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Alexandre, Álison Da Silva - One of the best experts on this subject based on the ideXlab platform.
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Avaliação da capacidade de identificação do alto risco cardiovascular pelos algoritmos clínicos, marcadores da atividade inflamatória sistêmica, ultrassonografia de carótida e eScore de cálcio estimado pela tomografia computadorizada em pacientes admitidos com infarto do miocárdio
2011Co-Authors: Alexandre, Álison Da SilvaAbstract:Este trabalho estima a freqüência de pacientes manifestando um infarto agudo do miocárdio (IAM) que não seriam candidatos a terapia intensiva hipolipemiante, antes do IAM, de acordo com as diretrizes clínicas vigentes. Uma coorte prospectiva no Hospital de Base do Distrito Federal, Brasília, Brasil, acompanhou 355 pacientes consecutivos com diagnóstico de IAM com supra-desnivelamento do segmento ST (IAMcSST), e foi determinada, no momento da admissão hospitalar, a concentração plasmática de proteína C-reativa de alta sensibilidade (PCRas) e aplicadas as estratificações de risco cardiovascular: Framingham, PROCAM, Reynolds, ASSIGN, QRisk e Score. Também foram realizadas tomografias cardíacas computadorizadas e ultrassonografias de artérias carotídeas para estratificação de risco por meio do eScore de cálcio da artéria coronária (CAC), espessura das camadas íntima e média das artérias carótidas (cIMT) e a presença de placas ateroscleróticas carotídeas. Menos de 50% dos pacientes de IAMcSST seriam classificados como alto risco antes do infarto por quaisquer dos métodos. Com exceção do Framingham (9%), os demais algoritmos atribuiriam baixo risco à aproximadamente metade dos pacientes admitidos no estudo. A PCRas plasmática foi menor que 1 mg/L em 70% e maior que 2 mg/L em 14% dos pacientes. O cIMT médio foi 0,8 ± 0,2 mm e somente em 24% dos pacientes foi maior ou igual a 1,0 mm. Placas carotídeas foram encontradas em 74% dos pacientes. CAC ≥ 100 foi encontrado em 66% dos pacientes. Considerados simultaneamente, CAC ≥100 e presença de placa carotídea, uma condição de alto risco seria identificada em 100% dos pacientes. Em conclusão, mais da metade dos pacientes de IAMcSST não seriam consideradas como candidatos para a terapia preventiva intensiva pelos algoritmos clínicos atuais. A adição de parâmetros anatômicos tais como CAC e a presença de placas carotídeas pode substancialmente reduzir a subestimação do risco cardiovascular. _________________________________________________________________________________ ABSTRACTObjective: The study we assessed how often patients who are manifesting a myocardial infarction (MI) would not be considered candidates for intensive lipidlowering therapy based on the current guidelines. Methods: In 355 consecutive patients manifesting ST elevation MI (STEMI), admission plasma C-reactive protein (CRP) was measured and Framingham Risk Score (FRS), PROCAM Risk Score, Reynolds Risk Score, ASSIGN Risk Score, QRisk, and Score algorithms were applied. Cardiac computed tomography and carotid ultrasound were performed to assess the coronary artery calcium Score (CAC), carotid intima-media thickness (cIMT) and the presence of carotid plaques. Results: Less than 50% of STEMI patients would be identified as having high Risk before the event by any of these algorithms. With the exception of FRS (9%), all other algorithms would assign low Risk to about half of the enrolled patients. Plasma CRP was 2 mg/L in 14% of the patients. The average cIMT was 0.8±0.2mm and only in 24% of patients was ≥1.0mm. Carotid plaques were found in 74% of patients. CAC ≥100 was found in 66% of patients. Adding CAC ≥100 plus the presence of carotid plaque, a high-Risk condition would be identified in 100% of the patients using any of the above mentioned algorithms. Conclusion: More than half of patients manifesting STEMI would not be considered as candidates for intensive preventive therapy by the current clinical algorithms. The addition of anatomical parameters such as CAC and the presence of carotid plaques can substantially reduce the CVD Risk underestimation
