European journal of preventive cardiology最新文献

{"title":"External validation of SCORE2-Diabetes in The Netherlands across various socioeconomic levels in native-Dutch and non-Dutch populations.","authors":"Sukainah A Alfaraj, Janet M Kist, Rolf H H Groenwold, Marco Spruit, Dennis Mook-Kanamori, Rimke C Vos","doi":"10.1093/eurjpc/zwae354","DOIUrl":"10.1093/eurjpc/zwae354","url":null,"abstract":"<p><strong>Aims: </strong>Adults with type 2 diabetes have an increased risk of cardiovascular events (CVEs), the world's leading cause of mortality. The SCORE2-Diabetes model is a tool designed to estimate the 10-year risk of CVE specifically in individuals with type 2 diabetes. However, the performance of such models may vary across different demographic and socioeconomic groups, necessitating validation and assessment in diverse populations. This study aims to externally validate SCORE2-Diabetes and assess its performance across various socioeconomic and migration origins in The Netherlands.</p><p><strong>Methods and results: </strong>We selected adults with type 2 diabetes, aged 40-79 years and without previous CVE from the Extramural LUMC Academic Network (ELAN) primary care data cohort from 2007 to 2023. ELAN data were linked with Statistics Netherlands registry data to obtain information about the country of origin and socioeconomic status (SES). Cardiovascular event was defined as myocardial infarction, stroke, or CV mortality. Non-CV mortality was considered a competing event. Analyses were stratified by sex, Dutch vs. other non-Dutch countries of origin, and quintiles of SES. Of the 26 544 included adults with type 2 diabetes, 2518 developed CVE. SCORE2-Diabetes showed strong predictive accuracy for CVE in the Dutch population [observed-to-expected ratio (OE) = 1.000, 95% CI = 0.990-1.008 for men, and OE = 1.050, 95% CI = 1.042-1.057 for women]. For non-Dutch individuals, the model underestimated CVE risk (OE = 1.121, 95% CI = 1.108-1.131 for men, and OE = 1.100, 95% CI = 1.092-1.111 for women). The model also underestimated the CVE risk (OE > 1) in low SES groups and overestimated the risk (OE < 1) in high SES groups. Discrimination was moderate across subgroups with c-indices between 0.6 and 0.7.</p><p><strong>Conclusion: </strong>SCORE2-Diabetes accurately predicted the risk of CVE in the Dutch population. However, it underpredicted the risk of CVE in the low SES groups and non-Dutch origins, while overpredicting the risk in high SES men and women. Additional clinical judgment must be considered when using SCORE2-Diabetes for different SES and countries of origin.</p><p><strong>Lay summary: </strong>A new study validates the SCORE2-Diabetes model for predicting a 10-year risk of cardiovascular events in type 2 diabetes. Strong accuracy for the Dutch population, but underestimation of the risk for low SES and non-Dutch groups. SCORE2-Diabetes should be used with extra caution across diverse subgroups.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":"555-563"},"PeriodicalIF":8.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of apolipoprotein B into the SCORE2 framework: implications for cardiovascular risk prediction.","authors":"Wen Kai Wong, Fumihiko Takeuchi, Le Thi Phuong Thao, Stephen J Nicholls, Derek P Chew, Karlheinz Peter","doi":"10.1093/eurjpc/zwaf039","DOIUrl":"10.1093/eurjpc/zwaf039","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate whether integrating Apolipoprotein B (ApoB) into the Systematic Coronary Risk Evaluation 2 (SCORE2) cardiovascular risk prediction framework improves its predictive accuracy and clinical applicability within the UK Biobank population.</p><p><strong>Methods and results: </strong>A 10-year prospective cohort study was conducted with 448 303 UK Biobank participants eligible for SCORE2 calculation. Three approaches were employed: (i) threshold analysis to determine the optimal ApoB cutoff for cardiovascular disease (CVD) risk prediction using Youden's Index, (ii) assessment of the synergistic effect of SCORE2 and ApoB through concordant and discordant classifications, and (iii) recalibration of the SCORE2 model by incorporating ApoB as an additional predictor. Each 0.2 g/L increase in ApoB was associated with an increased subdistribution hazard for CVD events [subdistribution hazard ratio (SHR): 1.13; 95% CI: 1.11-1.14, P < 0.001], accounting for non-cardiovascular death as a competing risk. Threshold analysis identified an optimal ApoB cutoff at 1.18 g/L; however, it demonstrated limited discriminatory performance (area under the curve 0.54), with low sensitivity (32.4%), and moderate specificity (74.4%). Individuals with both low ApoB (<1.18 g/L) and low SCORE2 risk (<5%) had a lower CVD incidence rate (232.51 per 100 000 person-years) compared with those identified as low risk by SCORE2 alone (253.69 per 100 000 person-years). Integration of ApoB into the SCORE2 model did not significantly improve the model discrimination, calibration, and net reclassification improvement.