scholarly journals SAT0309 Underestimation of cardiovascular events by cardiovascular risk scores in psoriatic arthritis patients

2018 ◽  
Author(s):  
H.M. Lam ◽  
S.H.O. Ngai ◽  
S.H. Cho ◽  
T.K. Chun ◽  
K.L. Kot ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Psoriatic Arthritis ◽  
Cardiovascular Events ◽  
Risk Scores

scholarly journals Incidence of cardiovascular events after kidney transplantation and cardiovascular risk scores: study protocol

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Salvador Pita-Fernández ◽  
Sonia Pértega-Díaz ◽  
Francisco Valdés-Cañedo ◽  
Rocío Seijo-Bestilleiro ◽  
Teresa Seoane-Pillado ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Cardiovascular Risk ◽  
Study Protocol ◽  
Cardiovascular Events ◽  
Risk Scores

scholarly journals Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality

Hypertension ◽  
2020 ◽  
Author(s):  
Christopher E. Clark ◽  
Fiona C. Warren ◽  
Kate Boddy ◽  
Sinead T.J. McDonagh ◽  
Sarah F. Moore ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Hazard Ratio ◽  
Risk Scores ◽  
Individual Participant Data ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Individual Participant

Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02–1.08) and 1.06 (95% CI, 1.02–1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01–1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00–1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01–1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06–1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227

scholarly journals POS1017 CARDIOVASCULAR RISK IN DIFFERENT CLINICAL VARIANTS OF SPONDYLOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 776.2-776
Author(s):  
A. Dadalova ◽  
E. Vasilenko ◽  
R. Samigullina ◽  
V. Mazurov
Keyword(s):  
Risk Assessment ◽  
New York ◽  
Cardiovascular Risk ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Risk Evaluation ◽  
Cardiovascular Events ◽  
Assessment Scales ◽  
Very High ◽  
Score Index

Background:Numerous studies have shown that the life expectancy of patients with spondyloarthritis (SPA) is, on average, 5-7 years less compared to the population, and the overall mortality rate is 1.6-1.9 times higher than the population, while mortality from cardiovascular disease increases by 20-40%.Objectives:of the current study were to assess the cardiovascular risk in pts with with ankylosing spondylitis, psoriatic arthritis and psoriatic spondyloarthritis and to compare different cardiovascular risk scales in these pts.Methods:The study included 54 patients with SpA aged 45 to 65 years. The patients were divided into 3 groups: patients with ankylosing spondylitis (AS) who meet the modified New York criteria for AS (1984) (n = 14), patients with psoriatic arthritis (PsA) who meet the CASPAR criteria (Classification criteria of Psoriatic Arthritis, 2006) (n = 18) and patients with psoriatic spondyloarthritis (PsSpA) meeting the modified New York criteria for AS and CASPAR criteria for PsA (n = 22).The average age in the AS group was 55.5 ± 6.43 years, in the PsA group - 57.4 ± 5.76 years, in the PsSpA group - 55.0 ± 6.45 years. Men made up 64.3% in the AC group, 50% in the PsA group, and 49% in the PsSpA group.Three indices of cardiovascular risk evaluation (Systematic COronary Risk Evaluation (SCORE) with increasing coefficient 1.5 for inflammatory diseases, Reynolds Risk Score (RRS), and the third modification of QRESEARCH Cardiovascular Risk Algorithm (QRISK3) were calculated.After the numerical assessment of the indicators, each patient was graded in the degree of CVR with the allocation of low, medium, high and very high degree. To stratify the degrees, an estimate of the total risk on the SCORE scale was used: with a value of less than 1%, the risk was considered low, from> 1% to 5% - medium or moderately increased, from> 5% to 10% - high, and> 10% - very high.Results:The values of the indices were in the AS group SCORE – 3,05±2,41%, RRS – 5,05±2,67%, QRISK3 – 6,68±3,11%, in pts with PsA SCORE - 4,11±2,22%, RRS - 5.72 ± 2.46%, QRISK3 - 7.25 ± 2.51% and in pts with PsSpA SCORE - 4.78 ± 2.65%, RRS - 6.35 ± 2.34 %, QRISK3 - 8.02 ± 3.25%.Table 1.The number of pts corresponding to different degrees of risk depending on the used CVD risk assessment scale, n = 54Degrees of riskSCORERRSQRISK3Low920Medium322616High122328Very high1310When assessing CVR using various risk assessment scales (RRS, QRISK3, SCORE), the highest values were obtained in the PsSpA group.When comparing the results obtained, it was found that the majority of the surveyed belonging to a low degree of CVR according to SCORE (9 people), when evaluated using other scales, fell into the group of medium or high risk. The assessment of the risks of 10-year significant cardiovascular events in patients with SPA using the SCORE index does not coincide with the QRISK3 index data in 70.4% of cases, with the RRS data - in 42.6% of cases, and the SCORE index shows lower values of the expected risk. The highest values were obtained when assessing CVR using the scale QRISK3.Conclusion:The highest CVR values were obtained in the PsSpA group using various risk assessment scales (RRS, QRISK3, SCORE). There was a discrepancy in the severity of CVR calculated using different rating scales in SpA patients. The largest values were obtained when using the scale QRISK3, and the smallest when calculating the CVR using the scale SCORE.References:[1]Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol 2013;27 Suppl 3:12–29.[2]Bengtsson K, Forsblad-d’Elia H, Lie E, et al. Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Res Ther. 2017 May 18;19(1):102. doi: 10.1186/s13075-017-1315-zDisclosure of Interests:None declared.