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Avaliação da capacidade de identificação do alto risco cardiovascular pelos algoritmos clínicos, marcadores da atividade inflamatória sistêmica, ultrassonografia de carótida e eScore de cálcio estimado pela tomografia computadorizada em pacientes admitidos com infarto do miocárdio
2010Co-Authors: Alexandre, Álison Da SilvaAbstract:Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2010.Este trabalho estima a freqüência de pacientes manifestando um infarto agudo do miocárdio (IAM) que não seriam candidatos a terapia intensiva hipolipemiante, antes do IAM, de acordo com as diretrizes clínicas vigentes. Uma coorte prospectiva no Hospital de Base do Distrito Federal, Brasília, Brasil, acompanhou 355 pacientes consecutivos com diagnóstico de IAM com supra-desnivelamento do segmento ST (IAMcSST), e foi determinada, no momento da admissão hospitalar, a concentração plasmática de proteína C-reativa de alta sensibilidade (PCRas) e aplicadas as estratificações de risco cardiovascular: Framingham, PROCAM, Reynolds, ASSIGN, QRisk e Score. Também foram realizadas tomografias cardíacas computadorizadas e ultrassonografias de artérias carotídeas para estratificação de risco por meio do eScore de cálcio da artéria coronária (CAC), espessura das camadas íntima e média das artérias carótidas (cIMT) e a presença de placas ateroscleróticas carotídeas. Menos de 50% dos pacientes de IAMcSST seriam classificados como alto risco antes do infarto por quaisquer dos métodos. Com exceção do Framingham (9%), os demais algoritmos atribuiriam baixo risco à aproximadamente metade dos pacientes admitidos no estudo. A PCRas plasmática foi menor que 1 mg/L em 70% e maior que 2 mg/L em 14% dos pacientes. O cIMT médio foi 0,8 ± 0,2 mm e somente em 24% dos pacientes foi maior ou igual a 1,0 mm. Placas carotídeas foram encontradas em 74% dos pacientes. CAC ≥ 100 foi encontrado em 66% dos pacientes. Considerados simultaneamente, CAC ≥100 e presença de placa carotídea, uma condição de alto risco seria identificada em 100% dos pacientes. Em conclusão, mais da metade dos pacientes de IAMcSST não seriam consideradas como candidatos para a terapia preventiva intensiva pelos algoritmos clínicos atuais. A adição de parâmetros anatômicos tais como CAC e a presença de placas carotídeas pode substancialmente reduzir a subestimação do risco cardiovascular. _________________________________________________________________________________ ABSTRACTObjective: The study we assessed how often patients who are manifesting a myocardial infarction (MI) would not be considered candidates for intensive lipidlowering therapy based on the current guidelines. Methods: In 355 consecutive patients manifesting ST elevation MI (STEMI), admission plasma C-reactive protein (CRP) was measured and Framingham Risk Score (FRS), PROCAM Risk Score, Reynolds Risk Score, ASSIGN Risk Score, QRisk, and Score algorithms were applied. Cardiac computed tomography and carotid ultrasound were performed to assess the coronary artery calcium Score (CAC), carotid intima-media thickness (cIMT) and the presence of carotid plaques. Results: Less than 50% of STEMI patients would be identified as having high Risk before the event by any of these algorithms. With the exception of FRS (9%), all other algorithms would assign low Risk to about half of the enrolled patients. Plasma CRP was 2 mg/L in 14% of the patients. The average cIMT was 0.8±0.2mm and only in 24% of patients was ≥1.0mm. Carotid plaques were found in 74% of patients. CAC ≥100 was found in 66% of patients. Adding CAC ≥100 plus the presence of carotid plaque, a high-Risk condition would be identified in 100% of the patients using any of the above mentioned algorithms. Conclusion: More than half of patients manifesting STEMI would not be considered as candidates for intensive preventive therapy by the current clinical algorithms. The addition of anatomical parameters such as CAC and the presence of carotid plaques can substantially reduce the CVD Risk underestimation
Peter Willeit - One of the best experts on this subject based on the ideXlab platform.