</p><p><strong>Conclusion: </strong>Apolipoprotein B exhibited a dose-response relationship with cardiovascular risk but had limited standalone predictive utility within the UK Biobank population. However, combining ApoB with SCORE2 thresholds improved the identification of low-risk individuals, suggesting a complementary role for ApoB in refining cardiovascular risk stratification.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":"575-584"},"PeriodicalIF":8.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the effect of physical activity on cardiovascular outcomes in individuals with diabetes: reply.","authors":"Chia-Lin Lee, Wei-Ju Liu, Yuta Hiraike","doi":"10.1093/eurjpc/zwae238","DOIUrl":"10.1093/eurjpc/zwae238","url":null,"abstract":"","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":"618"},"PeriodicalIF":8.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular risk prediction in older persons: ready for primetime.","authors":"Frank L J Visseren","doi":"10.1093/eurjpc/zwaf072","DOIUrl":"10.1093/eurjpc/zwaf072","url":null,"abstract":"","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":"537-538"},"PeriodicalIF":8.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Coronary Risk Evaluation 2 for Older Persons: 10 years risk validation, clinical utility, and potential improvement.","authors":"Yassin Belahnech, Eduard Ródenas-Alesina, Miguel Ángel Muñoz, Jose María Verdu-Rotellar, Augusto Sao-Avilés, Garazi Urio-Garmendia, Dimelza Osorio, Karla Salas, Efrain Pantoja, Aida Ribera, Ignacio Ferreira-González","doi":"10.1093/eurjpc/zwae383","DOIUrl":"10.1093/eurjpc/zwae383","url":null,"abstract":"<p><strong>Aims: </strong>European Systematic Coronary Risk Assessment 2 for Older Persons (SCORE2-OP) model has shown modest performance when externally validated in selected cohorts. We aim to investigate its predictive performance and clinical utility for 10-year cardiovascular (CV) risk in an unbiased and representative cohort of older people of a low CV risk country. Furthermore, we explore whether other clinical or echocardiographic features could improve its performance.</p><p><strong>Methods and results: </strong>A cohort of randomly selected individuals ≥65 years from a primary care population of Barcelona without established CV disease included 791 patients (63.1% female, median age 76 years, median follow-up 11.8 years). The model's performance yielded a Harrell's C-statistic of 0.706 (95% confidence interval [CI] 0.659-0.753) for the primary endpoint (myocardial infarction, stroke, and CV mortality) and 0.692 (95% CI 0.649-0.734) for the secondary endpoint (primary endpoint plus heart failure hospitalization), with better discrimination in females. SCORE2-OP underestimated the risk of primary endpoint in women [expected/observed (E/O) = 0.77], slightly overestimated in men (E/O = 1.06), and systematically underestimated the risk of the secondary endpoint (E/O = 0.52). Decision curve analysis showed net clinical benefit across a 7.5-30% risk range for primary endpoint. Valvular calcification was the only variable that significantly improved 10-year SCORE2-OP risk performance for both primary and secondary endpoints, with a change in Harrell's C of 0.028 (P = 0.017).</p><p><strong>Conclusion: </strong>In a low CV risk country, SCORE2-OP showed notable discrimination and excellent calibration to predict 10-year CV risk, with better performance in females. Incorporating valvular calcification in a future revised score may enhance accuracy and reduce unnecessary treatments.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":"527-536"},"PeriodicalIF":8.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing 5-year and 10-year predicted cardiovascular disease risks in Aotearoa New Zealand: national data linkage study of 1.7 million adults.","authors":"Jingyuan Liang, Susan Wells, Rod Jackson, Yeunhyang Choi, Suneela Mehta, Claris Chung, Pei Gao, Katrina Poppe","doi":"10.1093/eurjpc/zwae361","DOIUrl":"10.1093/eurjpc/zwae361","url":null,"abstract":"<p><strong>Aims: </strong>There is no consensus on the optimal time horizon for predicting cardiovascular disease (CVD) risk to inform treatment decisions. New Zealand and Australia recommend 5 years, whereas most countries recommend 10 years. We compared predicted risk and treatment-eligible groups using 5-year and 10-year equations.</p><p><strong>Methods and results: </strong>Individual-level linked administrative data sets identified 1 746 665 New Zealanders without CVD, aged 30-74 years in 2006, with follow-up to 2018. Participants were randomly allocated to derivation and validation cohorts. Sex-specific 5-year and 10-year risk prediction models were developed in the derivation cohort and applied in the validation cohort. There were 28 116 (3.2%) and 62 027 (7.1%) first CVD events that occurred during 5-year and 10-year follow-ups, respectively (cumulative risk, derivation cohort). Median predicted 10-year CVD risk (3.8%) was approximately 2.5 times 5-year risk (1.6%), and 95% of individuals in the top quintile of 5-year risk were also in the top quintile of 10-year risk, across age/gender groups (validation cohort). Using common guideline-recommended treatment thresholds (5% 5-year and 10% 10-year risk), approximately 14% and 28% of women and men, respectively, were identified as treatment-eligible applying 5-year equations compared with 17% and 32% of women and men applying 10-year equations. Older age was the major contributor to treatment eligibility in both sexes.