Miller School Researchers Design A New Model For Global Vascular Risk And Prevention

Main Category: Vascular
Also Included In: Cardiovascular / Cardiology;  Stroke;  Heart Disease
Article Date: 01 Dec 2009 - 4:00 PST

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Cardiovascular diseases and stroke remain the number one and number three killers in the United States, and finding ways to reduce risk and prevent disease onset is essential. Few risk models are currently available that predict heart attack, stroke, or vascular death in an ethnically diverse population, and most models do not fully include behavioral risk factors.

Researchers from the University of Miami Miller School of Medicine and Columbia University have constructed a model that addresses both issues and have published the details in the December 8 issue of the Journal of the American College of Cardiology.

"There are a number of tools to estimate risk of coronary heart disease alone, or stroke alone, but few risk prediction models exist for combined vascular outcomes along the wide spectrum of cardiovascular diseases," said Ralph Sacco, M.D., professor and chair of neurology at the Miller School, lead author of the study, and president-elect of the American Heart Association.

"The goal of primary prevention of cardiovascular disease should be to prevent both stroke and cardiac events. This is especially important because most of our preventative medications, such as antiplatelet agents and statins, prevent heart attack and stroke."

In constructing the model the researchers used a subset of participants from the Northern Manhattan Study (NOMAS), the pioneering study that examines risk factors, occurrence, and outcome of stroke and other vascular diseases in Northern Manhattan's multiethnic population.

Currently the Framingham-based models are the most widely studied tools, but they do not include many behavioral issues or body measurement indexes. The newly constructed model includes alcohol consumption and physical activity, along with waist circumference rather than body mass index. In addition, the researchers included fasting blood sugar as a measure instead of diabetes, and blood pressure instead of hypertension.

The study group consisted of 2,737 participants free of stroke and known coronary artery disease. The majority were women (63.2%), and 52.7% were Hispanic, 24.9% were African American, and 19.9% were white, and all were at least 40 years of age. They were followed for an average of nine years. During that time there were 166 ischemic strokes, 24 hemorrhagic strokes, 158 heart attacks, and 314 vascular deaths.

"We need to increase our efforts to prevent cardiac disease and stroke, especially in high-risk disadvantaged populations," said Dr. Sacco. "Our model allows someone of any race or ethnic group to estimate the 10-year risk of a stroke, heart attack or vascular death based on a variety of factors. It is essential that people know their individual global vascular risk and work on ways to personally prevent heart attack, stroke or vascular death."

This work was supported by a Javits Investigator award from the National Institute on Neurological Disorders and Stroke, part of the National Institutes of Health. The research was conducted at Columbia University and the University of Miami.

Source
University of Miami Miller School of Medicine