scholarly journals Cardiovascular Risk in Psoriasis: A Population-Based Analysis with Assessment of the Framingham Risk Score

Scientifica ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Elena Myasoedova ◽  
Bharath Manu Akkara Veetil ◽  
Eric L. Matteson ◽  
Hilal Maradit Kremers ◽  
Marian T. McEvoy ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Risk Score ◽  
Cardiovascular Events ◽  
Framingham Risk Score ◽  
Population Based ◽  
Risk Scores ◽  
Prior History ◽  
Apparent Difference ◽  
Cardiovascular Risks ◽  
Framingham Risk

Objective. To examine the utility of the Framingham risk score (FRS) in estimating cardiovascular risk in psoriasis.Methods. We compared the predicted 10-year risk of cardiovascular events, namely, cardiovascular death, myocardial infarction, heart failure, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting using the FRS, to the observed risk of cardiovascular events in a population-based cohort of patients with psoriasis. Patients with incident or prevalent adult-onset psoriasis aged 30–79 years without prior history of cardiovascular disease were included.Results. Among the 1197 patients with predicted risk scores, the median FRS was 6.0%, while the observed 10-year cardiovascular risk was 6.9% (standardized incidence ratio (SIR): 1.14; 95% confidence interval (CI): 0.92–1.42). The SIR was not elevated for women nor for men. The differences between observed and predicted cardiovascular risks in patients <60 years (SIR: 1.01; 95% CI: 0.73–1.41) or ≥60 years (SIR: 1.26; 95% CI: 0.95–1.68) were not statistically significant.Conclusion. There was no apparent difference between observed and predicted cardiovascular risks in patients with psoriasis in our study. FRS reasonably estimated cardiovascular risk in both men and women as well as in younger and older psoriasis patients, suggesting that FRS can be used in risk stratification in psoriasis without further adjustment.

scholarly journals POS0201 RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS INITIATING BIOLOGICS/APREMILAST FOR PSORIATIC ARTHRITIS: A NATIONWIDE POPULATION-BASED STUDY USING THE FRENCH HEALTH INSURANCE DATABASE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 317.2-317
Author(s):  
L. Pina Vegas ◽  
P. Le Corvoisier ◽  
L. Penso ◽  
M. Paul ◽  
E. Sbidian ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cardiovascular Risk ◽  
Psoriatic Arthritis ◽  
Propensity Score ◽  
Cardiovascular Events ◽  
Index Date ◽  
Tnf Inhibitors ◽  
National Database ◽  
Major Adverse Cardiovascular Events ◽  
Disease Modifying