</p><p><strong>Conclusion: </strong>Predicted 10-year CVD risk was approximately 2.5 times 5-year risk. Both equations identified mostly the same individuals in the highest risk quintile. Conversely, commonly used treatment thresholds identified more treatment-eligible individuals using 10-year equations, and both equations identified approximately twice as many treatment-eligible men as women. The treatment threshold, rather than the risk horizon, is the main determinant of treatment eligibility.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":"516-524"},"PeriodicalIF":8.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive medicine to prevent non-communicable disease.","authors":"Rachel E Climie, Jean-Philippe Empana","doi":"10.1093/eurjpc/zwaf003","DOIUrl":"10.1093/eurjpc/zwaf003","url":null,"abstract":"","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":"606-607"},"PeriodicalIF":8.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Despite More Aggressive Lipid Lowering Guidelines Worldwide, the Majority of High Risk Patients Remain Undertreated.","authors":"Peter P Toth","doi":"10.1093/eurjpc/zwaf288","DOIUrl":"https://doi.org/10.1093/eurjpc/zwaf288","url":null,"abstract":"","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthostatic hypertension is an accessible, low-cost marker of cardiovascular risk.","authors":"Leah Rethy","doi":"10.1093/eurjpc/zwad219","DOIUrl":"10.1093/eurjpc/zwad219","url":null,"abstract":"","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":"608-609"},"PeriodicalIF":8.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9782904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of repeated plaque visualization on cardiovascular risk reduction after 3 years: a randomized controlled trial.","authors":"Kristyn Whitmore, Zhen Zhou, Jacqueline D M Ryan, Costan G Magnussen, Melinda J Carrington, Thomas H Marwick","doi":"10.1093/eurjpc/zwae026","DOIUrl":"10.1093/eurjpc/zwae026","url":null,"abstract":"<p><strong>Aims: </strong>Helping people to understand their cardiovascular (CV) risk can influence the choices they make for risk reduction, including medication adherence and lifestyle modification. This study sought whether repeated visualization of coronary artery calcium (CAC) images was effective in sustaining long-term risk control in primary prevention, independent of a risk reduction programme.</p><p><strong>Methods and results: </strong>Asymptomatic, statin-naïve participants, 40-70 years, with a family history of premature coronary artery disease and a CAC score from 1-400 were randomized to a nurse-led CV risk reduction programme or standard care with bi-annual reviews. Only the intervention group (220 of 449 participants) visualized their CAC image (with repeat exposure in the first 3 months) and were initiated on statin therapy. The primary outcome was change in Framingham Risk Score (FRS) at 36 months, and the impact of CAC image recall on CV risk was assessed. The reduction in FRS (difference in differences (DID) -3.4% [95% CI: -4.4% to -2.4%], P ≤ 0.001 and low density lipoprotein cholesterol -1.2 mmol/L [95% CI: -1.4 to -1.0], P ≤ 0.001) over 36 months was greater in the intervention than the control group. Within the intervention group, sustained recall of CAC images at 24 months was associated with lower systolic blood pressure (DID -4.3 mmHg [95% CI: -7.7 to -0.9], P = 0.01) and waist circumference (DID -2.0 cm [95% CI: -3.9 to -0.1], P = 0.03) at 36 months compared to unsustained recall.</p><p><strong>Conclusion: </strong>A nurse-led programme, combining personalized patient visualization of CAC imaging with statin therapy, is beneficial for improving CV risk. Recalling the presentation of CAC images through repeated visual exposure may influence risk reduction.</p><p><strong>Registration: </strong>Australia New Zealand Clinical Trials Registry: ACTRN12614001294640.</p><p><strong>Lay summary: </strong>This trial sought to determine whether visualization of coronary artery calcium (CAC) images influences behaviour change and cardiovascular risk reduction within a structured nurse-led programme vs. standard care. Intervention participants visualized their personalized CAC images within the first three months and commenced statin therapy. Control participants were blinded to their CAC images and were not provided statin therapy. Intervention participants had a greater absolute reduction in the Framingham Risk Score (difference in differences -3.4% [95% CI: -4.4% to -2.4%], P ≤ 0.001) compared to controls. Those with sustained recollection of their CAC images within the intervention group also had greater reductions in systolic blood pressure and waist circumference.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":" ","pages":"596-605"},"PeriodicalIF":8.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139511791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}