title: Effective risk stratification in patients with moderate cardiovascular risk using albuminuria and atherosclerotic plaques in the carotid arteries.
abstract: OBJECTIVE
  The aim of this study was to investigate whether subclinical vascular damage improved traditional risk prediction, reclassifying individuals with regard to primary prevention.
  
  
  METHODS
  Two thousand and fifty-nine healthy individuals aged 41, 51, 61, and 71 years were divided into age, Systematic COronary Risk Evaluation (SCORE), and Framingham risk score (FRS) groups. Subclinical vascular damage was defined as carotid-femoral pulse wave velocity at least 12 m/s, and carotid atherosclerotic plaques or urine albumin/creatinine ratio (UACR) at least 90th percentile of 0.73/1.06 mg/mmol in men/women. The composite endpoint of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for ischemic heart disease was recorded (n = 229).
  
  
  RESULTS
  Both elevated UACR (P = 0.002) and atherosclerotic plaques (P < 0.0001) identified a subgroup of moderate SCORE risk patients and high-intermediate FRS risk patients with high risk (P = 0.04 and P = 0.001, respectively), whereas elevated carotid-femoral pulse wave velocity did not. Elevated UACR or presence of atherosclerotic plaques reclassified patients from moderate to high SCORE risk [net reclassification improvement of 6.4%; P = 0.025), or from high intermediate to high FRS risk (net reclassification improvement 8.8%; P = 0.002). Assuming primary prevention could reduce the relative cardiovascular risk by 24-27%, on the basis of actual levels of blood pressure and cholesterol, one composite endpoint could be avoided by giving primary prevention to 19 or 24 reclassified patients found by screening 52 or 104 patients with high-intermediate FRS or moderate SCORE risk, respectively.
  
  
  CONCLUSIONS
  Elevated UACR and presence of atherosclerotic plaques could in a potentially cost-effective manner identify patients with moderate SCORE risk or high-intermediate FRS with actual high cardiovascular risk who will benefit from primary prevention.
authors.affiliation: aCardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Odense University Hospital bDepartment of Cardiology, Herlev University Hospital cDepartment of Diagnostic Imaging, Gentofte University Hospital dResearch Centre for Prevention and Health eDepartment of Cardiology, Gentofte University Hospital, Denmark fHypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
authors.forename: Sara V
authors.initials: SV
authors.lastname: Greve
authors.forename: Marie K
authors.initials: MK
authors.lastname: Blicher
authors.forename: Thomas
authors.initials: T
authors.lastname: Sehestedt
authors.forename: Eva-Marie
authors.initials: EM
authors.lastname: Gram-Kampmann
authors.forename: Susanne
authors.initials: S
authors.lastname: Rasmussen
authors.forename: Julie K K
authors.initials: JK
authors.lastname: Vishram
authors.forename: Michael H
authors.initials: MH
authors.lastname: Olsen
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications* / Q000503:physiopathology; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D002339:Carotid Arteries; D002340:Carotid Artery Diseases / Q000150:complications* / Q000503:physiopathology; D003404:Creatinine / Q000652:urine; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000503:physiopathology; D011322:Primary Prevention; D063177:Pulse Wave Analysis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D003404:Creatinine