OA Epidemiology

Combined Measures of Atherosclerosis Improve Cardiovascular Risk Prediction in Women

Proceedings of the 2013 annual meeting of the Netherlands Epidemiology Society

Volume 1 Issue S1 Abstract 39


S. Holewijn, Radboud University, Nijmegen, the Netherlands
M. den Heijer, VU Medical Centre, Amsterdam, the Netherlands
L.A. Kiemeney, VU Medical Centre/Radboud University, the Netherlands
A.F.H. Stalenhoef, Radboud University, Nijmegen, the Netherlands
J. de Graaf, Radboud University, Nijmegen, the Netherlands

Cardiovascular risk stratification could be improved by adding measures of atherosclerosis to current risk scores, especially in intermediate risk individuals. We prospectively evaluated the additive value of different non-invasive measurements of atherosclerosis(NIMA)(both individual and combined) for gender-specific CV risk stratification on top of traditional risk factors in a middle-aged population-based cohort in order to improve cardiovascular risk stratification.

Carotid plaques, intima-media-thickness(IMT), ankle-brachial-index(ABI), pulse-wave- velocity(PWV), augmentation-index(AIx), central-augmented-pressure(CAP), and central- diastolic-pressure(CDP) were measured in 1367 cardiovascular  disease(CVD) free participants aged 50-70 years. Cardiovascular events were validated after a mean follow-up of 3.8 years. Area-under-the-curve(AUC) and net-reclassification-improvement-analyses (total-NRI for all risk groups and clinical-NRI for intermediate-risk) were used to determine the additive value of individual- and combined-NIMA.

Cardiovascular events occurred in 32 women and 39 men. Cardiovascular risk factors explained 6.2% and 12.5% of the variance in cardiovascular disease in women and men, respectively. AUC’s did not substantially increase by adding individual- or combined-NIMA. Individual-NIMA only improved reclassification in intermediate-risk women more than in men; clinical-NRI’s ranged between 48.0%-173.1% and 8.9%-20%, respectively. Combined- NIMA improved reclassification in all women, and even more in intermediate-risk; “IMT- presence-thickness-of-plaques” showed largest reclassification(total-NRI=33.8%,p=0.012; IDI=0.048,p=0.066; clinical-NRI=168.0%). In men, combined-NIMA improved reclassification only in those at intermediate-risk; “PWV-AIx-CSP-CAP-IMT” showed largest reclassification (total-NRI=14.5%,p=0.087; IDI=0.016,p=0.148;clinical-NRI=46.0%).

In all women cardiovascular risk stratification improved by adding combined-NIMA and in women at intermediate risk also by adding individual-NIMA. The additive value of individual- and combined-NIMA in men is limited to men at intermediate risk only, and to a lesser extent than in women.

Published: 06 Jun, 2013

Licensee OA Publishing London 2013. Creative Commons Attribution License (CC-BY)