A new score for improving cardiovascular risk prediction and prevention

Rosaria Del Giorno; Maud Reveilhac; Iris Stauffer; Maud Berthoud; Lucia Mazzolai; Michèle Depairon; Roger Darioli

doi:10.1016/j.numecd.2023.04.019

A new score for improving cardiovascular risk prediction and prevention

Nutr Metab Cardiovasc Dis. 2023 Aug;33(8):1546-1555. doi: 10.1016/j.numecd.2023.04.019. Epub 2023 May 3.

Authors

Rosaria Del Giorno¹, Maud Reveilhac², Iris Stauffer³, Maud Berthoud⁴, Lucia Mazzolai⁵, Michèle Depairon⁶, Roger Darioli⁷

Affiliations

¹ Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland. Electronic address: rosaria.del-giorno@chuv.ch.
² Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland. Electronic address: maudreve@hotmail.fr.
³ Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland. Electronic address: iris.stauffer@bluewin.ch.
⁴ Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland. Electronic address: berthoud.maud@hin.ch.
⁵ Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland. Electronic address: Lucia.Mazzolai@chuv.ch.
⁶ Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland. Electronic address: reveilhac-depairon@bluewin.ch.
⁷ University of Lausanne, Lausanne, Switzerland. Electronic address: roger.darioli@unisante.ch.

PMID: 37270305
DOI: 10.1016/j.numecd.2023.04.019

Abstract

Background and aims: The ultrasonographic detection of subclinical atherosclerosis (scATS) at carotid and femoral vascular sites using the atherosclerosis burden score (ABS) improves the risk stratification for atherosclerotic cardiovascular disease beyond traditional cardiovascular (CV) risk factors. However, its predictive value should be further enhanced. We hypothesize that combining the ABS and the Framingham risk score (FHRS) to create a new score called the FHRABS will improve CV risk prediction and prevention. We aim to investigate if incorporating the ABS into the FHRS improved CV risk prediction in a primary prevention setting.

Methods and results: 1024 patients were included in this prospective observational cohort study. Carotid and femoral plaques were ultra-sonographic detected. Major incident cardiovascular events (MACEs) were collected. The receiver operating characteristic curve (ROC-AUC) and Youden's index (Ysi) were used to compare the incremental contributions of each marker to predict MACEs. After a median follow-up of 6.0 ± 3.3 years, 60 primary MACEs (5.8%) occurred. The ROC-AUC for MACEs prediction was significantly higher for the FHRABS (0.74, p < 0.024) and for the ABS (0.71, p < 0.013) compared to the FHRS alone (0.71, p < 0.46). Ysi or the FHRABS (42%, p < 0.001) and ABS (37%, p < 0.001) than for the FHRS (31%). Cox proportional-hazard models showed that the CV predictive performance of FHRS was significantly enhanced by the ABS (10.8 vs. 5.5, p < 0.001) and FHRABS (HR 23.30 vs. 5.50, p < 0.001).

Conclusions: FHRABS is a useful score for improving CV risk stratification and detecting patients at high risk of future MACEs. FHRABS offers a simple-to-use, and radiation-free score with which to detect scATS in order to promote personalized CV prevention.

Keywords: Arterial ultrasound; Atherosclerosis; Cardiovascular prevention; Cardiovascular risk factor; Cardiovascular risk prediction; Carotid and femoral plaques.

Publication types

Observational Study

MeSH terms

Atherosclerosis*
Cardiovascular Diseases* / diagnostic imaging
Cardiovascular Diseases* / epidemiology
Carotid Intima-Media Thickness
Heart Disease Risk Factors
Humans
Prospective Studies
Risk Assessment
Risk Factors