title: Change in cardiometabolic score and incidence of cardiovascular disease: the multi-ethnic study of atherosclerosis.
abstract: OBJECTIVE
  Examine the relationship between changes in cardiometabolic risk profiles and subsequent cardiovascular disease (CVD).
  
  
  METHODS
  The study sample included 5557 Multi-Ethnic Study of Atherosclerosis participants, recruited in 2000 from six U.S. counties. Standardized scores were calculated for metabolic and cardiovascular components relative to accepted clinical cut points and summed to create an index of cardiometabolic risk. CVD events and/or deaths were assessed after examination 3 (years, 2004-2005) through December 2011. Cox proportional hazards models were used to examine the association between change in the cardiometabolic index (examination 3 minus examination 1) and subsequent cardiovascular outcomes adjusted for demographics, socioeconomic status, medication, and stratified by tertiles of baseline cardiometabolic risk.
  
  
  RESULTS
  We found a 31% relative increase in the CVD event rate per SD change in the cardiometabolic index among those in the highest tertile of baseline cardiometabolic risk (Hazard ratio = 1.31, 95% CI = 1.14-1.50); associations were not statistically significant in the lower tertiles of baseline risk.
  
  
  CONCLUSIONS
  We found that larger increases in the cardiometabolic index over time were significantly associated with higher risk for subsequent CVD events among those with elevated cardiometabolic risk at baseline. These findings highlight the importance of monitoring temporal changes in risk factor profiles for predicting cardiovascular outcomes.
authors.affiliation: Division of Geriatrics, Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: smerkin@mednet.ucla.edu.
authors.forename: Sharon Stein
authors.initials: SS
authors.lastname: Merkin
authors.affiliation: Division of Geriatrics, Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Arun
authors.initials: A
authors.lastname: Karlamangla
authors.affiliation: Department of Medicine Statistics Core, Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
authors.affiliation: Department of Medicine Statistics Core, Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Tristan
authors.initials: T
authors.lastname: Grogan
authors.affiliation: Division of Geriatrics, Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Seeman
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data
keywords: Cardiometabolic index; Cardiovascular disease