Universal estimation of cardiovascular risk in multi-risk constellations - a “relativity theory” for global risk calculation
Main Article Content
Joerg Piper
http://orcid.org/0000-0002-0234-788X
http://orcid.org/0000-0002-0234-788X
Abstract
According to various published studies, at least 26 cardiovascular risk factors can contribute to the individual cardiovascular risk. For all of these risk factors quantitative risk multipliers are known which can be systematically derived from various epidemiological findings.
On the other hand, only a few risk factors are considered by the risk scores established (FRAMINGHAM, PROCAM, ESC and HEART score, for instance). Thus, a relevant proportion of patients affected with myocardial infarction or other cardiovascular events do not belong to a high risk group according to these scores.
Thus, alternative tools for universal risk calculation are desirable to improve the significance and sensitivity of such estimations.
Based on “traditional“ risk factors considered by the scores mentioned, mathematical analyses were carried out to describe coincidences of various risk factors with regard to the resulting total risk. Their quantitative synergism and relativity can be mathematically described by a specific hyperbolic tangent function derived from the PROCAM score.
By other formulas PROCAM risk calculated in this way can be transformed into corresponding FRAMINGHAM and ESC risk which are targeted at other critical end points.
We consider that the special interaction of risk factors described in our mathematical models can be regarded as a general law of nature so that our formulas could be used for universal risk estimations in all risk constellations imaginable, even when multiple risk factors are coincident.
On the other hand, only a few risk factors are considered by the risk scores established (FRAMINGHAM, PROCAM, ESC and HEART score, for instance). Thus, a relevant proportion of patients affected with myocardial infarction or other cardiovascular events do not belong to a high risk group according to these scores.
Thus, alternative tools for universal risk calculation are desirable to improve the significance and sensitivity of such estimations.
Based on “traditional“ risk factors considered by the scores mentioned, mathematical analyses were carried out to describe coincidences of various risk factors with regard to the resulting total risk. Their quantitative synergism and relativity can be mathematically described by a specific hyperbolic tangent function derived from the PROCAM score.
By other formulas PROCAM risk calculated in this way can be transformed into corresponding FRAMINGHAM and ESC risk which are targeted at other critical end points.
We consider that the special interaction of risk factors described in our mathematical models can be regarded as a general law of nature so that our formulas could be used for universal risk estimations in all risk constellations imaginable, even when multiple risk factors are coincident.
Article Details
How to Cite
PIPER, Joerg.
Universal estimation of cardiovascular risk in multi-risk constellations - a “relativity theory” for global risk calculation.
Medical Research Archives, [S.l.], v. 3, n. 3, jan. 2016.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/475>. Date accessed: 18 apr. 2024.
Keywords
Risk factors, interaction, estimation, calculation, score, Framingham, PROCAM, ESC, mathematical models, multi-risk constellations, cardiovascular event, myocardial infarction, cardiovascular death
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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[6] Borch-Johnsen K, Feldt-Rasmussen B, Strandgaard S, Schroll M, Jensen JS (1999) Urinary albumin excretion. An independent predictor of ischemic heart disease. Arterioscler Thromb Vasc Biol 19:1992-1997
[7] Chrubasik-Hausmann, S., Chrubasik, C. (†), Piper, J., Schulte-Mönting, J, Erne, P.
