Implementation of a Cardiopsychiatry Clinic for Cardiovascular Primary Prevention in Individuals with Severe Mental Illness.

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

Recognizing Pregnancy-Associated Cardiovascular Risk Factors

Background: Research on the health impact of the built environment has focused on health behaviors such as diet and exercise, and conditions such as obesity and diabetes. Few studies have examined its influence on downstream outcomes such as cardiovascular disease. We investigated the proportional variance in the 10-year and 30-year Framingham risk score (FRS) attributable to neighborhoods in the Framingham Heart Study. Methods: Offspring- and Generation 3 cohort members’ homes at the time of exam 7 (Offspring, 1998-2001) or exam 1 (Generation 3, 2002-2005) were geocoded to 2000 Census block groups. We evaluated Framingham Offspring and Generation 3 cohort participants inhabiting private residences in block groups within Massachusetts containing the residences of 5 or more participants. Analyses of the 10-year FRS were further restricted to participants aged 30-74 at the time of the relevant exam and those of the 30-year FRS to participants 20-59 years old. Cardiovascular risk was determined on the bases of sex, age, systolic blood pressure, anti-hypertensive medication, smoking, diabetes, total cholesterol, and HDL. The outcomes were the standardized residuals of log-transformed FRS regressed on age and sex. We analyzed the percentage of variance of FRS explained at the block-group level and 95% confidence intervals using multilevel linear regression. An empty model was first used to estimate the total variance and the following factors were then added singly to evaluate their influence on the group-level FRS variance explained by education, body mass index, waist circumference, physical activity score, and depression (CES-D score ≥16). Analyses were repeated stratified by sex. Results: The analysis of 10-year FRS included a total of 2,882 participants in 188 census block groups. The block-group-level variance explained for this outcome was 1.77% (95% CI=0.69, 4.44). Upon the addition of BMI to the model, the variance explained dropped to 1.11% (95% CI=0.28%, 4.30%). None of the other covariates had a substantial impact. Among 1,363 women in 117 block groups, the block level group explained a total of 2.03% of the FRS variance at the block level group (95% CI=0.61, 6.56), which dropped to 0.64% (95% CI=0.03, 13.82) when BMI was added to the model. Results were somewhat stronger in analysis of the 30-year FRS. The group-level FRS variance explained by census blocks was 3.56% (95% CI=1.75, 7.12) among 2096 participants in 156 neighborhoods. Similar to the 10-year CVD risk score, the variance explained among women (959 in 97 block groups) was higher (6.06%, 95% CI=2.75, 12.83), but null among males. Conclusions: In this relatively homogenous suburban white population, census block groups explained a small percentage of the variance in CVD risk. The explained variance was higher among women (19% non-working vs. 5% of males), and largely explained by the clustering of obesity.

Prognostic Implication of Framingham Risk Score As a Comorbidity Measure on Treatment Outcomes Following First-Line Tyrosine Kinase Inhibitor in Newly Diagnosed CML Patients

Objectives Metabolic syndrome (MS) with its which is a clustering of atherogenic metabolic abnormalities is considered an important determinant of cardiovascular (CV) risk. Framingham risk scores (FRS) have been traditionally...

Prior research has suggested that delay or avoidance of cardiovascular disease and cardiovascular disease risk factors plays an important role in longevity. We studied 1697 Framingham Heart Study (FHS) offspring members 30 years or older, whose parents (1) participated in the original FHS cohort and (2) achieved age 85 years or died before January 1, 2005. Offspring participants (mean +/- SD age, 40 +/- 7 years; 51% women) were grouped according to whether neither (n = 705), one (n = 804), or both parents (n = 188) survived to 85 years or older. We examined offspring risk factors at examination cycle 1 (1971-1975) including age, sex, education, cigarette smoking, systolic and diastolic blood pressures, total-high-density lipoprotein cholesterol ratio, body mass index, and Framingham Risk Score. Participants returning for examination cycle 3 (1983-1987; n = 1319) were eligible for inclusion in longitudinal analyses evaluating risk factor progression from baseline to a higher follow-up risk category. For all factors studied, except body mass index, we observed statistically significant linear trends for lower offspring examination 1 risk factor levels with increasing parental survival category. The mean Framingham Risk Score was most favorable in offspring with both parents surviving to 85 years or older and was progressively worse in those with one or no long-lived parent (0.55, 1.08, and 1.71, respectively; P value for trend, <.001). Longitudinally, offspring of parents who lived longer had lower risk of blood pressure and Framingham Risk Score progression. Our findings suggest that individuals with long-lived parents have advantageous cardiovascular risk profiles in middle age compared with those whose parents died younger. The risk factor advantage persists over time.

