Article

As cardiovascular disease (CVD) is one of the most common causes of
mortality worldwide, much interest has been focused on reliable methods to
predict cardiovascular risk. DESIGN: A cross-sectional, population-based
screening study with 17-year follow-up in Southern Sweden. METHODS: We compared a
non-laboratory, consultation-based risk assessment method comprising age, sex,
present smoking, prevalent diabetes or hypertension at baseline, blood pressure
(systolic > or =140 or diastolic > or =90), waist/height ratio and family history
of CVD to Systemic COronary Risk Evaluation (SCORE) and a third model including
several laboratory analyses, respectively, in predicting CVD risk. The study
included clinical baseline data on 689 participants aged 40-59 years without CVD.
Blood samples were analyzed for blood glucose, serum lipids, insulin,
insulin-like growth factor-I, insulin-like growth factor binding protein-1,
C-reactive protein, asymmetric dimethyl arginine and symmetric dimethyl arginine.
During 17 years, the incidence of total CVD (first event) and death was
registered. RESULTS: A non-laboratory-based risk assessment model, including
variables easily obtained during one consultation visit to a general
practitioner, predicted cardiovascular events as accurately [hazard ratio (HR):
2.72; 95% confidence interval (CI): 2.18-3.39, P<0.001] as the established SCORE
algorithm (HR: 2.73; 95% CI: 2.10-3.55, P<0.001), which requires laboratory
testing. Furthermore, adding a combination of sophisticated laboratory
measurements covering lipids, inflammation and endothelial dysfunction, did not
confer any additional value to the prediction of CVD risk (HR: 2.72; 95% CI:
2.19-3.37, P<0.001). The c-statistics for the consultation model (0.794; 95% CI:
0.762-0.823) was not significantly different from SCORE (0.767; 95% CI:
0.733-0.798, P=0.12) or the extended model (0.806; 95% CI: 0.774-0.835, P=0.55).
CONCLUSION: A risk algorithm based on non-laboratory data from a single primary
care consultation predicted long-term cardiovascular risk as accurately as either
SCORE or an elaborate laboratory-based method in a defined middle-aged
population.

Langue : ANGLAIS

Tiré à part : OUI