Impact of Risk Factors on Cardiovascular Risk: a Perspective on Risk Estimation in a Swiss Population. Swiss Med Wkly, 2015 (in press)
[8] Clarke R, Lewintron S, Donald A (2001) Underestimation of the importance of homocsteine as a risk factor for cardiovascular disease in epidemiological studies. J. Cardiovasc Risk, 8, 363 – 369
[9] Clerarfield MB (2005) C-reaktives Protein: A new risk assessment tool for cardiovascular disease. JAOA, 105/9: 409 – 416
[10] Conroy RM, Pyörälä K, Fitzgerald AP et al, on behalf of the SCORE project group (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Result of a riks estimation study in Europe. Eur Heart J. 24: 987 – 1003
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http://www.escardio.org/initiatives/prevention/heartscore.htm http://www.escardio.org/knowledge/decision-tools/heartscore-old/Programme-Download.htm
[13] Fruchart JC, Nierman MC, Stroes ESG, Kastelein JJP, Duriez P (2004) New Risk Factors for Atherosclerosis and Patient Risk Assessment. Circulation, 109(23 suppl. 1), III 15 – III 19
[14] Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, Halle JP, Young J, Rashkow A, Joyce C, Nawaz S, Yusuf S (2001) Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. Jama 286:421-426
[15] Grundy SM (2001) Coronary calcium as a risk factor: role in global risk assessment. J. Am. Coll. Cardiol., 27, 1512 – 1515
[16] Harvard school of puplic health (2005) Health weight. www.hsph.harvard.edu
[17] Hillege HL, Fidler V, Diercks GF, van Gilst WH, de Zeeuw D, van Veldhuisen DJ, Gans RO, Janssen WM, Grobbee DE, de Jong PE (2002) Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 106:1777-1782
[18] Hillege HL, Janssen WM, Bak AA, Diercks GF, Grobbee DE, Crijns HJ, Van Gilst WH, De Zeeuw D, De Jong PE (2001) Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med 249:519-526
[19] Hopkins PN, Wu LL, Hunt SC, Brinton EA (2005) Plasma triglycerides and type III hyperlipidemia are independently associated with premature familial coronary artery disease. J. Am. Coll. Cardiol., 45(7), 1003 – 1012
[20] International Task Force for Prevention of Coronary Heart Disease (2005) Procam Risik Calculator. www.chd-taskforce.com/index.html
[21] Klausen K, Borch-Johnsen K, Feldt-Rasmussen B, Jensen G, Clausen P, Scharling H, Appleyard M, Jensen JS (2004) Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 110:32-35
[22] Luc G, Bard JM, Arveiler D (2002) Lipoprotein (a) as a predictor of coronary heart desease: the PRIME Study. Atherosclerosis, 163, 377 – 384
[23] National Heart Lung, and Blood Institute, National Institute of Health (2002) Framingham Heart Study. www.nhlbi.nih.gov/about/framingham/index.html
[24] Nurk E, Tell GS, Vollset SE (2002) Plasma total homocysteine and hospitalizations for cardiovascular disease: the Hordalend Homocysteine Study. Arch. Intern. Med., 162, 1374 – 1381
[25] Raggi P, Callister TQ, Cooil B, He ZX, Lippolis N J, Russo D, Zelinger A, Mahmarian J (2000) Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography. Circulation 101, 850 – 855
[26] Remuzzi G, Weening JJ (2005) Albuminuria as early test for vascular disease. Lancet 365:556-557
[27] Rexrode KM (2001) Abdominal and total adiposity and risk of coronary heart disease in Men. Int. J. Obes. 25, 1047 – 1056
[28] Ridker PM, Hennekens CH, Buring JE (2000) C-reactive protein and other markeers of inflammation in the prediction of cardiovascular disease in women. N. Engl. J. Med., 342, 836 – 843
[29] Rifai N, Ridker PM (2001) Proposed cardovascular risk assessment algorithen using high-sensitivity C-reaktive Protein and Lipid Scorering. Clinical Chemistry 47: 28 – 30
[30] Saikku P, Leinonen M, Tenkanen L, Ekman MR, Linnanmärki E, Manninen V, Mänttäri M, Frick MM, Huttunen JK (1992) Chronic Chlamydia pneumonoae infection as a risk factor for coronary heart disease in the Helsinki Heart Study Ann Int Med 116; 273-278
[31] Scarabin PY, Arveiler D, Amouyel P (2003) Plasma fibrinogen explains much of the difference in risk of coronary heart disease between France an Northern Ireland: the PRIME study. Atherosclerosis, 1666, 103 – 109
[32] Schulte H, Cullen P, Assmann G (1999) Obesity, mortality and cardiovascular disease in the Münster Heart Study (PROCAM). Atherosclerosis, 144, 199 – 209
[33] Stuveling E.M. HHL, Bakker S.J.L.,Gansevoort R.T.,Gans R.O.B.,de Zeeuw D.,de Jong P. (2003) Urinary albumin excretion and C-reactive protein independently add to the mortality risk. J.Am.Soc.Nephrol. 14:679a
