Aims The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40–69 years in Europe. Methods and results  We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65–0.68) to 0.81 (0.76–0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. Conclusion  SCORE2—a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations—enhances the identification of individuals at higher risk of developing CVD across Europe.

Background: Sex differences are known to exist in the management of older patients presenting with acute myocardial infarction (AMI). Few studies have examined the incidence and risk factors of AMI among young patients, or whether clinical management differs by sex. Methods: The Atherosclerosis Risk in Communities (ARIC) Surveillance study conducts hospital surveillance of AMI in 4 US communities (MD, MN, MS, and NC). AMI was classified by physician review, using a validated algorithm. Medications and procedures were abstracted from the medical record. Our study population was limited to young patients aged 35-54 years. Results: From 1995-2014, 28,732 weighted hospitalizations for AMI were sampled among patients aged 35-74. Of these, 8,737 (30%) were young. The annual incidence of AMI hospitalizations increased for young women but decreased for young men. The overall proportion of AMI admissions attributable to young patients steadily increased, from 27% in 1995-1999 to 32% in 2010-2014 (P for trend =0.002), with the largest increase observed in young women. History of hypertension (59% to 73%, P for trend<0.0001) and diabetes mellitus (25% to 35%, P for trend<0.0001) also increased among young AMI patients. Compared to young men, young women presenting with AMI were more often black and had a greater comorbidity burden. In adjusted analyses, young women had a lower probability of receiving lipid-lowering therapies (RR = 0.87; 95% CI: 0.80-0.94), non-aspirin antiplatelets (RR = 0.83; 95% CI: 0.75-0.91), beta blockers (RR = 0.96; 95% CI: 0.91-0.99), coronary angiography (RR = 0.93; 95% CI: 0.86-0.99) and coronary revascularization (RR = 0.79; 95% CI: 0.71-0.87). However, 1-year all-cause mortality was comparable for women vs. men (HR=1.10; 95% CI: 0.83-1.45). Conclusion: The proportion of AMI hospitalizations attributable to young patients increased from 1995-2014 and was especially pronounced among women. History of hypertension and diabetes among young patients admitted with AMI increased over time as well. Compared with young men, young women presenting with AMI had a lower likelihood of receiving guidelinebased AMI therapies. A better understanding of factors underlying these changes is needed to improve care of young patients with AMI.

Background Although HF disproportionately affects older adults, little data exist regarding the prevalence of American College of Cardiology/American Heart Association heart failure (HF) stages among older individuals in the community. Additionally, the role of contemporary measures of longitudinal strain (LS) and diastolic dysfunction in defining HF stages is unclear. Methods HF stages were classified in 6,118 participants in the Atherosclerosis Risk in Communities study (age 67 – 91 years) at the fifth study visit as follows: stage A (asymptomatic with HF risk factors but no cardiac structural or functional abnormalities), B (asymptomatic with structural abnormalities, defined as left ventricular hypertrophy, dilation or dysfunction, or significant valvular disease), C1 (clinical HF without prior hospitalization), and C2 (clinical HF with prior hospitalization). Results Using the traditional definitions of HF stages, only 5% of examined participants were free of HF risk factors or structural heart disease (Stage 0), 52% were categorized as Stage A, 30% Stage B, 7% Stage C1, and 6% Stage C2. Worse HF stage was associated with a greater risk of incident HF hospitalization or death at a median follow-up of 608 days. LVEF was preserved in 77% and 65% in Stages C1 and C2 respectively. Incorporation of LS and diastolic dysfunction into the Stage B definition reclassified 14% of the sample from Stage A to B and improved the net reclassification index (p=0.028) and integrated discrimination index (p=0.016). Abnormal LV structure, systolic function (based on LVEF and LS), and diastolic function (based on e′, E/e′, and left atrial volume index) were each independently and additively associated with risk of incident HF hospitalization or death in Stage A and B participants. Conclusions The majority of older adults in the community are at risk for HF (Stages A or B), appreciably more compared to previous reports in younger community-based samples. LVEF is robustly preserved in at least two-thirds of older adults with prevalent HF (Stage C), highlighting the burden of HFpEF in the elderly. LV diastolic function and LS provide incremental prognostic value beyond conventional measures of LV structure and LVEF in identifying persons at risk for HF hospitalization or death.

PURPOSE An association of low plasma HDL-cholesterol with risk of breast cancer has been suggested by multiple studies; the evidence, however, is not conclusive. We examined the possible association of low HDL-cholesterol with incidence of breast cancer using data from the Atherosclerosis Risk in Communities Study (ARIC) cohort, a prospective study of a randomly selected sample of women and men from four US communities. METHODS Among 7,575 female members of the ARIC cohort, 359 cases of incident breast cancer were ascertained during the follow-up from 1987 through 2000. In analysis adjusted for age, race, body mass index, smoking, and reproductive variables we observed no association of low baseline HDL-cholesterol (<50 mg/dL) with incident breast cancer in the total sample (HR=1.08(95% CI 0.84, 1.40)) and a modest association (HR=1.67 (95% CI 1.06, 2.63) among women who were pre-menopausal at baseline. No association was observed among women who were post-menopausal at baseline. Removal from analysis of the first five years of follow-up did not appreciably change the observed associations. CONCLUSION Results of our study suggest that low HDL-cholesterol among pre-menopausal women may be a marker of increased breast cancer risk.