Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study

Orozco-Beltrán, Domingo; Gil-Guillén, Vicente; Redón, Josep; Martín-Moreno, José M.; Pallarés‐Carratalá, Vicente; Navarro-Pérez, Jorge; Valls-Roca, Francisco; Sanchis-Domènech, Carlos; Fernández-Giménez, Antonio; Perez-Navarro, Ana María; Bertomeu‐Martínez, Vicente; Bertomeu‐González, Vicente; Cordero, Alberto; Torre, Manuel Pascual de la; Trillo, J.L.; Carratalá‐Munuera, Concepción; Pita-Fernández, Salvador; Uso, Ruth; Durazo‐Arvizu, Ramón; Cooper, Richard S.; Sanz, Ginés; Castellano, José María; Ascaso, Juan F.; Carmena, Rafael; Téllez-Plaza, María

doi:10.1371/journal.pone.0186196

Cited by 79 publications

(53 citation statements)

References 38 publications

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“…In many studies, increased serum lipids and lipoproteins are associated with a higher risk of total and cardiac mortality 27‐35 . However, absence of an association, or even an inverse association, has been reported, 5‐7 especially with increasing age 26,36 .…”

Section: Discussionmentioning

confidence: 99%

Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a* Study on Heart Disease

Berton

Cordiano²,

Mahmoud

et al. 2020

Int J Clin Pract

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Background The relationship between baseline plasma lipid levels during acute coronary syndrome and the outcome has clinical relevance. Methods To evaluate their long‐term prognostic value, we examined 589 patients admitted with acute coronary syndrome at three hospitals. Baseline plasma lipids were assessed on days 1 and 7. Patients were followed for 20 years or until death. Results Virtually, all patients completed follow‐up; 437 (74%) had died: 24% from coronary artery disease/heart failure (CAD/HF), 21% sudden cardiac death (SCD), 16% from other cardiovascular causes and 39% had non‐cardiac death. The incidence rate (IR) of all‐cause mortality was not different among patients with baseline plasma lipids less or greater than the median value. The IR of CAD/HF mortality was not significantly higher among patients with greater than median low‐density lipoprotein (LDL) cholesterol and triglyceride (TG) levels. The IR of non‐cardiac death tended to be lower among patients with greater than median total cholesterol (TC) and LDL levels. Using three levels of adjusted Cox survival models, baseline plasma lipids had no consistent independent or inverse association with all‐cause mortality, even after excluding patients who received statins. Competitive risk survival models for each cause of death revealed that the only hazard of non‐cardiac death was consistently higher among patients with less than or equal to median TC and LDL levels. Conclusion In the present prospective long‐term study, after acute coronary syndrome, baseline plasma lipid levels seem not to be associated with long‐term global mortality. Only an independent inverse association between TC and LDL and non‐cardiac death has been observed.

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Section: Discussionmentioning

confidence: 99%

Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a* Study on Heart Disease

Berton

Cordiano²,

Mahmoud

et al. 2020

Int J Clin Pract

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“…We designed an analytical observational study of the ESCARVAL RISK clinical practice cohort, following patients in primary care from January 2008 to December 2012. The study cohort consisted of patients aged 40 years or older and diagnosed with hypertension, dyslipidaemia, or diabetes.…”

Section: Methodsmentioning

confidence: 99%

“…We designed an analytical observational study of the ESCARVAL RISK clinical practice cohort, 29 Hospitalisations and CVD mortality were assessed by reviewing hospital records and annual mortality data during follow-up.…”

Section: Materials S and Me Thodsmentioning

confidence: 99%

Machine learning to predict cardiovascular risk

et al. 2019

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Aims To analyse the predictive capacity of 15 machine learning methods for estimating cardiovascular risk in a cohort and to compare them with other risk scales. Methods We calculated cardiovascular risk by means of 15 machine‐learning methods and using the SCORE and REGICOR scales and in 38 527 patients in the Spanish ESCARVAL RISK cohort, with 5‐year follow‐up. We considered patients to be at high risk when the risk of a cardiovascular event was over 5% (according to SCORE and machine learning methods) or over 10% (using REGICOR). The area under the receiver operating curve (AUC) and the C‐index were calculated, as well as the diagnostic accuracy rate, error rate, sensitivity, specificity, positive and negative predictive values, positive likelihood ratio, and number needed to treat to prevent a harmful outcome. Results The method with the greatest predictive capacity was quadratic discriminant analysis, with an AUC of 0.7086, followed by Naive Bayes and neural networks, with AUCs of 0.7084 and 0.7042, respectively. REGICOR and SCORE ranked 11th and 12th, respectively, in predictive capacity, with AUCs of 0.63. Seven machine learning methods showed a 7% higher predictive capacity (AUC) as well as higher sensitivity and specificity than the REGICOR and SCORE scales. Conclusions Ten of the 15 machine learning methods tested have a better predictive capacity for cardiovascular events and better classification indicators than the SCORE and REGICOR risk assessment scales commonly used in clinical practice in Spain. Machine learning methods should be considered in the development of future cardiovascular risk scales.

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“…Metabolic syndrome, obesity and type II diabetes mellitus all strongly increase the risk of cardiovascular disease [3]. Changes in body composition (i.e., greater fat mass, larger amounts of visceral adipose tissue, and less lean mass) [4], hypertension [5], impaired glucose metabolism (i.e., the development of insulin resistance) [6], altered lipid metabolism (i.e., raised plasma triglycerides, total cholesterol and low-density lipoprotein cholesterol [LDL-C], and reduced high-density lipoprotein cholesterol [HDL-C]) [7], low cardiorespiratory fitness [8], and an unhealthy lifestyle [9] all increase this risk.…”

Section: Introductionmentioning

confidence: 99%

Exercise Training as a Treatment for Cardiometabolic Risk in Sedentary Adults: Are Physical Activity Guidelines the Best Way to Improve Cardiometabolic Health? The FIT-AGEING Randomized Controlled Trial

Amaro‐Gahete¹,

De-la-O

Martínez-Téllez

et al. 2019

JCM

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This 12-week randomized controlled trial investigates the effects of different training modalities on cardiometabolic risk in sedentary, middle-aged adults, and examines whether alterations in cardiometabolic risk are associated with changes in those health-related variables that are modifiable by exercise training. The study subjects were 71 middle-aged adults (~54 years old;~50% women) who were randomly assigned to one of the following treatment groups: (1) no exercise (control group), (2) concurrent training based on international physical activity recommendations (PAR group), (3) high intensity interval training (HIIT) group, or (4) HIIT plus whole-body electromyostimulation (HIIT+EMS group). A cardiometabolic risk score was calculated based on the International Diabetes Federation's clinical criteria. A significant reduction in cardiometabolic risk was observed for all exercise training groups compared to the control group (all p < 0.05), which persisted after adjusting potential confounders (all p < 0.05). However, the HIIT+EMS group experienced the most significant reduction (p < 0.001). A significant inverse relationship was detected between the change in lean mass and the change in cardiometabolic risk (p = 0.045). A 12-week exercise training programs-especially the HIIT+EMS program-significantly reduced cardiometabolic risk in sedentary, middle-aged adults independent of sex, age, and cardiorespiratory fitness.

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Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study

Cited by 79 publications

References 38 publications

Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a* Study on Heart Disease

Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a* Study on Heart Disease

Machine learning to predict cardiovascular risk

Exercise Training as a Treatment for Cardiometabolic Risk in Sedentary Adults: Are Physical Activity Guidelines the Best Way to Improve Cardiometabolic Health? The FIT-AGEING Randomized Controlled Trial

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