[34] Swiss Atherosclerosis Association, Arbeitsgruppe Lipide und Atherosklerose (AGLA):
AGLA-Risikorechner. www.agla.ch/risikoberechnung/agla-risikorechner
[35] UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet; 332, 837 – 853
[36] U.S. Department of health and human services, puplic health service, national institute of health, national cancer institute (2001) Risk associated with smoking. Monography 13 http://www.krebsgesellschaft.de/downlowd/RisksAssociatedwithSmoking.pdf
[37] Wachtell K, Ibsen H, Olsen MH, Borch-Johnsen K, Lindholm LH, Mogensen CE, Dahlof B, Devereux RB, Beevers G, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Kristianson K, Lederballe-Pedersen O, Nieminen MS, Okin PM, Omvik P, Oparil S, Wedel H, Snapinn SM, Aurup P (2003) Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med 139:901-906
[38] Wang TJ, Larson MG, Levy D (2002) C-reactive protein is associated with subclinical epicardial coronary caldivication in men and women: the Framingham heart Study. Circulation, 106, 1189 – 1191
[39] Welborn TA, Dhaliwal SS, Bennett SA (2003) Waist-hip ratio is the dominant riskfactor predicting kardiovascular risk in Austria. M. J. A. 179, 580 – 585
[40] Yusuf S (2004) Effect of protencially modificable risk factors associated with myocardial infarction in 52 countries (the INTERHAERT study): chase control study. Lancet 364, 937 – 952
[41] Yusuf, S (2005) Obesity and the risk of myocardial infarction in 27000 parcipitens from 52 countries: access control-study. Lancet, 366, 1640 – 1649
[2] Arad Y, Spadaro LA, Goodman K (2000) Prediction of coronary events with electron beam cumputed tomography. J. Am. Coll. Cardiol., 36, 1253 – 1260
[3] Assmann, G.: PROCAM health check. Risk factor-based calculator for evaluating individual risk for myocardial infarction, PrevaMed GmbH, interactive DC-ROM for physicians, 2007
[4] Assmann G, Cullen,P, von Eckardstein A, Funke H, Schulte H (1999) The importance of triglycerides as a significant risk factor. Eur. Heart, J., 1, J 7 – J 11
[5] Assmann G, Cullen P, Schulte H (2002) Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the Prospective Cardiovascular Münster (PROCAM) Study. Circulation, 105, 310-315
[6] Borch-Johnsen K, Feldt-Rasmussen B, Strandgaard S, Schroll M, Jensen JS (1999) Urinary albumin excretion. An independent predictor of ischemic heart disease. Arterioscler Thromb Vasc Biol 19:1992-1997
[7] Chrubasik-Hausmann, S., Chrubasik, C. (†), Piper, J., Schulte-Mönting, J, Erne, P.
Impact of Risk Factors on Cardiovascular Risk: a Perspective on Risk Estimation in a Swiss Population. Swiss Med Wkly, 2015 (in press)
[8] Clarke R, Lewintron S, Donald A (2001) Underestimation of the importance of homocsteine as a risk factor for cardiovascular disease in epidemiological studies. J. Cardiovasc Risk, 8, 363 – 369
[9] Clerarfield MB (2005) C-reaktives Protein: A new risk assessment tool for cardiovascular disease. JAOA, 105/9: 409 – 416
[10] Conroy RM, Pyörälä K, Fitzgerald AP et al, on behalf of the SCORE project group (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Result of a riks estimation study in Europe. Eur Heart J. 24: 987 – 1003
[11] Craig WY, Neveux LM, Palomaki GE (1998) Lipoprotein(a) as a risk factor for ischemic heart disease: metaanalysis of prospective studies. Clin. Chem., 44: 2301 – 2306.
[12] European Society of Cardiology (2005) Heartscore: the interactive tool for predicting and managing the risk of heart attack and stroke in Europe.
http://www.escardio.org/initiatives/prevention/heartscore.htm http://www.escardio.org/knowledge/decision-tools/heartscore-old/Programme-Download.htm
[13] Fruchart JC, Nierman MC, Stroes ESG, Kastelein JJP, Duriez P (2004) New Risk Factors for Atherosclerosis and Patient Risk Assessment. Circulation, 109(23 suppl. 1), III 15 – III 19
[14] Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, Halle JP, Young J, Rashkow A, Joyce C, Nawaz S, Yusuf S (2001) Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. Jama 286:421-426
[15] Grundy SM (2001) Coronary calcium as a risk factor: role in global risk assessment. J. Am. Coll. Cardiol., 27, 1512 – 1515
[16] Harvard school of puplic health (2005) Health weight. www.hsph.harvard.edu
[17] Hillege HL, Fidler V, Diercks GF, van Gilst WH, de Zeeuw D, van Veldhuisen DJ, Gans RO, Janssen WM, Grobbee DE, de Jong PE (2002) Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 106:1777-1782
