Document Type : Original Article(s)
Authors
1 General Practitioner, School of Medicine, Najafabad Branch, Islamic Azad University, Najafabad, Iran
2 Associate Professor, Department of Cardiology, School of Medicine, Najafabad Branch, Islamic Azad University, Najafabad, Iran
3 Epidemiologist, Vice Chancellor for Research, Isfahan University of Medical Sciences, Isfahan, Iran
4 Medical Laboratory Scientist, Central Laboratory, Shariati Hospital, Isfahan, Iran
5 General Practitioner, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Risk assessment in clinical practice plays an important role in classifying population for appropriate preventive medicine for each category. Several multivariable risk predictor algorithms and inflammatory biomarkers are developed for assessing risk for cardiovascular diseases (CVDs). We aimed to depict a picture of the cardiovascular risk profiles in the Iranian population with diabetes mellitus (DM) through three risk predictors for the first time, as the patients with DM have an increased risk for CVDs.METHODS: In this cross-sectional study, the sample size consisted of 418 patients with DM from Diabetes Clinic of Shariati hospital, Isfahan, Iran, in February to July, 2014. We collected the latest information, and then calculated the 10-year CVD risk using Framingham risk score (FRS) and atherosclerotic cardiovascular disease (ASCVD) risk score; while high-sensitivity C-reactive protein (hs-CRP) was measured for them based on their physicians' prescription. Finally, all data were analyzed using SPSS software.RESULTS: The mean 10-year risk prediction of CVDs in the 30- to 74-year-old Iranian patients with DM was high in all three predictors based on their cut-off points, 16.31%, 12.39%, and 3.46 mg/l for FRS, ASCVD risk score, and hs-CRP level, respectively. Although the mean FRS and ASCVD risk scores were significantly higher among men than women (P < 0.0500), the mean hs-CRP level was slightly lower in men than women (P > 0.0500).CONCLUSION: Mean FRS and ASCVD risk scores and hs-CRP in patients were high, and a considerable proportion of patients with DM in our study were at intermediate and high risk for CVDs in the next 10 years. Future cohort studies would investigate the accuracy of different predictors in upcoming years, and also help to derive a specific model or recalibrate existing predictors with characteristic of Iranian populations and specific target groups.
Keywords
- World Health Organization. Global Status Report on Noncommunicable Diseases 2010. Geneva, Switzerland: WHO; 2011.
- Puska P, Norrving B, Mendis S. Global atlas on cardiovascular disease prevention and control. Geneva, Switzerland: World Health Organization; 2011.
- Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3(11): e442.
- Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics--2014 update: A report from the American Heart Association. Circulation 2014; 129(3): e28-e292.
- Chamnan P, Simmons RK, Sharp SJ, Griffin SJ, Wareham NJ. Cardiovascular risk assessment scores for people with diabetes: A systematic review. Diabetologia 2009; 52(10): 2001-14.
- Pfutzner A, Schondorf T, Hanefeld M, Forst T. High-sensitivity C-reactive protein predicts cardiovascular risk in diabetic and nondiabetic patients: Effects of insulin-sensitizing treatment with pioglitazone. J Diabetes Sci Technol 2010; 4(3): 706-16.
- Ryden L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 2013; 34(39): 3035-87.
- Chen SC, Su HM, Tsai YC, Huang JC, Chang JM, Hwang SJ, et al. Framingham risk score with cardiovascular events in chronic kidney disease. PLoS One 2013; 8(3): e60008.
- Mora S, Yanek LR, Moy TF, Fallin MD, Becker LC, Becker DM. Interaction of body mass index and framingham risk score in predicting incident coronary disease in families. Circulation 2005; 111(15): 1871-6.
- Bosomworth NJ. Practical use of the Framingham risk score in primary prevention: Canadian perspective. Can Fam Physician 2011; 57(4): 417-23.
- National Heart, Lung, and Blood Institute. Assessing cardiovascular risk: Systematic evidence review from the risk assessment work group [Online]. [cited 2013]; Available from: URL:
- https://www.nhlbi.nih.gov/sites/default/files/media/docs/risk-assessment.pdf
- Mazurek K, Zmijewski P, Czajkowska A, Lutoslawska G. High-sensitivity c-reactive protein (HSCRP) in young adults: Relation to aerobic capacity, physical activity and risk factors for cardiovascular diseases. Biology of Sport 2011; 28(4): 227-32.
