Subclinical atherosclerosis, cardiovascular health, and disease risk: is there a case for the Cardiovascular Health Index in the primary prevention population?
Open accessAbstract
BACKGROUND: Current primary prevention guidelines for cardiovascular disease (CVD) prioritize risk identification, risk stratification using clinical and risk scores, and risk reduction with lifestyle interventions and pharmacotherapy. Subclinical atherosclerosis is an early indicator of atherosclerotic burden and its timely recognition can slow or prevent progression to CVD. Thus, individuals with subclinical atherosclerosis are a priority for primary prevention. This study takes a practical approach to answering a challenge commonly faced by primary care practitioners: in patients with no known CVD, how can individuals likely to have subclinical atherosclerosis be easily identified using existing clinical data and/or information provided by the patient? METHODS: Using NHANES (1999-2004), 6091 men and women aged ≥40 years without any CVD comprised the primary prevention population for this study. Subclinical atherosclerosis was determined via ankle-brachial index (ABI) using established cutoffs (subclinical atherosclerosis defined as ABI (0.91-0.99); normal defined as ABI (1.00-1.30)). Three common scores were calculated: the Framingham Risk Score (FRS), the Metabolic Syndrome (MetS), and the Cardiovascular Health Index (CVHI). Logistic regression analysis assessed the association between these scores and subclinical atherosclerosis. The sensitively and specificity of these scores in identifying subclinical atherosclerosis was determined. RESULTS: In eligible participants, 3.8% had subclinical atherosclerosis. Optimum and average CVHI was associated with decreased odds for subclinical atherosclerosis. High, but not intermediate-risk, FRS was associated with increased odds for subclinical atherosclerosis. MetS was not associated with subclinical atherosclerosis. Of the 3 scores, CVHI was the most sensitive in identifying subclinical atherosclerosis and had the lowest number of missed cases. The FRS was the most specific but least sensitive of the 3 scores, and had almost 10-fold more missed cases vs. the CVHI. The MetS had "middle" sensitivity and specificity, and 10-fold more missed cases vs. the CVHI. CONCLUSIONS: Results from this study suggest that routine administration of the CVHI in a primary prevention population would yield the benefits of identifying patients with existing subclinical CVD not identified through traditional CVD risk factors or scores, and bring physical activity and nutrition to the forefront of provider-patient discussions about lifestyle factors critical to maintaining and prolonging cardiovascular health.
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The association between serum TG and subclinical atherosclerosis can be used to identify those individuals in the greatest need of primary prevention measures to halt atherosclerosis and thus prevent transition to manifest disease.
“The association between serum TG and subclinical atherosclerosis can be used to identify those individuals in the greatest need of primary prevention measures to halt atherosclerosis and thus prevent transition to manifest disease (21).”
From Triglycerides and residual atherosclerotic risk (2021) · cites this paper as [21]
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Pathophysiology, Diagnosis and Prevention of Subclinical Atherosclerosis
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- Authors
- Singh, S. S., Pilkerton, C. S., Shrader, C. D., & Frisbee, S. J.
- Affiliations
- Western University (CA)
- West Virginia University (US)
- Corresponding author
- Frisbee, Stephanie J.
- Venue
- BMC Public Health
- Published
- 2018-04-02
- Volume
- 18
- Issue
- 1
- Pages
- 429-429
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC5880087
- OpenAlex
- W2803662755
- Cited by
- 53
- References
- 51
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 6 · 2023: 7 · 2022: 2 · 2021: 20 · 2020: 3 · 2019: 4 · 2018: 1
- FWCI
- 5.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- The Research Repository @ WVU (West Virginia University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- subclinical atherosclerosis, primary prevention, cardiovascular risk score, Framingham risk score, metabolic syndrome, ankle-brachial index, risk stratification, sensitivity and specificity, cardiovascular disease
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Cardiovascular System, Female, Health Status Indicators, Humans, Male, Middle Aged, Primary Prevention, Risk Factors, Atherosclerosis
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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