Framingham score and LV mass predict events in young adults: CARDIA study

• Published in: International journal of cardiology Vol. 172; no. 2; pp. 350 - 355
• Main Authors: Armstrong, Anderson C, Jacobs, David R, Gidding, Samuel S, Colangelo, Laura A, Gjesdal, Ola, Lewis, Cora E, Bibbins-Domingo, Kirsten, Sidney, Stephen, Schreiner, Pamela J, Williams, O.D, Goff, David C, Liu, Kiang, Lima, Joao A.C
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 15.03.2014; Elsevier
• Subjects: Adult; Algorithms; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Black People; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - ethnology; Cardiovascular Diseases - etiology; Cardiovascular risk; Cardiovascular system; Echocardiography; Female; Follow-Up Studies; Heart; Humans; Hypertrophy, Left Ventricular - complications; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - ethnology; Incidence; Investigative techniques, diagnostic techniques (general aspects); Left ventricular hypertrophy; Longitudinal Studies; Male; Medical sciences; Predictive Value of Tests; Prevalence; Risk Assessment; Risk Factors; Sex Factors; Ultrasonic investigative techniques; United States - epidemiology; White People; Young adults; United States; Young adults; Echocardiography; Cardiovascular risk; Left ventricular hypertrophy; Sonography; Human; Prediction; Cardiovascular disease; Left ventricle; Vascular disease; Mass; Young adult; Atherosclerosis; Risk factor; Tumor; Cardiology; Predictive factor; Hypertrophy
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2014.01.003

Abstract Background Framingham risk score (FRS) underestimates risk in young adults. Left ventricular mass (LVM) relates to cardiovascular disease (CVD), with unclear value in youth. In a young biracial cohort, we investigate how FRS predicts CVD over 20 years and the incremental value of LVM. We also explore the predictive ability of different cut-points for hypertrophy. Methods We assessed FRS and echocardiography-derived LVM (indexed by body surface area or height2.7 ) from 3980 African–American and white Coronary Artery Risk Development in Young Adults (CARDIA) participants (1990–1991); and followed over 20 years for a combined endpoint: cardiovascular death; nonfatal myocardial infarction, heart failure, cerebrovascular disease, and peripheral artery disease. We assessed the predictive ability of FRS for CVD and also calibration, discrimination, and net reclassification improvement for adding LVM to FRS. Results Mean age was 30 ± 4 years, 46% males, and 52% white. Event incidence ( n = 118) across FRS groups was, respectively, 1.3%, 5.4%, and 23.1% ( p < 0.001); and was 1.4%, 1.3%, 3.7%, and 5.4% ( p < 0.001) across quartiles of LVM (cut-points 117 g, 144 g, and 176 g). LVM predicted CVD independently of FRS, with the best performance in normal weight participants. Adding LVM to FRS modestly increased discrimination and had a statistically significant reclassification. The 85th percentile (≥ 116 g/m2 for men; ≥ 96 g/m2 for women) showed event prediction more robust than currently recommended cut-points for hypertrophy. Conclusion In a biracial cohort of young adults, FRS and LVM are helpful independent predictors of CVD. LVM can modestly improve discrimination and reclassify participants beyond FRS. Currently recommended cut-points for hypertrophy may be too high for young adults.