BACKGROUNDRisk assessment in clinical practice plays an important role in classifying population for appropriate preventive medicine for each category. Several multivariable risk predictor algorithms and inflammatory biomarkers are developed for assessing risk for cardiovascular diseases (CVDs). We aimed to depict a picture of the cardiovascular risk profiles in the Iranian population with diabetes mellitus (DM) through three risk predictors for the first time, as the patients with DM have an increased risk for CVDs.METHODSIn this cross-sectional study, the sample size consisted of 418 patients with DM from Diabetes Clinic of Shariati hospital, Isfahan, Iran, in February to July, 2014. We collected the latest information, and then calculated the 10-year CVD risk using Framingham risk score (FRS) and atherosclerotic cardiovascular disease (ASCVD) risk score; while high-sensitivity C-reactive protein (hs-CRP) was measured for them based on their physicians' prescription. Finally, all data were analyzed using SPSS software.RESULTSThe mean 10-year risk prediction of CVDs in the 30- to 74-year-old Iranian patients with DM was high in all three predictors based on their cut-off points, 16.31%, 12.39%, and 3.46 mg/l for FRS, ASCVD risk score, and hs-CRP level, respectively. Although the mean FRS and ASCVD risk scores were significantly higher among men than women (P < 0.0500), the mean hs-CRP level was slightly lower in men than women (P > 0.0500).CONCLUSIONMean FRS and ASCVD risk scores and hs-CRP in patients were high, and a considerable proportion of patients with DM in our study were at intermediate and high risk for CVDs in the next 10 years. Future cohort studies would investigate the accuracy of different predictors in upcoming years, and also help to derive a specific model or recalibrate existing predictors with characteristic of Iranian populations and specific target groups.

Limited data are available on hepatic steatosis (HS) in HIV patients who are not infected with hepatitis C virus (HCV). The aims of this study were to assess the prevalence of HS and its risk factors in HIV patients with and without HCV infection, and to evaluate whether HS correlates with advanced liver fibrosis and/or cardiovascular disease risk. Fifty-seven HIV mono-infected and 61 HIV/HCV co-infected patients were enrolled consecutively. All patients underwent liver ultrasound and transient elastography. The main parameters of liver function, HIV and HCV viral loads, CD4+ cell counts, and data on highly active antiretroviral therapy (HAART) were recorded. Cardiovascular disease risk was evaluated using the 10-year Framingham risk score. HS prevalence in the whole HIV population was 53% (54% in mono-infected patients and 51% in co-infected patients). HS was associated with lipodystrophy and triglyceride values (p<0.0001), metabolic syndrome (p<0.0004), and total cholesterol levels (p<0.001) in both HIV groups. In HIV mono-infected patients, HS was linked with HAART exposure of >1 year (p<0.01). By multivariate analysis, only triglyceride levels (p<0.02) and Framingham risk score (p<0.05) were independently associated with HS in both HIV groups. No correlation was observed between HS and advanced liver fibrosis, measured by transient elastography. HS was common in HIV patients, occurring in about half of the population. HS was found to be linked with the Framingham risk score, but was not correlated with advanced liver fibrosis. We suggest that in our HIV population with HS, the burden of cardiovascular disease risk is greater than that of liver disease progression.

Cardiovascular (CV) events represent major impediments to the long-term survival of liver transplantation (LT) patients. The aim of this study was to assess whether the Framingham risk score (FRS) at transplantation can predict the development of post-LT cardiovascular events (CVEs). Patients transplanted between 2006 and 2008 were included. Baseline features, CV risk factors, and CVEs occurring after LT (ischemic heart disease, stroke, heart failure, de novo arrhythmias, and peripheral arterial disease) were recorded. In total, 250 patients (69.6% men) with a median age of 56 years (range, 18-68 years) were included. At transplantation, 34.4%, 34.4%, and 33.2% of patients, respectively, had a low, moderate, and high FRS with a median FRS of 14.9 (range, 0.09-30); 14.4% of LT recipients developed at least 1 CVE at a median of 2.619 years (range, 0.006-6.945 years). In the univariate analysis, factors associated with the development of CVEs were the continuous FRS at LT (P = 0.003), age (P = 0.007), creatinine clearance [estimated glomerular filtration rate (eGFR); P = 0.020], and mycophenolate mofetil use at discharge (P = 0.011). In the multivariate analysis, only the eGFR [hazard ratio (HR), 0.98; 95% confidence interval (CI), 0.97-1.00; P = 0.009] and FRS (HR, 1.06; 95% CI, 1.02-1.10; P = 0.002) remained in the model. Moreover, an association was also found between the FRS and overall survival (P = 0.004) with 5-year survival rates of 82.5%, 77.8%, and 61.4% for the low-, moderate-, and high-risk groups, respectively. Continuous FRS, eGFR, and hepatitis C virus infection were independent risk factors for overall mortality. In our series, the FRS and eGFR at LT were able to predict the development of post-LT CVEs and poor outcomes. Liver Transpl 21:812-822, 2015. © 2015 AASLD.