Background:Psoriatic arthritis (PsA) is associated with other diseases of the spectrum of spondyloarthritis but also appears to be linked to an increased prevalence of numerous comorbidities and more specifically cardiovascular risk factors and events. Several biological disease-modifying anti-rheumatic drugs (bDMARDs) have demonstrated anti-inflammatory effects in PsA. However, their comparative cardiovascular safety profiles remain unknown.Objectives:Our objective was to assess the relative comparative risk of major adverse cardiovascular events (MACEs) of different classes of bDMARDs or apremilast for PsA.Methods:This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme covering approximately 67 million individuals linked to the hospital discharge database. All adults with PsA who were new users of bDMARDs/apremilast (neither in the year before the index date) during 2015-2019 were included. Patients with previous cardiovascular diseases were excluded. End of follow-up was December 31, 2019. The primary end point was an occurrence of MACE (acute myocardial infarction and ischaemic stroke) in a time-to-event analysis with propensity score-weighted Cox and Fine-Gray models (including age, sex, inflammatory diseases associated, cardiovascular risk biomarkers and other comorbidities). To assess the sensitivity of the estimated weighted hazard ratio (HRw) with respect to several possible models, we performed a per-protocol analysis, a conventional multivariate Cox model, an analysis using a larger definition of MACE, an analysis modifying the new-user definition (as those who had not filled a prescription for a bDMARDs or apremilast for 5 years before the index date) and an analysis modifying the treatment discontinuation definition.Results:Between 2015 and 2019, we included 9,510 bDMARD new users (mean age 48.5±12.7 years; 42% men), including 7,289 starting a TNF inhibitor, 1,058 an IL12/23 inhibitor and 1,163 an IL17 inhibitor, with 1,885 apremilast new users (mean age 54.0±12.5 years; 44% men). MACEs occurred in 51 (0.4%) patients (Figure 1). After propensity score weighting, the risk of MACEs was significantly greater with IL12/23 (HRw 2.0, 95%CI 1.3-3.0) and IL17 (HRw 1.9, 95%CI 1.2-3.0) inhibitors than TNF inhibitors, with no significant increased risk with apremilast (HRw 1.3, 95%CI 0.8-2.2). Similar results were observed with the Fine-Gray competing-risks survival model. The sensitivity analyses results were consistent with those of the main analysis.Conclusion:Analysis of a large national database revealed an overall small number of MACEs. Using robust methodology from the causal inference field, the risk of MACEs was greater for PsA new users of IL12/23 and IL17 versus TNF inhibitors. The risk of MACEs did not significantly differ between new users of apremilast and new users of TNF inhibitors.Figure 1.Flowchart for analytic approach Data are n. bDMARD: biological disease-modifying antirheumatic drugs; CVD: cardiovascular disease; TNF: tumor necrosis factor; IL: interleukin; MACE: major adverse cardiac events.Acknowledgements:L Pina Vegas received a Master 2 grant from the French Society of Rheumatology (Bourse Master 2ème Année 2019)Disclosure of Interests:Laura Pina Vegas: None declared, Philippe Le Corvoisier: None declared, Laetitia Penso: None declared, Muriel Paul: None declared, Emilie Sbidian: None declared, Pascal Claudepierre Speakers bureau: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, Pfizer, Roche-Chugai, Bristol-Myers Squibb, MSD, UCB, Novartis, Janssen, Lilly, Celgene (consulting fees, less than 10,000 $ each)., Employee of: Roche Chugai, Sanofi Aventis, Celgene, Pfizer, MSD, Novartis and BMS (investigator).

scholarly journals Can machine learning bring cardiovascular risk assessment to the next level?