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equalization of four cardiovascular Risk algorithms after systematic recalibration individual participant meta analysis of 86 prospective studies
European Heart Journal, 2019Co-Authors: Lisa Pennells, Stephen Kaptoge, Angela M Wood, Michael J Sweeting, Xiaohui Zhao, Ian R White, Stephen Burgess, Peter Willeit, Thomas BoltonAbstract: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 Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology. (Less)
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discrimination and net reclassification of cardiovascular Risk with lipoprotein a prospective 15 year outcomes in the bruneck study
Journal of the American College of Cardiology, 2014Co-Authors: Peter Willeit, Stefan Kiechl, Florian Kronenberg, Joseph L Witztum, Peter Santer, Manuel Mayr, Agnes Mayr, Johann Willeit, Sotirios TsimikasAbstract:Abstract Background Recent studies showed that lipoprotein(a) [Lp(a)] is a causal Risk factor for cardiovascular disease (CVD). However, whether Lp(a) modifies clinical Risk assessment was not established. Objectives This study was conducted to determine whether Lp(a) improves CVD Risk prediction. Methods In 1995, Lp(a) was measured in 826 men and women (age range, 45 to 84 years) from the general community. Incidence of CVD was recorded over 15 years of follow-up. Results In models adjusted for Framingham Risk Score (FRS) and Reynolds Risk Score (RRS) variables, the hazard ratio (HR) for incident CVD was 1.37 per 1-SD higher Lp(a) level (SD = 32 mg/dl) and 2.37 when comparing the top fifth quintile with other quintiles. The addition of Lp(a) to the RRS increased the C-index by 0.016. Of the 502 subjects who remained free of CVD, 82 were correctly reclassified to a lower Risk category and 49 were reclassified to a higher Risk category (predicted 15-year categories: Conclusions Elevated Lp(a) predicts 15-year CVD outcomes and improves CVD Risk prediction. These findings suggest that Lp(a) levels may be used in Risk assessment of subjects in the general community, particularly in intermediate-Risk groups.
Jessica E Harberer - One of the best experts on this subject based on the ideXlab platform.
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distribution and performance of cardiovascular Risk Scores in a mixed population of hiv infected and community based hiv uninfected individuals in uganda
Journal of Acquired Immune Deficiency Syndromes, 2018Co-Authors: Anthony N Muiru, Prossy Bibangambah, Linda C Hemphill, Ruth Sentongo, Kim Juneho, Virginia A Triant, David R Bangsberg, Alexander C Tsai, Jeffrey N Martin, Jessica E HarbererAbstract:BACKGROUND: The utility and validity of cardiovascular diseases (CVD) Risk Scores are not well studied in sub-Saharan Africa. We compared and correlated CVD Risk Scores with carotid intima media thickness (c-IMT) among HIV-infected and uninfected people in Uganda. METHODS: We first calculated CVD Risk using the (1) Framingham laboratory-based Score; (2) Framingham nonlaboratory Score (FRS-BMI); (3) Reynolds Risk Score; (4) American College of Cardiology and American Heart Association Score; and (5) the Data collection on Adverse Effects of Anti-HIV Drugs Score. We then compared absolute Risk Scores and Risk categories across each Score using Pearson correlation and kappa statistics, respectively. Finally, we fit linear regression models to estimate the strength of association between each Risk Score and c-IMT. RESULTS: Of 205 participants, half were females and median age was 49 years [interquartile range (IQR) 46-53]. Median CD4 count was 430 cells/mm (IQR 334-546), with median 7 years of antiretroviral therapy exposure (IQR 6.4-7.5). HIV-uninfected participants had a higher median systolic blood pressure (121 vs. 110 mm Hg), prevalent current smokers (18% vs. 4%, P = 0.001), higher median CVD Risk Scores (P 0.80). In linear regression models, we found significant correlations between increasing CVD Risk and higher c-IMT (P < 0.01 in all models). CONCLUSIONS: In this cross-sectional study from Uganda, the FRS-BMI correlated well with standard Risk Scores and c-IMT. HIV-uninfected individuals had higher Risk Scores than HIV-infected individuals, and the difference seemed to be driven by modifiable factors.
Christina M Dieliconwright - One of the best experts on this subject based on the ideXlab platform.
