[Assessment of the application of atherosclerotic disease risk scores in the workplace].

Abstract

Objective: In occupational health activities in Japan, evaluating workers' fitness for work following health checkups is a primary task. Health checkups are used to identify workers at high risk of cerebrovascular and cardiovascular diseases and conduct fit-for-work evaluations. However, identifying high-risk individuals based on a single risk factor may overlook those with multiple risk factors who have a high risk of developing cerebrovascular and cardiovascular diseases. Presently, we aimed to investigate the atherosclerotic cardiovascular disease (ASCVD) risk score from a previous study by Hisayama (Hisayama study) and examine its use in the workplace.

Methods: Baseline data from health checkups conducted in 2010 of 41,815 employees (men; 34,024, women; 7,791) aged 19-64 years without previous cerebrovascular or cardiovascular disease were analyzed. The relationship between baseline ASCVD risk scores and the incidence of ASCVD > 10 years (2011-2020) was examined using Cox regression analysis with hazard ratios (HR). Receiver operating curve (ROC) analysis was conducted to evaluate the model's performance and determine optimal cut-off values for the identification of high-risk individuals in the workplace.

Results: The 10-year incidence of ASCVD was 2.6% (men; 3.0%, women; 0.8%). In men, each 1% increase in ASCVD risk score was associated with a 1.5-fold increase in ASCVD incidence (HR; 1.46, 95% confidence interval [CI]; 1.42-1.51, p < .001), which was observed from age 30 and even after multivariate adjustment. In women, univariate analysis showed an association between increased ASCVD risk score and incidence (HR; 3.19, 95% CI; 2.10-4.85, p < .001); however, this was not significant after adjustment. ROC analysis identified 1.62% as the optimal cut-off (sensitivity; 58.6%, specificity; 71.9%, positive predictive value [PPV]; 5.2%).

Conclusion: The ASCVD risk score is a useful tool for risk management and prevention in the workplace, particularly for men. In women, this association disappeared after age adjustment, possibly due to reduced estrogen effects with aging. Based on the ROC analysis, stratifying at ≥ 1.5% for intervention, ≥ 2.0% (top 20%) for "high risk," and ≥ 3.5% (PPV > 10%) for "extremely high risk" is advised. However, this study may have underestimated the risk levels; therefore, companies should adapt the use of ASCVD risk scores flexibly according to their circumstances.