title: Risk Estimates for Atherosclerotic Cardiovascular Disease in Adults With Congenital Heart Disease.
abstract: The adult with congenital heart disease (CHD) is at risk of developing atherosclerotic cardiovascular disease (ASCVD). We performed a cross-sectional study to describe established ASCVD risk factors and estimate 10-year and lifetime risk of ASCVD in adults over age 18 with CHD of moderate or great complexity using 3 validated risk assessment tools-the Framingham Study Cardiovascular Disease Risk Assessment, the Reynolds Risk Score, and the ASCVD Risk Estimator. We obtained extensive clinical and survey data on 178 enrolled patients, with average age 37.1 ± 12.6 years, 51% men. At least 1 modifiable ASCVD risk factor was present in 70%; the 2 most common were overweight/obesity (53%) and systemic hypertension (24%). Laboratory data were available in 103 of the 178 patients. Abnormal levels of glycated hemoglobin, high-sensitivity C-reactive protein, and high-density lipoprotein were each found in around 30% of patients. The 10-year ASCVD predicted risk using all 3 tools was relatively low (i.e., at least 90% of patients <10% risk), yet the median estimated lifetime risk was 36%. In conclusion, ASCVD risk factors are prevalent in adults with CHD. The risk estimation tools suggest that this population is particularly vulnerable to ASCVD with aging and should undergo guideline-based screening and management of modifiable risk factors.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California; Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California; Stanford Children's Health Research Institute, Palo Alto, California; Stanford Cardiovascular Institute, Palo Alto, California. Electronic address: glui@stanford.edu.
authors.forename: George K
authors.initials: GK
authors.lastname: Lui
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California; Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California; Stanford Cardiovascular Institute, Palo Alto, California.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Rogers
authors.affiliation: Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, California.
authors.forename: Victoria Y
authors.initials: VY
authors.lastname: Ding
authors.affiliation: Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, California.
authors.forename: Haley K
authors.initials: HK
authors.lastname: Hedlin
authors.affiliation: Stanford University, Spectrum Child Health, Center for Clinical and Translational Research and Education, Palo Alto, California.
authors.forename: Kirstie
authors.initials: K
authors.lastname: MacMillen
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.affiliation: Lucile Packard Children's Hospital, Children's Heart Center, Palo Alto, California.
authors.forename: Christy
authors.initials: C
authors.lastname: Sillman
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California; Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Anitra
authors.initials: A
authors.lastname: Romfh
authors.affiliation: Stanford Health Care, Palo Alto, California.
authors.forename: Tara C
authors.initials: TC
authors.lastname: Dade
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California; Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Christiane
authors.initials: C
authors.lastname: Haeffele
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Stafford R
authors.initials: SR
authors.lastname: Grady
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Murphy
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California; Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California; Stanford Children's Health Research Institute, Palo Alto, California; Stanford Cardiovascular Institute, Palo Alto, California.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Fernandes
mesh_terms: D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D050197:Atherosclerosis / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D002648:Child; D003324:Coronary Artery Disease / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors