, Doi, Yasufumi, Rodriguez, Beatriz, Nijpels, Giel, A Stehouwer, Coen D, Sato, Shinichi, Kazumasa, Yamagishi, Iso, Hiroyasu, Goldbourt, Uri, Salomaa, Veikko, Kurl, Sudhir, Tuomainen, Tomi-Pekka, T Salonen, Jukka, Visser, Marjolein, H Deeg, Dorly J, W Meade, Tom, M Nilsson, Peter, Hedblad, Bo, Melander, Olle, H De Boer, Ian, Paul DeFilippis, Andrew, M Monique Verschuren, W, Sattar, Naveed, Watt, Graham, Meisinger, Christa, Koenig, Wolfgang, H Kuller, Lewi, Tverdal, Aage, F Gillum, Richard, A Cooper, Jackie, Kirkland, Susan, Shimbo, Daichi, Shaffer, Jonathan, Ducimetiere, Pierre, L Bakker, Stephan J, van der Harst, Pim, L Hillege, Han, J Crespo, Carlo, Amouyel, Philippe, Dallongeville, Jean, Assmann, Gerd, Schulte, Helmut, Trompet, Stella, J Smit, Roelof A, J Stott, David, T van der Schouw, Yvonne, Després, Jean-Pierre, Cantin, Bernard, R Dagenais, Gille, Laughlin, Gail, Wingard, Deborah, Trevisan, Maurizio, Aspelund, Thor, Eiriksdottir, Gudny, Freyr Gudmundsson, Elia, Ikram, Arfan, A van Rooij, Frank J, H Franco, Oscar, L Rueda-Ochoa, Oscar, Muka, Taulant, Glisic, Marija, Tunstall-Pedoe, Hugh, Völzke, Henry, V Howard, Barbara, Zhang, Ying, Jolly, Stacey, Davey-Smith, George, Can, Günay, Yüksel, Hüsniye, Nakagawa, Hideaki, Morikawa, Yuko, Miura, Katsuyuki, Njølstad, Inger, Ingelsson, Martin, Giedraitis, Vilmanta, M Ridker, Paul, Michael Gaziano, J, Kivimaki, Mika, Shipley, Martin, J Brunner, Eric, Arndt, Volker, Brenner, Hermann, Cook, Nancy, Ford, Ian, Marín Ibañez, Alejandro, M Geleijnsed, Johanna, Rod, Jackson, Paul M, Ridker, Nancy R, Cook, Ralph B, D'Agostino, Simon G, Thompson, John, Danesh, and Emanuele, Di Angelantonio

Subjects
Male, Cardiac & Cardiovascular Systems, Nutrition and Disease, Prevention and Epidemiology, PREDICTION, Áhættuþættir, 030204 cardiovascular system & hematology, GUIDELINES, 0302 clinical medicine, Risk Factors, Voeding en Ziekte, FRAMINGHAM, Discrimination, Medicine, Cardiac and Cardiovascular Systems, Blóðrásarsjúkdómar, Prospective Studies, Prospective cohort study, Non-U.S. Gov't, 1102 Cardiorespiratory Medicine and Haematology, CALIBRATION, Kardiologi, Framingham Risk Score, Emerging Risk Factors Collaboration, SCORES, Research Support, Non-U.S. Gov't, Incidence (epidemiology), Middle Aged, Cardiovascular disease, Justice and Strong Institutions, Risk prediction, ddc, 3. Good health, Cardiovascular Diseases, Meta-analysis, Cohort, Calibration, Female, Risk assessment, Cardiology and Cardiovascular Medicine, Algorithm, Life Sciences & Biomedicine, Algorithms, SDG 16 - Peace, Risk algorithms, DISEASE PREVENTION, Research Support, Risk Assessment, VALIDATION, 03 medical and health sciences, Clinical Research, Journal Article, Humans, ddc:610, Risk factor, VLAG, Aged, Science & Technology, business.industry, SDG 16 - Peace, Justice and Strong Institutions, 030229 sport sciences, R1, STATIN USE, Cardiovascular System & Hematology, Cardiovascular System & Cardiology, business, PRIMARY PREVENTION, TASK-FORCE
Abstract

