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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

TitleIncremental predictive value of vascular assessments combined with the Framingham Risk Score for prediction of coronary events in subjects of low-intermediate risk
Authors
Issue Date2008
PublisherB 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?
AbstractBackground: 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 Identifierhttp://hdl.handle.net/10722/57513
ISSN
2015 Impact Factor: 1.633
2015 SCImago Journal Rankings: 0.531
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLau, KKen_HK
dc.contributor.authorChan, YHen_HK
dc.contributor.authorYiu, KHen_HK
dc.contributor.authorTam, Sen_HK
dc.contributor.authorLi, SWen_HK
dc.contributor.authorLau, CPen_HK
dc.contributor.authorTse, HFen_HK
dc.date.accessioned2010-04-12T01:38:53Z-
dc.date.available2010-04-12T01:38:53Z-
dc.date.issued2008en_HK
dc.identifier.citationPostgraduate Medical Journal, 2008, v. 84 n. 989, p. 153-157en_HK
dc.identifier.issn0032-5473en_HK
dc.identifier.urihttp://hdl.handle.net/10722/57513-
dc.description.abstractBackground: 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.languageengen_HK
dc.publisherB M J Publishing Group. The Journal's web site is located at http://www.postgradmedj.comen_HK
dc.relation.ispartofPostgraduate Medical Journalen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsPostgraduate Medical Journal. Copyright © B M J Publishing Group.en_HK
dc.subject.meshBrachial Artery - pathologyen_HK
dc.subject.meshCarotid Arteries - pathologyen_HK
dc.subject.meshCoronary Artery Disease - pathologyen_HK
dc.subject.meshTunica Intima - pathologyen_HK
dc.subject.meshCase-Control Studiesen_HK
dc.titleIncremental predictive value of vascular assessments combined with the Framingham Risk Score for prediction of coronary events in subjects of low-intermediate risken_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://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+risken_HK
dc.identifier.emailLau, KK:gkklau@hku.hken_HK
dc.identifier.emailChan, YH:chanwill@hku.hken_HK
dc.identifier.emailYiu, KH:khkyiu@hku.hken_HK
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_HK
dc.identifier.authorityLau, KK=rp01499en_HK
dc.identifier.authorityChan, YH=rp01313en_HK
dc.identifier.authorityYiu, KH=rp01490en_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1136/pgmj.2007.064089en_HK
dc.identifier.pmid18372487-
dc.identifier.scopuseid_2-s2.0-41849116681en_HK
dc.identifier.hkuros140856-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-41849116681&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume84en_HK
dc.identifier.issue989en_HK
dc.identifier.spage153en_HK
dc.identifier.epage157en_HK
dc.identifier.eissn1469-0756-
dc.identifier.isiWOS:000254388300008-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridLau, KK=22635159600en_HK
dc.identifier.scopusauthoridChan, YH=22633700600en_HK
dc.identifier.scopusauthoridYiu, KH=35172267800en_HK
dc.identifier.scopusauthoridTam, S=7202037323en_HK
dc.identifier.scopusauthoridLi, SW=13807028100en_HK
dc.identifier.scopusauthoridLau, CP=7401968501en_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK

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