Background: Cardiovascular disease is the worldwide leading cause of death, and its incidence is directly linked to cardiovascular risk factors. Identifying these factors is the foundation of treatment. Objective: This work aims to determine the prevalence of cardiovascular risk factors and then estimate the overall cardiovascular risk of each patient seen in the department for consultation. Materials and methods: This was a descriptive and analytical cross-sectional study conducted in the cardiology department of the Kara University Hospital over a period of 30 months from January 1, 2022, to June 30, 2024. It took into account all patients seen in outpatient cardiology consultations who were aged 18 or over, had never previously had a cardiovascular event, and were able to complete the minimum assessment required to evaluate their overall cardiovascular risk. Results: The sample consisted of 1,860 patients with an average age of 48.5 years and women’s predominance. The most common socio-professional groups were civil servants (28.1%) and housewives (21.8%). The risk factors identified were: hypertension (51.7%), obesity (20.2%), dyslipidaemia (18.7%), triglyceridaemia (15.3%), sedentary lifestyle (7.6%), diabetes (6.8%), smoking (2.5%) and chronic renal failure (0.4%). The rate of patients with a high cardiovascular risk was 29.9% using the Framingham score and only 9.7% using the WHO score. Using the SCORE tool, the rate of patients with a high cardiovascular risk was higher in men than in women. Conclusion: The prevalence of cardiovascular risk factors is high in our department, led by arterial hypertension. The rate of patients with a high cardiovascular risk remains high, hence the importance of raising awareness of lifestyle and eating habits in order to reduce the prevalence of these risk factors in the population.

Background: The heightened cardiovascular risk associated with metabolic syndrome (MetS) has been documented by several researchers. The Framingham risk score (FRS) provides a simple and efficient method for identifying individuals at cardiovascular risk. The objective was to describe the prevalence of MetS and its association with FRS in predicting cardiovascular disease among a cohort of semi-urban women; Method: Clinical and laboratory parameters were evaluated among 189 healthy women. The International Diabetes Federation definition was used to diagnose metabolic syndrome. FRS was calculated for each participant; Result: About two thirds of the participant make less than $US 90 per month. The mean systolic blood pressure was 131.80 ± 30. Eighty (42.3%) participants were overweight with a mean waist circumference of 91.64 ± 11.19 cm. MetS was present in 46 (24.3%). Individuals with MetS were more likely to have increased FRS, p = 0.012. One hundred and eighty seven (98.9%) were in the low risk category according to FRS. There was a significant difference in the mean FRS between participants with and without MetS (13.52 versus 10.29 p = 0.025); Conclusion: Prevalence of MetS in this study was comparable to the global rate, despite a low economic status. Individuals with MetS were more likely to have cardiovascular disease than persons without MetS, thus emphasizing the need for risk stratification and prompt management.

People with schizophrenia or bipolar disorder have increased morbidity and shortened life expectancy compared with the general population. The prevalence of many physical illnesses is increased in people with severe mental illness and accounts for around three quarters of all deaths; cardiovascular disease is the most common cause of death. The increased prevalence of cardiovascular disease is explained, at least in part, by increased rates of traditional cardiovascular risk factors including diabetes, dyslipidaemia, obesity and smoking, but mental illness is an independent risk factor for cardiovascular disease and mortality. Despite national and international guidance and an increasing awareness of physical health issues in people with severe mental illness, the level of screening for and management of cardiovascular risk factors remains poor. While there are additional challenges in managing cardiovascular risk in people with severe mental illness, the principles are similar to those in the general population. A multidisciplinary approach involving healthcare professionals within psychiatry, general practice and medical specialties as well as and clear patient pathways are needed to reduce the health inequalities experienced by people with severe mental illness.