Publisher's version (útgefin grein), Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied. Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at 'high' 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22-24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44-51 such individuals using original algorithms, in contrast to 37-39 individuals with recalibrated algorithms. Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need., The work of the co-ordinating centre was funded by the UK Medical Research Council (G0800270), British Heart Foundation (SP/09/ 002), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, UK National Institute for Health Research Cambridge Biomedical Research Centre, European Research Council (268834), and European Commission Framework Programme 7 (HEALTH-F2-2012-279233). The Emerging Risk Factor Collaboration’s website https://www.phpc.cam.ac.uk/ceu/erfc/list-of-studies/ has compiled a list provided by investigators of some of the funders of the component studies in this analysis. I.W. was supported by the Medical Research Council Unit Programme MC_UU_12023/21. M.K. is supported by the Netherlands Organization for Scientific Research (NWO) Veni grant (Veni, 91616079). J.P. is supported by Erasmus Mundus Western Balkans (ERAWEB), a project funded by the European Commission.

Published
2019

7. Equalization of four cardiovascular risk algorithms after systematic recalibration:individual-participant meta-analysis of 86 prospective studies

Author

Pennells, Lisa, Kaptoge, Stephen, Wood, Angela, Sweeting, Mike, Zhao, Xiaohui, White, Ian, Burgess, Stephen, Willeit, Peter, Bolton, Thomas, Moons, Karel G. M., van der Schouw, Yvonne T., Selmer, Randi, Khaw, Kay-Tee, Gudnason, Vilmundur, Assmann, Gerd, Amouyel, Philippe, Salomaa, Veikko, Kivimaki, Mika, Nordestgaard, Borge G., Blaha, Michael J., Kuller, Lewis H., Brenner, Hermann, Gillum, Richard F., Meisinger, Christa, Ford, Ian, Knuiman, Matthew W., Rosengren, Annika, Lawlor, Debbie A., Volzke, Henry, Cooper, Cyrus, Ibanez, Alejandro Marin, Casiglia, Edoardo, Kauhanen, Jussi, Cooper, Jackie A., Rodriguez, Beatriz, Sundstrom, Johan, Barrett-Connor, Elizabeth, Dankner, Rachel, Nietert, Paul J., Davidson, Karina W., Wallace, Robert B., Blazer, Dan G., Bjorkelund, Cecilia, Donfrancesco, Chiara, Krumholz, Harlan M., Nissinen, Aulikki, Davis, Barry R., Coady, Sean, Whincup, Peter H., Jørgensen, Torben, Ducimetiere, Pierre, Trevisan, Maurizio, Engstrom, Gunnar, Crespo, Carlos J., Meade, Tomw., Visser, Marjolein, Kromhout, Daan, Kiechl, Stefan, Daimon, Makoto, Price, Jackie F., de la Camara, Agustin Gomez, Jukema, J. Wouter, Lamarche, Benoit, Onat, Altan, Simons, Leon A., Kavousi, Maryam, Ben-Shlomo, Yoav, Gallacher, John, Dekker, Jacqueline M., Arima, Hisatomi, Shara, Nawar, Tipping, RobertW., Roussel, Ronan, Brunner, Eric J., Koenig, Wolfgang, Sakurai, Masaru, Pavlovic, Jelena, Gansevoort, Ron T., Nagel, Dorothea, Goldbourt, Uri, Barr, Elizabeth L. M., Palmieri, Luigi, Njølstad, Inger, Sato, Shinichi, Verschuren, W. M. Monique, Varghese, Cherian V., Graham, Ian, Onuma, Oyere, Greenland, Philip, Woodward, Mark, Ezzati, Majid, Psaty, Bruce M., Sattar, Naveed, Jackson, Rod, Ridker, Paul M., Cook, Nancy, D'Agostino, Ralph B., Sr., Thompson, Simon G., Danesh, John, Di Angelantonio, Emanuele, Tipping, Robert W., Simpson, Lara M., Pressel, Sara L., Couper, David J., Nambi, Vijay, Matsushita, Kunihiro, Folsom, Aaron R., Shaw, Jonathan E., Magliano, Dianna J., Zimmet, Paul Z., Wannamethee, S. Goya, Willeit, Johann, Santer, Peter, Egger, Georg, Casas, Juan Pablo, Amuzu, Antointtte, Tikhonoff, Valerie, Sutherland, Susan E., Cushman, Mary, Sogaard, Anne Johanne, Haheim, Lise Lund, Ariansen, Inger, Tybjærg-Hansen, Anne, Jensen, Gorm B., Schnohr, Peter, Giampaoli, Simona, Vanuzzo, Diego, Panico, Salvatore, Balkau, Beverley, Bonnet, Fabrice, Marre, Michel, Herrera, Miguel Angel Rubio, Friedlander, Yechiel, McCallum, John, McLachlan, Stela, Guralnik, Jack, Phillips, Caroline L., Wareham, Nick, Schottker, Ben, Saum, Kai-Uwe, Holleczek, Bernd, Tolonen, Hanna, Jousilahti, Pekka, Harald, Kennet, Massaro, Joseph M., Pencina, Michael, Vasan, Ramachandran, Kayama, Takamasa, Kato, Takeo, Oizumi, Toshihide, Jespersen, Jorgen, Møller, Lars, Bladbjerg, Else Marie, Chetrit, A., Wilhelmsen, Lars, Lissner, Lauren, Dennison, Elaine, Kiyohara, Yutaka, Ninomiya, Toshiharu, Doi, Yasufumi, Nijpels, Giel, Stehouwer, Coen D. A., Kazumasa, Yamagishi, Iso, Hiroyasu, Vartiainen, Erkki, Kurl, Sudhir, Tuomainen, Tomi-Pekka, Salonen, Jukka T., Deeg, Dorly J. H., Nilsson, Peter M., Hedblad, Bo, Melander, Olle, De Boer, Ian H., DeFilippis, Andrew Paul, Watt, Graham, Verschuren, Monique, Tverdal, Aage, Kirkland, Susan, Shimbo, Daichi, Shaffer, Jonathan, Bakker, Stephan J. L., van der Harst, Pim, Hillege, Hans L., Dallongeville, Jean, Schulte, Helmut, Trompet, Stella, Smit, Roelof A. J., Stott, David J., Despres, Jean-Pierre, Cantin, Bernard, Dagenais, Gilles R., Laughlin, Gail, Wingard, Deborah, Aspelund, Thor, Eiriksdottir, Gudny, Gudmundsson, Elias Freyr, Ikram, Arfan, van Rooij, Frank J. A., Franco, Oscar H., Rueda-Ochoa, Oscar L., Muka, Taulant, Glisic, Marija, Tunstall-Pedoe, Hugh, Howard, Barbara V., Zhang, Ying, Jolly, Stacey, Davey-Smith, George, Can, Gunay, Yuksel, Husniye, Nakagawa, Hideaki, Morikawa, Yuko, Miura, Katsuyuki, Ingelsson, Martin, Giedraitis, Vilmantas, Gaziano, J. Michael, Shipley, Martin, Arndt, Volker, Geleijnse, Johanna M., Pennells, Lisa, Kaptoge, Stephen, Wood, Angela, Sweeting, Mike, Zhao, Xiaohui, White, Ian, Burgess, Stephen, Willeit, Peter, Bolton, Thomas, Moons, Karel G. M., van der Schouw, Yvonne T., Selmer, Randi, Khaw, Kay-Tee, Gudnason, Vilmundur, Assmann, Gerd, Amouyel, Philippe, Salomaa, Veikko, Kivimaki, Mika, Nordestgaard, Borge G., Blaha, Michael J., Kuller, Lewis H., Brenner, Hermann, Gillum, Richard F., Meisinger, Christa, Ford, Ian, Knuiman, Matthew W., Rosengren, Annika, Lawlor, Debbie A., Volzke, Henry, Cooper, Cyrus, Ibanez, Alejandro Marin, Casiglia, Edoardo, Kauhanen, Jussi, Cooper, Jackie A., Rodriguez, Beatriz, Sundstrom, Johan, Barrett-Connor, Elizabeth, Dankner, Rachel, Nietert, Paul J., Davidson, Karina W., Wallace, Robert B., Blazer, Dan G., Bjorkelund, Cecilia, Donfrancesco, Chiara, Krumholz, Harlan M., Nissinen, Aulikki, Davis, Barry R., Coady, Sean, Whincup, Peter H., Jørgensen, Torben, Ducimetiere, Pierre, Trevisan, Maurizio, Engstrom, Gunnar, Crespo, Carlos J., Meade, Tomw., Visser, Marjolein, Kromhout, Daan, Kiechl, Stefan, Daimon, Makoto, Price, Jackie F., de la Camara, Agustin Gomez, Jukema, J. Wouter, Lamarche, Benoit, Onat, Altan, Simons, Leon A., Kavousi, Maryam, Ben-Shlomo, Yoav, Gallacher, John, Dekker, Jacqueline M., Arima, Hisatomi, Shara, Nawar, Tipping, RobertW., Roussel, Ronan, Brunner, Eric J., Koenig, Wolfgang, Sakurai, Masaru, Pavlovic, Jelena, Gansevoort, Ron T., Nagel, Dorothea, Goldbourt, Uri, Barr, Elizabeth L. M., Palmieri, Luigi, Njølstad, Inger, Sato, Shinichi, Verschuren, W. M. Monique, Varghese, Cherian V., Graham, Ian, Onuma, Oyere, Greenland, Philip, Woodward, Mark, Ezzati, Majid, Psaty, Bruce M., Sattar, Naveed, Jackson, Rod, Ridker, Paul M., Cook, Nancy, D'Agostino, Ralph B., Sr., Thompson, Simon G., Danesh, John, Di Angelantonio, Emanuele, Tipping, Robert W., Simpson, Lara M., Pressel, Sara L., Couper, David J., Nambi, Vijay, Matsushita, Kunihiro, Folsom, Aaron R., Shaw, Jonathan E., Magliano, Dianna J., Zimmet, Paul Z., Wannamethee, S. Goya, Willeit, Johann, Santer, Peter, Egger, Georg, Casas, Juan Pablo, Amuzu, Antointtte, Tikhonoff, Valerie, Sutherland, Susan E., Cushman, Mary, Sogaard, Anne Johanne, Haheim, Lise Lund, Ariansen, Inger, Tybjærg-Hansen, Anne, Jensen, Gorm B., Schnohr, Peter, Giampaoli, Simona, Vanuzzo, Diego, Panico, Salvatore, Balkau, Beverley, Bonnet, Fabrice, Marre, Michel, Herrera, Miguel Angel Rubio, Friedlander, Yechiel, McCallum, John, McLachlan, Stela, Guralnik, Jack, Phillips, Caroline L., Wareham, Nick, Schottker, Ben, Saum, Kai-Uwe, Holleczek, Bernd, Tolonen, Hanna, Jousilahti, Pekka, Harald, Kennet, Massaro, Joseph M., Pencina, Michael, Vasan, Ramachandran, Kayama, Takamasa, Kato, Takeo, Oizumi, Toshihide, Jespersen, Jorgen, Møller, Lars, Bladbjerg, Else Marie, Chetrit, A., Wilhelmsen, Lars, Lissner, Lauren, Dennison, Elaine, Kiyohara, Yutaka, Ninomiya, Toshiharu, Doi, Yasufumi, Nijpels, Giel, Stehouwer, Coen D. A., Kazumasa, Yamagishi, Iso, Hiroyasu, Vartiainen, Erkki, Kurl, Sudhir, Tuomainen, Tomi-Pekka, Salonen, Jukka T., Deeg, Dorly J. H., Nilsson, Peter M., Hedblad, Bo, Melander, Olle, De Boer, Ian H., DeFilippis, Andrew Paul, Watt, Graham, Verschuren, Monique, Tverdal, Aage, Kirkland, Susan, Shimbo, Daichi, Shaffer, Jonathan, Bakker, Stephan J. L., van der Harst, Pim, Hillege, Hans L., Dallongeville, Jean, Schulte, Helmut, Trompet, Stella, Smit, Roelof A. J., Stott, David J., Despres, Jean-Pierre, Cantin, Bernard, Dagenais, Gilles R., Laughlin, Gail, Wingard, Deborah, Aspelund, Thor, Eiriksdottir, Gudny, Gudmundsson, Elias Freyr, Ikram, Arfan, van Rooij, Frank J. A., Franco, Oscar H., Rueda-Ochoa, Oscar L., Muka, Taulant, Glisic, Marija, Tunstall-Pedoe, Hugh, Howard, Barbara V., Zhang, Ying, Jolly, Stacey, Davey-Smith, George, Can, Gunay, Yuksel, Husniye, Nakagawa, Hideaki, Morikawa, Yuko, Miura, Katsuyuki, Ingelsson, Martin, Giedraitis, Vilmantas, Gaziano, J. Michael, Shipley, Martin, Arndt, Volker, and Geleijnse, Johanna M.