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aerobic and resistance exercise improves Reynolds Risk Score in overweight or obese breast cancer survivors
Cardio-oncology (London England), 2020Co-Authors: Kyuwan Lee, Debu Tripathy, Wendy Demarkwahnefried, Kerry S Courneya, Nathalie Sami, Mary K Norris, Christina M DieliconwrightAbstract:Breast cancer survivors have double the Risk of mortality from cardiovascular disease than age-matched women without a cancer history. Reynolds Risk Score (RRS) is a validated algorithm for the assessment of cardiovascular disease Risk. This secondary analysis sought to examine the effects of a 16-week aerobic and resistance exercise intervention on RRS in overweight or obese breast cancer survivors. One hundred overweight or obese (BMI > 25 kg/m2) breast cancer survivors were randomized to exercise or usual care. The exercise group underwent aerobic and resistance exercise sessions for 16 weeks. RRS was calculated using a validated equation. Group differences in mean change for RRS were evaluated using repeated-measures analyses of variance. Post-intervention, RRS was significantly reduced (7.9 ± 0.9% to 1.0 ± 0.5%; p < 0.001) in the exercise group compared to a significant increase (9.0 ± 0.8% to 11.6 ± 1.2%; p = 0.002%) in the usual care group (p < 0.01). RRS was significantly reduced in exercise vs usual care (between group difference, − 10.6; 95% CI, − 16.3 to − 7.4; p < 0.001). A 16-week aerobic and resistance exercise intervention is an effective approach to reduce the Risk of cardiovascular disease in breast cancer survivors. Exercise during cancer survivorship should be considered to reduce the Risk for cardiovascular disease Risk in overweight women breast cancer survivors. ClinicalTrials.gov: NCT01140282 . Registered 9 June 2010
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abstract p1 11 01 effect of aerobic and resistance exercise on Reynolds Risk Score in overweight or obese breast cancer survivors
Cancer Research, 2020Co-Authors: Kyuwan Lee, Debu Tripathy, Wendy Demarkwahnefried, Kerry S Courneya, Joanne E Mortimer, Christina M DieliconwrightAbstract:Background Breast cancer survivors have approximately double the Risk of mortality from cardiovascular disease than age-matched women without a cancer history. Reynolds Risk Score is a validated algorithm for the assessment of cardiovascular disease, which incorporates high sensitivity C-Reactive Protein (hsCRP), hemoglobin A1c (HbA1c), and parental history of myocardial infarction with traditional biomarkers including cholesterol, systolic blood pressure (SBP), and presence of diabetes. We previously demonstrated that exercise improves Framingham Risk Score (12.0±2.0 to 2.0±1.5), calculated by traditional Risk factors of cardiovascular disease, SBP (132.9±13.0 to 120.7±9.5 mmHg), high-density lipoprotein cholesterol (HDL-C; 43.1±6.6 to 64.7±7.8 mg/dL), and total cholesterol (TC; 196.5 ± 53.4 to 157.5 ± 37.1 mg/dL), in breast cancer survivors. This secondary analysis sought to examine the effects of a 16-week aerobic and resistance exercise intervention on Reynolds Risk Score in breast cancer survivors. Methods One hundred overweight or obese (BMI>25kg/m2) sedentary breast cancer survivors (stage I-III) who completed cancer treatment within 6 months prior to enrollment were randomized to the Exercise group (EX; n=50) or the Control (CON; n=50). The EX underwent supervised moderate-to-vigorous intensity aerobic and resistance exercise sessions 3 times/week for 16 weeks. The CON was asked to maintain their current level of activity. Reynolds Risk Score was calculated for each participant by assigning values for each of the following eight categories: age, SBP, TC, HDL-C, presence of diabetes; HbA1c, smoking status, hsCRP; and parental history of myocardial infarction. Within-group and between-group differences in mean change for individual outcomes measured at 16 weeks were evaluated using general linear models repeated-measures analyses of variance and mixed model repeated-measures analysis, respectively. Results Following the 16-week study period, Reynolds Risk Score was significantly reduced (8.3% to 0.9%), with improvements in hsCRP (3.4±0.6 to 2.3±0.3 mg/L), presence of diabetes (40 to 20%), and HbA1c (7.5±0.9 to 2.9±0.2%) in EX compared to CON (P 0.05). Conclusion A 16-week supervised aerobic and resistance exercise intervention is an effective approach to reduce the Risk of developing cardiovascular disease by reducing hsCRP, cholesterol, diabetes status, and SBP in breast cancer survivors. Participation in supervised exercise training during cancer survivorship should be considered to reduce the Risk for cardiovascular disease mortality in breast cancer survivors. Citation Format: Kyuwan Lee, Debu Tripathy, Wendy Demark-Wahnefried, Kerry Courneya, Joanne Mortimer, Christina Dieli-Conwright. Effect of aerobic and resistance exercise on Reynolds Risk Score in overweight or obese breast cancer survivors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-11-01.
Thomas Bolton - One of the best experts on this subject based on the ideXlab platform.
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equalization of four cardiovascular Risk algorithms after systematic recalibration individual participant meta analysis of 86 prospective studies
European Heart Journal, 2019Co-Authors: Lisa Pennells, Stephen Kaptoge, Angela M Wood, Michael J Sweeting, Xiaohui Zhao, Ian R White, Stephen Burgess, Peter Willeit, Thomas BoltonAbstract: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 Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology. (Less)