- Bisoendial RJ, Boekholdt SM, Vergeer M, Stroes ES, Kastelein JJ. C-reactive protein is a mediator of cardiovascular disease. Eur Heart J 2010; 31(17): 2087-91.
- Hense HW, Schulte H, Lowel H, Assmann G, Keil U. Framingham risk function overestimates risk of coronary heart disease in men and women from Germany-results from the MONICA Augsburg and the PROCAM cohorts. Eur Heart J 2003; 24(10): 937-45.
- Jimenez-Corona A, Lopez-Ridaura R, Williams K, Gonzalez-Villalpando ME, Simon J, Gonzalez-Villalpando C. Applicability of Framingham risk equations for studying a low-income Mexican population. Salud Publica Mex 2009; 51(4): 298-305.
- Liu J, Hong Y, D'Agostino RB Sr, Wu Z, Wang W, Sun J, et al. Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese Multi-Provincial Cohort Study. JAMA 2004; 291(21): 2591-9.
- D'Agostino RB Sr, Grundy S, Sullivan LM, Wilson P. Validation of the Framingham coronary heart disease prediction scores: Results of a multiple ethnic groups investigation. JAMA 2001; 286(2): 180-7.
- DeFilippis AP, Young R, McEvoy JW, Michos ED, Sandfort V, Kronmal RA, et al. Risk score overestimation: The impact of individual cardiovascular risk factors and preventive therapies on the performance of the American Heart Association-American College of Cardiology-Atherosclerotic Cardiovascular Disease risk score in a modern multi-ethnic cohort. Eur Heart J 2017; 38(8): 598-608.
- Brindle P, Beswick A, Fahey T, Ebrahim S. Accuracy and impact of risk assessment in the primary prevention of cardiovascular disease: A systematic review. Heart 2006; 92(12): 1752-9.
- Bozorgmanesh M, Hadaegh F, Azizi F. Predictive accuracy of the 'Framingham's general CVD algorithm' in a Middle Eastern population: Tehran Lipid and Glucose Study. Int J Clin Pract 2011; 65(3): 264-73.
- Khalili D, Hadaegh F, Soori H, Steyerberg EW, Bozorgmanesh M, Azizi F. Clinical usefulness of the Framingham cardiovascular risk profile beyond its statistical performance: The Tehran Lipid and Glucose Study. Am J Epidemiol 2012; 176(3): 177-86.
- Chia YC, Lim HM, Ching SM. Validation of the pooled cohort risk score in an Asian population-a retrospective cohort study. BMC Cardiovasc Disord 2014; 14: 163.
- Seo SM, Baek SH, Jeon HK, Kang SM, Kim DS, Kim WS, et al. Correlations between the level of high-sensitivity C-reactive protein and cardiovascular risk factors in Korean adults with cardiovascular disease or diabetes mellitus: The CALLISTO study. J Atheroscler Thromb 2013; 20(7): 616-22.
- Ballantyne CM, Hoogeveen RC, Bang H, Coresh J, Folsom AR, Heiss G, et al. Lipoprotein-associated
- phospholipase A2, high-sensitivity C-reactive protein, and risk for incident coronary heart disease in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study. Circulation 2004; 109(7): 837-42.
- Ford ES, Giles WH, Mokdad AH. The distribution of 10-Year risk for coronary heart disease among US adults: Findings from the National Health and Nutrition Examination Survey III. J Am Coll Cardiol 2004; 43(10): 1791-6.
- Motamed N, Mardanshahi A, Saravi BM, Siamian H, Maadi M, Zamani F. The 10-year absolute risk of cardiovascular (CV) events in northern Iran: A Population Based Study. Mater Sociomed 2015; 27(3): 158-62.
- Khera A, McGuire DK, Murphy SA, Stanek HG, Das SR, Vongpatanasin W, et al. Race and gender differences in C-reactive protein levels. J Am Coll Cardiol 2005; 46(3): 464-9.
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