Published
2019

8. Associations of cigarette smoking with subclinical inflammation and atherosclerosis : ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health)

Author

Kianoush, Sina, Yakoob, Mohammad Yawar, Al-Rifai, Mahmoud, DeFilippis, Andrew Paul, Bittencourt, Márcio Sommer, Duncan, Bruce Bartholow, Benseñor, Isabela Judith Martins, Bhatnagar, Aruni, Lotufo, Paulo Andrade, and Blaha, Michael Joseph

Subjects
Inflammation, Tobacco products, Inflamação, Tabagismo, Aterosclerose, Smoking, Atherosclerosis, Subclinical atherosclerosis risk factor
Abstract

Background-—There is a need to identify sensitive biomarkers of early tobacco-related cardiovascular disease. We examined the association of smoking status, burden, time since quitting, and intensity, with markers of inflammation and subclinical atherosclerosis. Methods and Results-—We studied 14 103 participants without clinical cardiovascular disease in ELSA-Brasil (Brazilian Longitudinal Study of Adult Health). We evaluated baseline cross-sectional associations between smoking parameters and inflammation (highsensitivity C-reactive protein [hsCRP]) and measures of subclinical atherosclerosis (carotid intima–media thickness, ankle-brachial index, and coronary artery calcium [CAC]). The cohort included 1844 current smokers, 4121 former smokers, and 8138 never smokers. Mean age was 51.7 8.9 years; 44.8% were male. After multivariable adjustment, compared with never smokers, current smokers had significantly higher levels of hsCRP (b=0.24, 0.19–0.29 mg/L; P0 (odds ratio: 1.83; 95% confidence interval, 1.46–2.30; P0 were lower with increasing time since quitting (P0 (P=0.03) after adjusting for duration of smoking. Conclusions-—Strong associations were observed between smoking status, burden, and intensity with inflammation (hsCRP) and subclinical atherosclerosis (carotid intima–media thickness, ankle-brachial index, CAC). These markers of early cardiovascular disease injury may be used for the further study and regulation of traditional and novel tobacco products.

Published
2017

12. Risk score overestimation: the impact of individual cardiovascular risk factors and preventive therapies on the performance of the American Heart Association-American College of Cardiology-Atherosclerotic Cardiovascular Disease risk score in a modern multi-ethnic cohort

Author

DeFilippis, Andrew Paul, primary, Young, Rebekah, additional, McEvoy, John W., additional, Michos, Erin D., additional, Sandfort, Veit, additional, Kronmal, Richard A., additional, McClelland, Robyn L., additional, and Blaha, Michael J., additional

Published
2016
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14. Platelet Count and Mean Platelet Volume at the Time of and After Acute Myocardial Infarction.

Author

Amraotkar, Alok Ravindra, Song, David Day, Otero, Diana, Trainor, Patrick James, Ismail, Imtiaz, Kothari, Vallari, Singh, Ayesha, Moore IV, Joseph B., Rai, Shesh Nath, and DeFilippis, Andrew Paul

Abstract

Platelet count has been shown to be lower and mean platelet volume (MPV) to be higher in acute myocardial infarction (MI). However, it is not known whether these changes persist post-MI or if these measures are able to distinguish between acute thrombotic and non-thrombotic MI. Platelet count and MPV were measured in 80 subjects with acute MI (thrombotic and nonthrombotic) and stable coronary artery disease (CAD) at cardiac catheterization (acute phase) and at >3-month follow-up (quiescent phase). Subjects were stratified using stringent clinical, biochemical, histological, and angiographic criteria. Outcome measures were compared between groups by analysis of variance. Forty-seven subjects met criteria for acute MI with clearly defined thrombotic (n = 22) and non-thrombotic (n = 12) subsets. Fourteen subjects met criteria for stable CAD. No significant difference was observed in platelet count between subjects with acute MI and stable CAD at the acute or quiescent phase. MPV was higher in acute MI (9.18 ± 1.21) compared to stable CAD (8.13 ± 0.66; P = 0.003) at the acute phase but not at the quiescent phase (8.48 ± 0.58 vs 8.94 ± 1.42; P = 0.19). No difference in platelet count or MPV was detected between thrombotic and nonthrombotic subsets at acute or quiescent phases. The power to detect differences in these measures between thrombotic and non-thrombotic subsets was 58%. Higher MPV at the time of acute MI is not observed by 3 months post-MI (quiescent phase). Platelet count and MPV do not differ in subjects with thrombotic versus non-thrombotic MI. Further investigation is warranted to evaluate the utility of these measures in the diagnosis of acute MI. [ABSTRACT FROM AUTHOR]

Published
2017
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18. Smoking-associated Electrocardiographic Abnormalities Predict Cardiovascular Mortality: Insights from NHANES.

