Key result
Expanded vascular risk score predicts 10-year event-free survival declining from ~95% to 56% across quartiles.
Why the study?
Few cardiovascular risk models predict global vascular risk including MI, stroke, or vascular death in multi-ethnic individuals and fully incorporate behavioral risk factors.
Does a global vascular risk score incorporating behavioral and anthropometric factors improve prediction of stroke, myocardial infarction, or vascular death compared to traditional Framingham variables in a multi-ethnic primary prevention cohort?
Cohort (n=2,737)
Does a global vascular risk score incorporating behavioral and anthropometric factors improve prediction of stroke, myocardial infarction, or vascular death compared to traditional Framingham variables in a multi-ethnic primary prevention cohort?
Answers are grounded in this paper and cite their sources.
Integrating behavioral factors such as waist circumference, alcohol consumption, and physical activity with traditional cardiovascular risk factors improves global vascular risk prediction in a multi-ethnic population.
Objective To improve global vascular risk prediction with behavioral and anthropometric factors. Background Few cardiovascular risk models are designed to predict the global vascular risk of MI, stroke, or vascular death in multi-ethnic individuals, and existing schemes do not fully include behavioral risk factors. Methods A randomly-derived, population-based, prospective cohort of 2737 community participants free of stroke and coronary artery disease were followed annually for a median of 9.0 years in the Northern Manhattan Study (mean age 69 years; 63.2% women; 52.7% Hispanic, 24.9% African-American, 19.9% white). A global vascular risk score (GVRS) predictive of stroke, myocardial infarction, or vascular death was developed by adding variables to the traditional Framingham cardiovascular variables based on the likelihood ratio criterion. Model utility was assessed through receiver operating characteristics, calibration, and effect on reclassification of subjects. Results Variables which significantly added to the traditional Framingham profile included waist circumference, alcohol consumption, and physical activity. Continuous measures for blood pressure and fasting blood sugar were used instead of hypertension and diabetes. Ten -year event-free probabilities were 0.95 for the first quartile of GVRS, 0.89 for the second quartile, 0.79 for the third quartile, and 0.56 for the fourth quartile. The addition of behavioral factors in our model improved prediction of 10 -year event rates compared to a model restricted to the traditional variables. Conclusion A global vascular risk score that combines both traditional, behavioral, and anthropometric risk factors, uses continuous variables for physiological parameters, and is applicable to non-white subjects could improve primary prevention strategies.
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Sacco et al. (2009) conducted a cohort in Primary prevention (free of stroke and coronary artery disease) (n=2,737). Global vascular risk score (GVRS) including behavioral and anthropometric factors vs. Traditional Framingham cardiovascular variables was evaluated on Stroke, myocardial infarction, or vascular death. A global vascular risk score adding behavioral factors to traditional ones predicted 10-year event-free probabilities of 0.95 to 0.56 from the first to fourth quartiles.
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