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 risk markers (both individual and combined) for gender-specific cardiovascular risk stratification on top of traditional risk factors in a middle-aged population-based cohort. Carotid-plaques, IMT (intima–media thickness), ABI (ankle–brachial index), PWV (pulse–wave velocity), AIx (augmentation index), CAP (central augmented pressure) and CSP (central-systolic pressure) were measured in 1367 CVD (cardiovascular disease)-free participants aged 50–70 years old. Cardiovascular events were validated after a mean follow-up of 3.8 years. AUC (area-under-the-curve) and NRI (net reclassification improvement) analyses (total-NRI for all and clinical-NRI for intermediate-risk groups) were used to determine the additive value of individual and combined risk markers. Cardiovascular events occurred in 32 women and 39 men. Traditional cardiovascular risk factors explained 6.2% and 12.5% of the variance in CVD in women and men respectively. AUCs did not substantially increase by adding individual or combined non-invasive risk markers. Individual risk markers only improved reclassification in intermediate-risk women and more than in men; clinical-NRIs ranged between 48.0 and 173.1% in women and 8.9 and 20% in men. Combined non-invasive-risk markers improved reclassification in all women and even more in those at intermediate risk; ‘IMT-presence-thickness-of-plaques’ showed largest reclassification [total-NRI=33.8%, P=0.012; IDI (integrated-discrimination-improvement)=0.048, P=0.066; clinical-NRI=168.0%]. In men, combined non-invasive risk markers improved reclassification only in those at intermediate risk; ‘PWV-AIx-CSP-CAP-IMT’ showed the 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 combinations and in women at intermediate risk also by adding individual non-invasive risk markers. The additive value of individual and combined non-invasive risk markers in men is limited to men at intermediate risk only, and to a lesser extent than in women.
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Research Article|
September 19 2013
Combining risk markers improves cardiovascular risk prediction in women
Suzanne Holewijn;
*Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
Correspondence: Dr Suzanne Holewijn (email [email protected]).
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Martin den Heijer;
Martin den Heijer
1
‡Department of Urology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Lambertus A. Kiemeney;
Lambertus A. Kiemeney
†Department of Health Evidence, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
‡Department of Urology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Anton F. H. Stalenhoef;
Anton F. H. Stalenhoef
*Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Jacqueline de Graaf
Jacqueline de Graaf
*Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Publisher: Portland Press Ltd
Received:
April 02 2013
Revision Received:
July 08 2013
Accepted:
July 24 2013
Accepted Manuscript online:
July 24 2013
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2014 Biochemical Society
2014
Clin Sci (Lond) (2014) 126 (2): 139–146.
Article history
Received:
April 02 2013
Revision Received:
July 08 2013
Accepted:
July 24 2013
Accepted Manuscript online:
July 24 2013
Citation
Suzanne Holewijn, Martin den Heijer, Lambertus A. Kiemeney, Anton F. H. Stalenhoef, Jacqueline de Graaf; Combining risk markers improves cardiovascular risk prediction in women. Clin Sci (Lond) 1 January 2014; 126 (2): 139–146. doi: https://doi.org/10.1042/CS20130178
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