Key result
FHRABS improves MACE prediction over Framingham score alone, linked to ~23-fold higher risk.
Why the study?
Although the atherosclerosis burden score improves cardiovascular risk stratification beyond traditional risk factors, whether combining it with the Framingham risk score enhances risk prediction in primary prevention is unknown.
Does the FHRABS score improve prediction of MACEs compared to FHRS alone in patients in a primary prevention setting?
Cohort (n=1,024)
No
Does the FHRABS score improve prediction of MACEs compared to FHRS alone in patients in a primary prevention setting?
Hazard Ratio: 23.3
p-value: p=<0.001
Combining ultrasonographic atherosclerosis burden score with the Framingham risk score significantly improves cardiovascular risk prediction in primary prevention.
May improve MACE prediction in primary prevention; extends Framingham score in observational data but leaves open clinical impact.
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.
No takes yet. Share an insight, caveat, or question.
Giorno et al. (2023) conducted a cohort in Cardiovascular risk prediction in primary prevention (n=1,024). FHRABS (Framingham risk score + atherosclerosis burden score) vs. FHRS (Framingham risk score) alone was evaluated on Major incident cardiovascular events (MACEs) (HR 23.30, p=<0.001). The FHRABS score, combining the atherosclerosis burden score with the Framingham risk score, significantly improved the prediction of major cardiovascular events compared to the Framingham risk score alone (HR 23.30 vs 5.50).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: