Established and New Risk Scores Both Accurately Predict Subclinical Atherosclerosis

The established ideal cardiovascular health score (ICHS) and the new Fuster-BEWAT score (FBS) predict the presence and extent of subclinical atherosclerosis with similar accuracy, according to an analysis from the PESA study. The Fuster-BEWAT score does not require laboratory tests. The findings were published Nov. 13 in the Journal of the American College of Cardiology.

Juan Miguel Fernandez-Alvira, PhD, et al., compared the established ICHS and the newly devised FBS in 3,983 asymptomatic participants without cardiovascular disease in the PESA study to determine their predictive accuracy of the presence and extent of subclinical atherosclerosis. The presence of subclinical atherosclerosis in the abdominal aorta, left carotid arteries, iliofemoral arteries and coronary arteries was determined with noninvasive vascular imaging tests. Subclinical atherosclerosis was defined as the presence of atherosclerotic plaque or coronary artery calcification score (CACS) ≥1.

Using both the ICHS and FBS, participants were classified as having poor, intermediate or ideal cardiovascular health. Each of the seven ICHS components (exercise, body mass index, diet, smoking status, blood pressure, serum cholesterol and fasting glucose) and five FBS components (blood pressure, exercise, weight, alimentation and tobacco) were classified as ideal or non-ideal. The participants were classified as having poor, intermediate or ideal cardiovascular health based on the total number of ideal components (ICHS: 0-2 ideal, 3-5 intermediate, 6-7 ideal; FBS: 0-1 poor, 2-3 intermediate, 4-5 ideal).

All ICHS and FBS components were ideal in 3.2 percent and 6.5 percent of participants, respectively. Most patients had intermediate cardiovascular health based on the ICHS (71.7 percent) and the FBS (61.2 percent).

A strong inverse association between ICHS and FBS classification and subclinical atherosclerosis was found. The adjusted odds ratios (ORs) for plaque presence were significantly lower among participants with scores that were intermediate (ICHS, p < 0.001; FBS, p = 0.001) or ideal (ICHS, p < 0.001; FBS, p < 0.001) vs. those with poor scores. The ORs for CACS ≥1 were significantly lower with intermediate (ICHS, p < 0.001; FBS, p = 0.014) or ideal (ICHS, p < 0.001; FBS, p < 0.001) scores vs. poor scores. Both scores were similarly associated with the extent of subclinical atherosclerosis.

Area under the curve (AUC) analyses found similar accuracy of ICHS and FBS for predicting the presence of plaque or CACS ≥1 and generalized subclinical atherosclerosis.

The results of these analyses demonstrate good and comparable predictive values with both scores for all outcomes in this cohort. "While the ICHS and the FBS show a similar predictive value for detecting subclinical disease, the FBS is simpler and does not need laboratory results. Therefore, it may be considered as a first option in settings where access to laboratory analysis is limited," the investigators concluded.

In a related editorial, Roger S. Blumenthal, MD, FACC, et al, wrote, "In resource-poor settings, it is promising to see that simple risk tools appear capable of doing the 'heavy lifting' with regards to risk prediction and lifestyle modification." However, "further research is needed to confirm the utility of the Fuster-BEWAT Score in long-term outcomes studies," the reviewers concluded.


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