[18] Hillege HL, Janssen WM, Bak AA, Diercks GF, Grobbee DE, Crijns HJ, Van Gilst WH, De Zeeuw D, De Jong PE (2001) Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med 249:519-526
[19] Hopkins PN, Wu LL, Hunt SC, Brinton EA (2005) Plasma triglycerides and type III hyperlipidemia are independently associated with premature familial coronary artery disease. J. Am. Coll. Cardiol., 45(7), 1003 – 1012
[20] International Task Force for Prevention of Coronary Heart Disease (2005) Procam Risik Calculator. www.chd-taskforce.com/index.html
[21] Klausen K, Borch-Johnsen K, Feldt-Rasmussen B, Jensen G, Clausen P, Scharling H, Appleyard M, Jensen JS (2004) Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 110:32-35
[22] Luc G, Bard JM, Arveiler D (2002) Lipoprotein (a) as a predictor of coronary heart desease: the PRIME Study. Atherosclerosis, 163, 377 – 384
[23] National Heart Lung, and Blood Institute, National Institute of Health (2002) Framingham Heart Study. www.nhlbi.nih.gov/about/framingham/index.html
[24] Nurk E, Tell GS, Vollset SE (2002) Plasma total homocysteine and hospitalizations for cardiovascular disease: the Hordalend Homocysteine Study. Arch. Intern. Med., 162, 1374 – 1381
[25] Raggi P, Callister TQ, Cooil B, He ZX, Lippolis N J, Russo D, Zelinger A, Mahmarian J (2000) Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography. Circulation 101, 850 – 855
[26] Remuzzi G, Weening JJ (2005) Albuminuria as early test for vascular disease. Lancet 365:556-557
[27] Rexrode KM (2001) Abdominal and total adiposity and risk of coronary heart disease in Men. Int. J. Obes. 25, 1047 – 1056
[28] Ridker PM, Hennekens CH, Buring JE (2000) C-reactive protein and other markeers of inflammation in the prediction of cardiovascular disease in women. N. Engl. J. Med., 342, 836 – 843
[29] Rifai N, Ridker PM (2001) Proposed cardovascular risk assessment algorithen using high-sensitivity C-reaktive Protein and Lipid Scorering. Clinical Chemistry 47: 28 – 30
[30] Saikku P, Leinonen M, Tenkanen L, Ekman MR, Linnanmärki E, Manninen V, Mänttäri M, Frick MM, Huttunen JK (1992) Chronic Chlamydia pneumonoae infection as a risk factor for coronary heart disease in the Helsinki Heart Study Ann Int Med 116; 273-278
[31] Scarabin PY, Arveiler D, Amouyel P (2003) Plasma fibrinogen explains much of the difference in risk of coronary heart disease between France an Northern Ireland: the PRIME study. Atherosclerosis, 1666, 103 – 109
[32] Schulte H, Cullen P, Assmann G (1999) Obesity, mortality and cardiovascular disease in the Münster Heart Study (PROCAM). Atherosclerosis, 144, 199 – 209
[33] Stuveling E.M. HHL, Bakker S.J.L.,Gansevoort R.T.,Gans R.O.B.,de Zeeuw D.,de Jong P. (2003) Urinary albumin excretion and C-reactive protein independently add to the mortality risk. J.Am.Soc.Nephrol. 14:679a
[34] Swiss Atherosclerosis Association, Arbeitsgruppe Lipide und Atherosklerose (AGLA):
AGLA-Risikorechner. www.agla.ch/risikoberechnung/agla-risikorechner
[35] UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet; 332, 837 – 853
[36] U.S. Department of health and human services, puplic health service, national institute of health, national cancer institute (2001) Risk associated with smoking. Monography 13 http://www.krebsgesellschaft.de/downlowd/RisksAssociatedwithSmoking.pdf
[37] Wachtell K, Ibsen H, Olsen MH, Borch-Johnsen K, Lindholm LH, Mogensen CE, Dahlof B, Devereux RB, Beevers G, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Kristianson K, Lederballe-Pedersen O, Nieminen MS, Okin PM, Omvik P, Oparil S, Wedel H, Snapinn SM, Aurup P (2003) Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med 139:901-906
[38] Wang TJ, Larson MG, Levy D (2002) C-reactive protein is associated with subclinical epicardial coronary caldivication in men and women: the Framingham heart Study. Circulation, 106, 1189 – 1191
[39] Welborn TA, Dhaliwal SS, Bennett SA (2003) Waist-hip ratio is the dominant riskfactor predicting kardiovascular risk in Austria. M. J. A. 179, 580 – 585
[40] Yusuf S (2004) Effect of protencially modificable risk factors associated with myocardial infarction in 52 countries (the INTERHAERT study): chase control study. Lancet 364, 937 – 952
[41] Yusuf, S (2005) Obesity and the risk of myocardial infarction in 27000 parcipitens from 52 countries: access control-study. Lancet, 366, 1640 – 1649