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- Publisher Website: 10.1136/pgmj.2007.064089
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Article: Incremental predictive value of vascular assessments combined with the Framingham Risk Score for prediction of coronary events in subjects of low-intermediate risk
Title | Incremental predictive value of vascular assessments combined with the Framingham Risk Score for prediction of coronary events in subjects of low-intermediate risk |
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Authors | |
Issue Date | 2008 |
Publisher | B M J Publishing Group. The Journal's web site is located at http://www.postgradmedj.com |
Citation | Postgraduate Medical Journal, 2008, v. 84 n. 989, p. 153-157 How to Cite? |
Abstract | Background: In patients with low-intermediate risk, the use of the Framingham Risk Score (FRS) may not allow accurate prediction of the occurrence of coronary events. Objective: To determine whether non-invasive vascular sonographic assessments add value to the FRS for prediction of coronary events. Methods: Brachial artery flow-mediated dilatation (FMD), carotid intima-media thickness (IMT) and the presence of carotid plaque in 70 male subjects (mean (SD) age 62 (9) years) with a low-intermediate FRS who presented with a recent coronary event were evaluated and compared with those in 35 male controls matched for age (mean age 60 (9) years). Results: Patients with a recent coronary event had a significantly higher FRS than controls. They had a significantly lower FMD (3.56 (2.41)% vs 5.18 (2.69)%, p = 0.003) and significantly higher prevalence of carotid plaque (67% vs 40%, p = 0.008), but there was no significant difference in mean maximum IMT between the two groups (1.01 (0.28) vs 0.96 (0.14) mm, p = 0.32). Multivariate analysis revealed that FMD ≤ 4.75% was an independent predictor of an acute coronary event. Of the three vascular markers, FMD ≤ 4.75% and presence of carotid plaque provided the best diagnostic accuracy for a coronary event, with area under the curve (AUC) of 0.70 and 0.64 (p = 0.001 and p = 0.033), respectively, based on receiver operating characteristic curve analysis. Furthermore, incorporating carotid plaque or FMD ≤ 4.75% into the FRS (AUC = 0.72 and AUC = 0.78) provided incremental benefit in risk stratification over FRS alone (AUC = 0.66) (p = 0.008 and p = 0.007, for comparison of difference in two receiver operating characteristic curves). Conclusions: Incorporating a measure of FMD or carotid plaque burden with FRS significantly increases the accuracy of predicting coronary events in subjects of low-intermediate risk and hence should be considered as additional investigations to improve coronary risk assessment. |
Persistent Identifier | http://hdl.handle.net/10722/57513 |
ISSN | 2023 Impact Factor: 3.6 2023 SCImago Journal Rankings: 0.876 |
ISI Accession Number ID | |
References |
DC Field | Value | Language |
---|---|---|
dc.contributor.author | Lau, KK | en_HK |
dc.contributor.author | Chan, YH | en_HK |
dc.contributor.author | Yiu, KH | en_HK |
dc.contributor.author | Tam, S | en_HK |
dc.contributor.author | Li, SW | en_HK |
dc.contributor.author | Lau, CP | en_HK |
dc.contributor.author | Tse, HF | en_HK |
dc.date.accessioned | 2010-04-12T01:38:53Z | - |
dc.date.available | 2010-04-12T01:38:53Z | - |
dc.date.issued | 2008 | en_HK |
dc.identifier.citation | Postgraduate Medical Journal, 2008, v. 84 n. 989, p. 153-157 | en_HK |
dc.identifier.issn | 0032-5473 | en_HK |
dc.identifier.uri | http://hdl.handle.net/10722/57513 | - |
dc.description.abstract | Background: In patients with low-intermediate risk, the use of the Framingham Risk Score (FRS) may not allow accurate prediction of the occurrence of coronary events. Objective: To determine whether non-invasive vascular sonographic assessments add value to the FRS for prediction of coronary events. Methods: Brachial artery flow-mediated dilatation (FMD), carotid intima-media thickness (IMT) and the presence of carotid plaque in 70 male subjects (mean (SD) age 62 (9) years) with a low-intermediate FRS who presented with a recent coronary event were evaluated and compared with those in 35 male controls matched for age (mean age 60 (9) years). Results: Patients with a recent coronary event had a significantly higher FRS than controls. They had a significantly lower FMD (3.56 (2.41)% vs 5.18 (2.69)%, p = 0.003) and significantly higher prevalence of carotid plaque (67% vs 40%, p = 0.008), but there was no significant difference in mean maximum IMT between the two groups (1.01 (0.28) vs 0.96 (0.14) mm, p = 0.32). Multivariate analysis revealed that FMD ≤ 4.75% was an independent predictor of an acute coronary event. Of the three vascular markers, FMD ≤ 4.75% and presence of carotid plaque provided the best diagnostic accuracy for a coronary event, with area under the curve (AUC) of 0.70 and 0.64 (p = 0.001 and p = 0.033), respectively, based on receiver operating characteristic curve analysis. Furthermore, incorporating carotid plaque or FMD ≤ 4.75% into the FRS (AUC = 0.72 and AUC = 0.78) provided incremental benefit in risk stratification over FRS alone (AUC = 0.66) (p = 0.008 and p = 0.007, for comparison of difference in two receiver operating characteristic curves). Conclusions: Incorporating a measure of FMD or carotid plaque burden with FRS significantly increases the accuracy of predicting coronary events in subjects of low-intermediate risk and hence should be considered as additional investigations to improve coronary risk assessment. | en_HK |
dc.language | eng | en_HK |
dc.publisher | B M J Publishing Group. The Journal's web site is located at http://www.postgradmedj.com | en_HK |
dc.relation.ispartof | Postgraduate Medical Journal | en_HK |
dc.rights | Postgraduate Medical Journal. Copyright © B M J Publishing Group. | en_HK |
dc.subject.mesh | Brachial Artery - pathology | en_HK |
dc.subject.mesh | Carotid Arteries - pathology | en_HK |
dc.subject.mesh | Coronary Artery Disease - pathology | en_HK |
dc.subject.mesh | Tunica Intima - pathology | en_HK |
dc.subject.mesh | Case-Control Studies | en_HK |
dc.title | Incremental predictive value of vascular assessments combined with the Framingham Risk Score for prediction of coronary events in subjects of low-intermediate risk | en_HK |
dc.type | Article | en_HK |
dc.identifier.openurl | http://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0032-5473&volume=84&issue=989&spage=153&epage=157&date=2008&atitle=Incremental+predictive+value+of+vascular+assessments+combined+with+the+Framingham+Risk+Score+for+prediction+of+coronary+events+in+subjects+of+low-intermediate+risk | en_HK |
dc.identifier.email | Lau, KK:gkklau@hku.hk | en_HK |
dc.identifier.email | Chan, YH:chanwill@hku.hk | en_HK |
dc.identifier.email | Yiu, KH:khkyiu@hku.hk | en_HK |
dc.identifier.email | Tse, HF:hftse@hkucc.hku.hk | en_HK |
dc.identifier.authority | Lau, KK=rp01499 | en_HK |
dc.identifier.authority | Chan, YH=rp01313 | en_HK |
dc.identifier.authority | Yiu, KH=rp01490 | en_HK |
dc.identifier.authority | Tse, HF=rp00428 | en_HK |
dc.description.nature | published_or_final_version | en_HK |
dc.identifier.doi | 10.1136/pgmj.2007.064089 | en_HK |
dc.identifier.pmid | 18372487 | - |
dc.identifier.scopus | eid_2-s2.0-41849116681 | en_HK |
dc.identifier.hkuros | 140856 | - |
dc.relation.references | http://www.scopus.com/mlt/select.url?eid=2-s2.0-41849116681&selection=ref&src=s&origin=recordpage | en_HK |
dc.identifier.volume | 84 | en_HK |
dc.identifier.issue | 989 | en_HK |
dc.identifier.spage | 153 | en_HK |
dc.identifier.epage | 157 | en_HK |
dc.identifier.eissn | 1469-0756 | - |
dc.identifier.isi | WOS:000254388300008 | - |
dc.publisher.place | United Kingdom | en_HK |
dc.identifier.scopusauthorid | Lau, KK=22635159600 | en_HK |
dc.identifier.scopusauthorid | Chan, YH=22633700600 | en_HK |
dc.identifier.scopusauthorid | Yiu, KH=35172267800 | en_HK |
dc.identifier.scopusauthorid | Tam, S=7202037323 | en_HK |
dc.identifier.scopusauthorid | Li, SW=13807028100 | en_HK |
dc.identifier.scopusauthorid | Lau, CP=7401968501 | en_HK |
dc.identifier.scopusauthorid | Tse, HF=7006070805 | en_HK |
dc.identifier.issnl | 0032-5473 | - |