Heartscore calculated in individuals younger than 40 years is related to vascular markers of early atherosclerosis

Abstract

Background

Heartscore is not well validated for individuals less than 40 years of age. In the latest guidelines a relative risk chart is provided with the proposal to be used for young adults aged less than 60 years instead of projecting risk at the age of 60 years. Moreover, coronary artery disease is insidiously manifested in younger patients.

Design

Cross-sectional study.

Methods

Two hundred and two young Greeks of age less than 40 years and 232 middle-aged adults aged 40–60 years without clinically overt cardiovascular disease or diabetes were consecutively recruited. Flow-mediated dilatation of the brachial artery, carotid, and femoral intima media thickness (IMT), carotid-radial and carotid-femoral pulse wave velocity (PWV) were measured in all individuals in one session. The European Society of Cardiology online Heartscore calculator was used for mortality risk (MR) 60 and Systematic Coronary Risk Evaluation risk charts for relative risk (RR) computation.

Results

MR60 in the younger significantly correlated with all measured vascular markers whereas RR significantly correlated with carotid IMT. By multivariate regression analysis, MR60 was a stronger identifier than RR for PWV, mean carotid and femoral IMT in both groups. Young adults (<40 years) with a high MR60 (>5%) had significantly higher carotid-radial PWV, carotid and femoral IMT whereas those with a high RR (>3rd tertile) had significantly higher carotid IMT.

Conclusion

MR60 was a stronger identifier of most of the measured markers of early atherosclerosis as compared with RR. These data support Heartscore as a prognostic tool in terms of primary prevention for participants younger than 40 years old. Eur J Cardiovasc Prev Rehabil 15:619–624 © 2008 The European Society of Cardiology

Keywords

cardiovascular risk endothelial function primary prevention vascular function

Get full access to this article

View all access options for this article.

References

Kannel

. Contributions of the Framingham study to the conquest of coronary artery disease. Am J Cardiol 1988; 62:1109–1112.

Graham

. Guidelines on cardiovascular prevention in clinical practice: the European perspective. Curr Opin Cardiol 2005; 20:430–439.

Thomsen

. HeartScore: a new web-based approach to European cardiovascular disease risk management. Eur J Cardiovasc Prev Rehab 2005; 12:424–426.

Panagiotakos

Fitzgerald

Pitsavos

Pipilis

Graham

Stefanadis

. Statistical modelling of 10-year fatal cardiovascular disease risk in Greece: the HellenicSCORE (a calibration of the ESC SCORE project). Hellenic J Cardiol 2007; 48:55–63.

Graham

Atar

Borch-Johnsen

Boysen

Burell

Cifkova

European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other Societies on Cardiovascular Disease Prevention in Clinical Practice

Eur J Cardiovasc Prev Rehab 2007; 14 (Suppl 2):1–9.

De Backer

Ambrosioni

Borch-Johnsen

Brotons

Cifkova

Dallongeville

Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2003; 24:1601–1610.

Fournier

Sanchez

Quero

Fernandez-Cortacero

Gonzalez-Barrero

. Myocardial infarction in men aged 40 years or less: a prospective clinical-angiographic study. Clin Cardiol 1996; 19:631–636.

Chen

Chester

Kaski

. Clinical factors and angiographic features associated with premature coronary artery disease. Chest 1995; 108:364–369.

Strong

Malcom

McMahan

Tracy

Newman

3rd Herderick

Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the pathobiological determinants of atherosclerosis in youth study. J Am Med Assoc 1999; 281:727–735.

10.

Cohn

Quyyumi

Hollenberg

Jamerson

. Surrogate markers for cardiovascular disease: functional markers Circulation 2004; 109 (Suppl 1):IV31–IV46.

11.

Mancini

Dahlöf

Diez

. Surrogate markers for cardiovascular disease: structural markers Circulation 2004; 109 (Suppl 1):IV22–IV30.

12.

Lee

Shim

Lee

. Association between brachial-ankle pulse wave velocity and cardiovascular risk factors in healthy adolescents. J Pediatr 2007; 150:247–251.

13.

Azra

Feely

. Effect of smoking on arterial stiffness and pulse pressure amplification. Hypertension 2003; 41:183–187.

14.

Raitakari

Juonala

Kähönen

Taittonen

Laitinen

Mäki-Torkko

Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood. The cardiovascular risk in young finns study. J Am Med Assoc 2003; 290:2277–2283.

15.

Patel

Celermajer

. Assessment of vascular disease using flow mediated dilatation Pharmacol Rep 2006; 56 (Suppl):3–7I.

16.

Nurnberger

Keflioglu-Scheiber

Opazo Saezb

Wenzel

Philipp

Schafers

. Augmentation index is associated with cardiovascular risk. J Hypert 2002; 20:2407–2414.

17.

Van Trijp

MJCA

Bosb

WJW

Van der Schouwa

Muller

Grobbee

Bots

. Non-invasively measured structural and functional arterial characteristics and coronary heart disease risk in middle aged and elderly men. Atherosclerosis 2006; 187:110–115.

18.

Stamatelopoulos

Kalpakos

Protogerou

Papamichael

Ikonomidis

Tsitsirikos

The combined effect of augmentation index and carotid intima-media thickness on cardiovascular risk in young and middle-aged men without cardiovascular disease

J Hum Hypert 2006; 1–7.

19.

Celermajer

Sorensen

Gooch

Spiegelhalter

Miller

Sullivan

Non invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340:1111–1115.

20.

Khoury

Schwartz

Gottlieb

Chenzbraun

Stern

Keren

. Relation of coronary artery disease to atherosclerotic disease in the aorta, carotid and femoral arteries evaluated by ultrasound. Am J Cardiol 1997; 80:1429–1433.

21.

Nichols

O'Rourke

. Properties of the arterial wall. In: Arnold

Edward

, editor. McDonalds' Blood flow in arteries. Theoretical, experimental and clinical principles, 5th Edition. New York: Oxford University Press Inc.; 2005. pp. 80–82.

22.

Kieltyka

Urbina

Tang

Bond

Srinivasan

Berenson

. Framingham risk score is related to carotid artery intima-media thickness in both white and black young adults: the Bogalusa Heart Study. Atherosclerosis 2003; 170:125–130.

23.

Conroy

Pyörälä

Fitzgerald

Sans

Menotti

De Backer

Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project; SCORE project group. Eur Heart J 2003; 24:987–1003.