2021 ◽  
Author(s):  
Adrien Rousset ◽  
David Dellamonica ◽  
Romuald Menuet ◽  
Armando Lira Pineda ◽  
Lea Ricci ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Assessment ◽  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Linear Models ◽  
Risk Scores ◽  
Gradient Boosting ◽  
Major Adverse Cardiovascular Events ◽  
Learning Methods ◽  
Machine Learning Methods

Abstract Objective Through this proof of concept, we studied the potential added value of machine learning methods in building cardiovascular risk scores from structured data and the conditions under which they outperform linear statistical models. Methods Relying on extensive cardiovascular clinical data from FOURIER, a randomized clinical trial to test for evolocumab efficacy, we compared linear models, neural networks, random forest, and gradient boosting machines for predicting the risk of major adverse cardiovascular events. To study the relative strengths of each method, we extended the comparison to restricted subsets of the full FOURIER dataset, limiting either the number of available patients or the number of their characteristics. Results When using all the 428 covariates available in the dataset, machine learning methods significantly (c-index 0.67, p-value 2e-5) outperformed linear models built from the same variables (c-index 0.62), as well as a reference cardiovascular risk score based on only 10 variables (c-index 0.60). We showed that gradient boosting—the best performing model in our setting—requires fewer patients and significantly outperforms linear models when using large numbers of variables. On the other hand, we illustrate how linear models suffer from being trained on too many variables, thus requiring a more careful prior selection. These machine learning methods proved to consistently improve risk assessment, to be interpretable despite their complexity and to help identify the minimal set of covariates necessary to achieve top performance. Conclusion In the field of secondary cardiovascular events prevention, given the increased availability of extensive electronic health records, machine learning methods could open the door to more powerful tools for patient risk stratification and treatment allocation strategies.

scholarly journals Omega-3 Fatty Acids in Erythrocyte Membranes as Predictors of Lower Cardiovascular Risk in Adults without Previous Cardiovascular Events

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1919
Author(s):  
Gustavo Henrique Ferreira Gonçalinho ◽  
Geni Rodrigues Sampaio ◽  
Rosana Aparecida Manólio Soares-Freitas ◽  
Nágila Raquel Teixeira Damasceno
Keyword(s):  
Fatty Acids ◽  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Risk Scores ◽  
Erythrocyte Membranes ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Exclusion Criteria ◽  
Total N ◽  
Reactive Protein

Background: This study investigated the association of omega-3 polyunsaturated fatty acids (n-3 PUFA) within erythrocyte membranes and cardiovascular risk assessed by three different estimates. Methods: Inclusion criteria were individuals of both sexes, 30 to 74 years, with at least one cardiovascular risk factor, and no previous cardiovascular events (n = 356). Exclusion criteria were individuals with acute or chronic severe diseases, infectious diseases, pregnant, and/or lactating women. Plasma biomarkers (lipids, glucose, and C-reactive protein) were analyzed, and nineteen erythrocyte membrane fatty acids (FA) were identified. The cardiovascular risk was estimated by Framingham (FRS), Reynolds (RRS), and ACC/AHA-2013 Risk Scores. Three patterns of FA were identified (Factor 1, poor in n-3 PUFA), (Factor 2, poor in PUFA), and (Factor 3, rich in n-3 PUFA). Results: Total cholesterol was inversely correlated with erythrocyte membranes C18:3 n-3 (r = −0.155; p = 0.004), C22:6 n-3 (r = −0.112; p = 0.041), and total n-3 (r = −0.211; p < 0.001). Total n-3 PUFA was associated with lower cardiovascular risk by FRS (OR = 0.811; 95% CI= 0.675–0.976). Regarding RRS, Factor 3 was associated with 25.3% lower odds to have moderate and high cardiovascular risk (OR = 0.747; 95% CI = 0.589–0.948). The ACC/AHA-2013 risk score was not associated with isolated and pooled FA. Conclusions:n-3 PUFA in erythrocyte membranes are independent predictors of low-risk classification estimated by FRS and RRS, which could be explained by cholesterol-lowering effects of n-3 PUFA.

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