International Journal of Cardiovascular Sciences. 07/Jul/2021;34(4):383-92.
Exercise Testing, Family History, and Subclinical Atherosclerosis Markers for Cardiovascular Risk Reclassification in Middle-Aged Women
Ricardo Quental Coutinho
, Ulisses Ramos Montarroyos
, Isly Maria Lucena de Barros
, Maria José Bezerra Guimarães
, Ana Paula Dornelas Leão
, Laura Olinda Bregieiro Fernandes Costa
, Ana Kelley de Lima Medeiros
, Maria de Fátima Monteiro
, Moacir de Novaes Lima Ferreira
, William Azem Chalela
, Rodrigo Pinto Pedrosa
Abstract
Background
Cardiovascular diseases are the main cause of death in women and the accuracy of currently available risk scores is questionable.
Objective
To reclassify the risk estimated by the Framingham Risk Score (FRS) in asymptomatic middle-aged women by incorporating family history, exercise testing variables, and subclinical atherosclerosis markers.
Methods
This cross-sectional study included 509 women (age range, 46-65 years) without cardiovascular symptoms. Those at low or intermediate risk by the FRS were reclassified to a higher level considering premature family history of acute myocardial infarction and/or sudden death; four variables from exercise testing; and two variables related to subclinical atherosclerosis markers. The homogeneity of these variables according to the FRS was verified by Pearson chi-square test (p<0.05).
Results
According to the FRS, 80.2%, 6.2%, and 13.6% of the women were classified as low (<5%), intermediate (5-10%), and high (>10%) risks, respectively. The intermediate-risk stratum showed the highest increase (from 6.2% to 33.3%) with addition of family history; followed by addition of chronotropic index <80% (to 24.2%); functional capacity <85% (22.2%), coronary calcium score >0 (20.6%); decreased one-minute heart rate recovery ≤12 bpm (15.2%); carotid intima-media thickness >1 mm and/or carotid plaque (13.8%) and ST-segment depression (9.0%). The high-risk stratum increased to 14.4% with the addition of reduced heart rate recovery and to 17.1% with the coronary calcium score.
Conclusion
Incorporation of premature family history of cardiovascular events, exercise testing abnormal parameters, and subclinical atherosclerosis markers into the FRS led to risk reclassification in 3.0-29.7% of asymptomatic middle-aged women, mainly by an increase from low to intermediate risk.
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