Author

Irfan A, Riggs DW, Koromia G, DeFilippis AP, Soliman EZ, Bhatnagar A, and Carll AP

Abstract

Background—: Smoking is associated with arrhythmia and sudden cardiac death, but the biological mechanisms remain unclear. Abnormal electrocardiogram (ECG) durations of ventricular repolarization (QT interval), atrial depolarization (P wave), and atrioventricular depolarization (PR interval and segment), predict cardiac arrhythmia and mortality., Objectives—: To elucidate how smoking affects cardiac excitation, we assessed in a nationally representative sample (NHANES III) associations between cotinine, abnormalities in P duration, PR interval, PR segment, rate-corrected QT (QTc), QRS duration, and JT interval, and long-term mortality., Methods—: We analyzed data from 5,633 adults using survey-weighted multinomial logistic regression to estimate associations between tobacco use (>15 ng/ml serum cotinine) and short (<5th percentile) or long (>95th percentile) ECG intervals, relative to reference (5 - 95th percentile)., Results—: After adjustment for demographics, risk factors, and conduction-altering medications, smoking was associated with a higher odds of short PR interval, PR segment, and QRS, and long JT. Broader ECG effects of smoking were also assessed by survey-weighted linear regression of continuous cotinine and ECG intervals, which revealed cotinine inversely associated with PR segment and QTc. Over a 22-year follow-up, many ECG abnormalities predicted cardiovascular mortality in smokers, including long JT, QRS, and QTc, and short QRS., Conclusions—: Smoking increases likelihood for rapid atrioventricular conduction, rapid ventricular depolarization, and slow ventricular repolarization. The ventricular electrophysiologic abnormalities associated with smoking also predict cardiovascular mortality in smokers; however, traditional ECG measures of cardiac risk like QTc can overlook these ventricular defects and their independent predictive value in smokers., Competing Interests: Competing interests The authors have no conflicts or competing interest to disclose.

Published
2024
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19. Risk score overestimation: the impact of individual cardiovascular risk factors and preventive therapies on the performance of the American Heart Association-American College of Cardiology-Atherosclerotic Cardiovascular Disease risk score in a modern multi-ethnic cohort.

Author

DeFilippis AP, Young R, McEvoy JW, Michos ED, Sandfort V, Kronmal RA, McClelland RL, and Blaha MJ

Subjects
Adult, Black or African American statistics & numerical data, Aged, American Heart Association, Asian statistics & numerical data, Cardiology, Coronary Artery Disease epidemiology, Coronary Artery Disease ethnology, Female, Hispanic or Latino statistics & numerical data, Humans, Male, Middle Aged, Prospective Studies, Risk Assessment, Sex Distribution, United States epidemiology, White People ethnology, Coronary Artery Disease prevention & control
Abstract

Aims: To evaluate the 2013 American Heart Association (AHA)-American College of Cardiology (ACC)-Atherosclerotic Cardiovascular Disease (ASCVD) risk score among four different race/ethnic groups and to ascertain which factors are most associated with risk overestimation by the AHA-ACC-ASCVD score., Methods and Results: The Multi-Ethnic Study of Atherosclerosis (MESA), a prospective community-based cohort, was used to examine calibration and discrimination of the AHA-ACC-ASCVD risk score in 6441 White, Black, Chinese, and Hispanic Americans (aged 45-79 years and free of known ASCVD at baseline). Using univariable and multivariable absolute risk regression, we modelled the impact of individual risk factors on the discordance between observed and predicted 10-year ASCVD risk. Overestimation was observed in all race/ethnic groups in MESA and was highest among Chinese (252% for women and 314% for men) and lowest in White women (72%) and Hispanic men (67%). Higher age, Chinese race/ethnicity (when compared with White), systolic blood pressure (treated and untreated), diabetes, alcohol use, exercise, lipid-lowering medication, and aspirin use were all associated with more risk overestimation, whereas family history was associated with less risk overestimation in a multivariable model (all P < 0.05)., Conclusion: The AHA-ACC-ASCVD risk score overestimates ASCVD risk among men, women, and all four race/ethnic groups evaluated in a modern American primary prevention cohort. Clinicians treating patients similar to those in MESA, particularly older individuals and those with factors associated with more risk overestimation, may consider interpreting absolute ASCVD risk estimates with caution., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)

Published
2017
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