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

Thomas Sehestedt; Jørgen Jeppesen; Tine W Hansen; Kristian Wachtell; Hans Ibsen; Christian Torp-Petersen; Per Hildebrandt; Michael H Olsen; Thomas Sehestedt; Jørgen Lykke Jeppesen; Tine W Hansen; Kristian Wachtell; Hans Ibsen; Christian Torp-Pedersen; Per Hildebrandt; Michael H Olsen

doi:10.1093/eurheartj/ehp546

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

Thomas Sehestedt, Jørgen Jeppesen, Tine W Hansen, Kristian Wachtell, Hans Ibsen, Christian Torp-Petersen, Per Hildebrandt, Michael H Olsen, Thomas Sehestedt, Jørgen Lykke Jeppesen, Tine W Hansen, Kristian Wachtell, Hans Ibsen, Christian Torp-Pedersen, Per Hildebrandt, Michael H Olsen

186 Citations (Scopus)

Abstract

AimsIt is unclear whether subclinical vascular damage adds significantly to Systemic Coronary Risk Evaluation (SCORE) risk stratification in healthy subjects.Methods and resultsIn 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 ≥ 90th percentile [HR 3.3 (1.8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE ≥ 5 and 7.3 (3.2-16.1) for SCORE < 5]. Restricting primary prevention to subjects with SCORE ≥ 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 ≥ 5 to include subjects with 1 ≤ 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).ConclusionSubclinical organ damage predicted cardiovascular death independently of SCORE and the combination may improve risk prediction.

Original language	English
Journal	European Heart Journal
Volume	31
Issue number	7
Pages (from-to)	883-91
Number of pages	9
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehp546
Publication status	Published - 1 Apr 2010

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https://academic.oup.com/eurheartj/article-pdf/31/7/883/1190806/ehp546.pdf

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Sehestedt, T., Jeppesen, J., Hansen, T. W., Wachtell, K., Ibsen, H., Torp-Petersen, C., Hildebrandt, P., Olsen, M. H., Sehestedt, T., Jeppesen, J. L., Hansen, T. W., Wachtell, K., Ibsen, H., Torp-Pedersen, C., Hildebrandt, P., & Olsen, M. H. (2010). Risk prediction is improved by adding markers of subclinical organ damage to SCORE. European Heart Journal, 31(7), 883-91. https://doi.org/10.1093/eurheartj/ehp546

Sehestedt, T, Jeppesen, J, Hansen, TW, Wachtell, K, Ibsen, H, Torp-Petersen, C, Hildebrandt, P, Olsen, MH, Sehestedt, T, Jeppesen, JL, Hansen, TW, Wachtell, K, Ibsen, H, Torp-Pedersen, C, Hildebrandt, P & Olsen, MH 2010, 'Risk prediction is improved by adding markers of subclinical organ damage to SCORE', European Heart Journal, vol. 31, no. 7, pp. 883-91. https://doi.org/10.1093/eurheartj/ehp546

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title = "Risk prediction is improved by adding markers of subclinical organ damage to SCORE",

abstract = "AimsIt is unclear whether subclinical vascular damage adds significantly to Systemic Coronary Risk Evaluation (SCORE) risk stratification in healthy subjects.Methods and resultsIn 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 ≥ 90th percentile [HR 3.3 (1.8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE ≥ 5 and 7.3 (3.2-16.1) for SCORE < 5]. Restricting primary prevention to subjects with SCORE ≥ 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 ≥ 5 to include subjects with 1 ≤ 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).ConclusionSubclinical organ damage predicted cardiovascular death independently of SCORE and the combination may improve risk prediction.",

author = "Thomas Sehestedt and J{\o}rgen Jeppesen and Hansen, {Tine W} and Kristian Wachtell and Hans Ibsen and Christian Torp-Petersen and Per Hildebrandt and Olsen, {Michael H} and Thomas Sehestedt and Jeppesen, {J{\o}rgen Lykke} and Hansen, {Tine W} and Kristian Wachtell and Hans Ibsen and Christian Torp-Pedersen and Per Hildebrandt and Olsen, {Michael H}",

year = "2010",

month = apr,

day = "1",

doi = "10.1093/eurheartj/ehp546",

language = "English",

volume = "31",

pages = "883--91",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

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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 - AimsIt is unclear whether subclinical vascular damage adds significantly to Systemic Coronary Risk Evaluation (SCORE) risk stratification in healthy subjects.Methods and resultsIn 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 ≥ 90th percentile [HR 3.3 (1.8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE ≥ 5 and 7.3 (3.2-16.1) for SCORE < 5]. Restricting primary prevention to subjects with SCORE ≥ 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 ≥ 5 to include subjects with 1 ≤ 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).ConclusionSubclinical organ damage predicted cardiovascular death independently of SCORE and the combination may improve risk prediction.

AB - AimsIt is unclear whether subclinical vascular damage adds significantly to Systemic Coronary Risk Evaluation (SCORE) risk stratification in healthy subjects.Methods and resultsIn 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 ≥ 90th percentile [HR 3.3 (1.8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE ≥ 5 and 7.3 (3.2-16.1) for SCORE < 5]. Restricting primary prevention to subjects with SCORE ≥ 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 ≥ 5 to include subjects with 1 ≤ 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).ConclusionSubclinical 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

SN - 0195-668X

VL - 31

SP - 883

EP - 891

JO - European Heart Journal

JF - European Heart Journal

IS - 7

ER -

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

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