TY - JOUR

T1 - Risk prediction is improved by adding markers of subclinical organ damage to SCORE

AU - Sehestedt, Thomas

AU - Jeppesen, Jørgen

AU - Hansen, Tine W

AU - Wachtell, Kristian

AU - Ibsen, Hans

AU - Torp-Petersen, Christian

AU - Hildebrandt, Per

AU - Olsen, Michael H

AU - Sehestedt, Thomas

AU - Jeppesen, Jørgen Lykke

AU - Hansen, Tine W

AU - Wachtell, Kristian

AU - Ibsen, Hans

AU - Torp-Pedersen, Christian

AU - Hildebrandt, Per

AU - Olsen, Michael H

PY - 2010/4/1

Y1 - 2010/4/1

N2 - AIMS: It is unclear whether subclinical vascular damage adds significantly to Systemic Coronary Risk Evaluation (SCORE) risk stratification in healthy subjects. METHODS AND RESULTS: In a population-based sample of 1968 subjects without cardiovascular disease or diabetes not receiving any cardiovascular, anti-diabetic, or lipid-lowering treatment, aged 41, 51, 61, or 71 years, we measured traditional cardiovascular risk factors, left ventricular (LV) mass index, atherosclerotic plaques in the carotid arteries, carotid/femoral pulse wave velocity (PWV), and urine albumin/creatinine ratio (UACR) and followed them for a median of 12.8 years. Eighty-one subjects died because of cardiovascular causes. Risk of cardiovascular death was independently of SCORE associated with LV hypertrophy [hazard ratio (HR) 2.2 (95% CI 1.2-4.0)], plaques [HR 2.5 (1.6-4.0)], UACR > or = 90th percentile [HR 3.3 (1.8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE > or = 5% and 7.3 (3.2-16.1) for SCORE < 5%]. Restricting primary prevention to subjects with SCORE > or = 5% as well as subclinical organ damage, increased specificity of risk prediction from 75 to 81% (P < 0.002), but reduced sensitivity from 72 to 65% (P = 0.4). Broaden primary prevention from subjects with SCORE > or = 5% to include subjects with 1% < or = SCORE < 5% together with subclinical organ damage increased sensitivity from 72 to 89% (P = 0.006), but reduced specificity from 75 to 57% (P < 0.002) and positive predictive value from 11 to 8% (P = 0.07). CONCLUSION: Subclinical organ damage predicted cardiovascular death independently of SCORE and the combination may improve risk prediction.

AB - AIMS: It is unclear whether subclinical vascular damage adds significantly to Systemic Coronary Risk Evaluation (SCORE) risk stratification in healthy subjects. METHODS AND RESULTS: In a population-based sample of 1968 subjects without cardiovascular disease or diabetes not receiving any cardiovascular, anti-diabetic, or lipid-lowering treatment, aged 41, 51, 61, or 71 years, we measured traditional cardiovascular risk factors, left ventricular (LV) mass index, atherosclerotic plaques in the carotid arteries, carotid/femoral pulse wave velocity (PWV), and urine albumin/creatinine ratio (UACR) and followed them for a median of 12.8 years. Eighty-one subjects died because of cardiovascular causes. Risk of cardiovascular death was independently of SCORE associated with LV hypertrophy [hazard ratio (HR) 2.2 (95% CI 1.2-4.0)], plaques [HR 2.5 (1.6-4.0)], UACR > or = 90th percentile [HR 3.3 (1.8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE > or = 5% and 7.3 (3.2-16.1) for SCORE < 5%]. Restricting primary prevention to subjects with SCORE > or = 5% as well as subclinical organ damage, increased specificity of risk prediction from 75 to 81% (P < 0.002), but reduced sensitivity from 72 to 65% (P = 0.4). Broaden primary prevention from subjects with SCORE > or = 5% to include subjects with 1% < or = SCORE < 5% together with subclinical organ damage increased sensitivity from 72 to 89% (P = 0.006), but reduced specificity from 75 to 57% (P < 0.002) and positive predictive value from 11 to 8% (P = 0.07). CONCLUSION: Subclinical organ damage predicted cardiovascular death independently of SCORE and the combination may improve risk prediction.

U2 - 10.1093/eurheartj/ehp546

DO - 10.1093/eurheartj/ehp546

M3 - Journal article

C2 - 20034972

VL - 31

SP - 883

EP - 891

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 7

ER -