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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
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L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Reclassification of the intermediate group classified according to HEARTSCORE taking in consideration individual genetic predisposition to CAD
Session:
CO4 - Prevenção / Reabilitação
Speaker:
Andreia Pereira
Congress:
CPC 2019
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Andreia Pereira; Maria Isabel Mendonça; Joao Adriano Sousa; Flávio Mendonça; Joel Monteiro; Micaela Rodrigues Neto; Ana Célia Sousa; Eva Henriques; Mariana Rodrigues; Sofia Borges; Ana Isabel; Ilídio Ornelas; A. Drumond de Freitas; Roberto Palma dos Reis
Abstract
<p><strong>Introduction:</strong> Cardiovascular risk stratification has included traditional cardiovascular risk factors (TRF) including smoking, diabetes and hypertension adjusted to age and sex. The utility of genetic risk scores (GRS) as predictors of cardiovascular risk remains inconclusive.</p> <p><strong>Objective:</strong> Evaluate the ability of a multi-locus GRS within the intermediate risk subgroup, defined by the European Heart score, to provide additive power to predict coronary artery disease (CAD).</p> <p><strong>Methods:</strong> After applying European SCORE (ES) stratification to a total population of 2703 Portuguese individuals, 639 individuals with 59.0 ± 4.3 years were considered to be at intermediate risk subgroup (2<ES<9). A Multiplicative GRS based on 33 genes associated with CAD was determined in the whole population. Multivariate analysis and respective ROC curves and Area Under Curve (AUC) were performed using the TRF and GRS. ROC Curves were compared with DeLong test and Net Reclassification Index (NRI) was determined using R (version 3.2.0).</p> <p><strong>Results:</strong> GRS was an independent predictor for CAD (OR=2.41; p<0.0001). Smoking (OR=3.15; p<0.0001), Diabetes (OR=3.19; p<0.0001), hypertension (OR=2.20; p=0.003) were also significantly associated with CAD. AUC increased from 0.694 to 0.734 after adding GRS to TRF. When discriminated by tertiles of GRS, the AUC for TRF was maximum for the 2nd GRS tertile [AUC (TRF)=0.734] and lower for the 1st and 3rd tertiles (AUC =0.673 and AUC =0.671, respectively). NRI showed better increase in the intermediate risk subgroup with 35.2% interpreted as the proportion of patients reclassified to a more appropriate risk category, and 29.4% on the lower risk subgroup.</p> <p><strong>Conclusion:</strong> In our population, the GRS increased the predictive value of TRF in the subgroup of patients at intermediate risk by the European Score. The predictive value of TRF is lower in patients with higher GRS. In this subgroup, the inclusion of genotyping may be considered for better stratification of cardiovascular risk.</p>
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