BackgroundCardiovascular disease (CVD) remains the major cause of global mortality. Applying a comprehensive interventional program may reduce the incidence of cardiovascular disease and its complications.ObjectiveThis study compared the effects of a three-month intervention involving lifestyle modification and physical activity with standard care in women ≥30 years having a moderate to high risk of CVD, with respect to improving physical activity and cardiovascular disease risk factors at the National Guard Residential City in Jeddah, Saudi Arabia, in 2015.MethodsThe effects of this community-based lifestyle program were assessed through a randomized controlled trial from January 1st to September 6th, 2015. Women in the intervention group (n = 31) received health education, exercise training, and diet counselling as individuals and in groups according to the participant’s risk. Women in the control group (n = 28) received one health education session at the screening site. The primary outcome was the proportion of women with moderate Framingham risk scores (FRS) reducing their risk by 10% and the proportion of women with high FRS reducing their risk by 25%. The secondary outcome was the proportion of women reducing their risk by ≥1 risk category.ResultsThe mean participant age was 42 ± 8 years. At three-month’s follow-up, reductions were greater in the intervention group and the difference between groups was statistically significant (p < 0.05). Lifestyle intervention program significantly reduced systolic blood pressure (-9.2 mmHg), blood glucose (-45 mg/dL) and Framingham risk score (-13.6). Linear regression analysis revealed a significant improvement in the Framingham risk score (p < 0.01).ConclusionIn a population of women with moderate-to-high risk of CVD, a personalized lifestyle modification program showed positive association in improving the 10-year cardiovascular Framingham risk score after three months.

Introduction. Early atherosclerosis is characterized by vessel-wall thickening with preserved lumen size. Contrast-enhanced coronary artery computed tomography (CTA) has been validated for stenosis detection and characterization of atherosclerotic plaques but vessel wall thickening in patients with high Framingham risk score (FRS) has not been shown. We hypothesized that increased mean percent vessel wall area (PVWA) and remodeling index (RI) reflect early vessel wall thickening in subjects with higher FRS, with preservation of luminal size. Methods. We assessed 25 patients with coronary CTA using a validated, highly standardized approach on a commercial post processing workstation (Vitrea; SurePlaque 4.0). FRS was calculated by standard criteria. We evaluated 153 segments in patients with low FRS (&lt;10%) and 35 segments in patients with intermediate-high FRS (&gt;10%). Mean minimal lumen diameter (MLD), minimal lumen area (MLA), remodeling index (RI), and PVWA were compared with unpaired t-test in patients with low versus &gt;10% FRS. Mean PVWA was calculated as follows: (total vessel area-lumen area)/total vessel area. p-value &lt;0.05 was considered significant. Results. In all patients, mean FRS was 7%; 20 patients had FRS&lt;10% and 5 had FRS&gt;10%. PVWA and RI were significantly higher in the intermediate-high FRS group compared to low FRS (0.46±0.07 vs 0.42±0.07; p=0.04 and 0.97±0.15 vs 0.92±0.13; p=0.004, respectively), while MLD/MLA were similar (Figure 1 ). Conclusions. This is the first demonstration that coronary CTA can detect vessel wall thickening with preserved lumen size in patients with FRS&gt;10%. Figure 1. Cross sectional image demonstrating normal wall thickness (A). Cross sectional image demonstrating increased wall thickness (B). Bar graph demonstrating significant difference in PVWA between low and intermediate-high Framingham risk groups (C). Bar graph demonstrating significant difference in RI between low and intermediate-high Framingham risk groups (D).

To determine the association between altitude and the Framingham risk score in the Peruvian population, we performed a cross-sectional analytical study of data collected by the 2017–2018 Food and Nutrition Surveillance by Life Stages survey. The outcome of this study was the Framingham 10-year cardiovascular disease event risk prediction, which is composed of six modifiable and non-modifiable coronary risk factors. A generalized linear model (GLM) of the gamma family and log link function was used to report the crude and adjusted β coefficients. Several sensitivity analyses were performed to assess the association of interest. Data from a total of 833 surveyed participants were included. After adjusting for educational level, poverty level, alcohol consumption, physical activity level, the presence of any limitation, obesity, and area of residence, it was observed that altitude ≥ 2500 m above sea level (β = −0.42 [95% CI: −0.69 to −0.16]) was negatively and significantly associated with a decrease in the Framingham 10-year risk score. High altitude was significantly and negatively associated with Framingham 10-year risk scores. Our results will allow prevention strategies considering modifiable risk factors to avoid the development of cardiovascular diseases, especially in people living at low altitudes.