Early cardiovascular structural and functional abnormalities as a guide to future morbid events

Daniel A. Duprez, Sue Duval, Lynn Hoke, Natalia Florea, Gregory Grandits, Claire Carlson, Joy Lee, Jay N Cohn

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


AIMS: Our aim was to evaluate the predictive value of a battery of 10 non-invasive tests of cardiovascular structural and functional health on the future risk of cardiovascular morbid events.

METHODS AND RESULTS: A total of 1900 asymptomatic adults concerned about their risk for cardiovascular disease underwent non-invasive assessment with 10 tests of vascular and cardiac structure and function. A disease score (DS) was calculated for each individual based on these 10 tests. Follow-up (mean 9.2 years) for cardiovascular morbidity and mortality was available for 1442 individuals (mean age 53.2 years, 48.2% women). Those in the lowest DS tertile (0-2) experienced 0.16 cardiovascular events per 100 patient-years (PY), those in the middle tertile (3-5) experienced 0.86 events per 100 PY, and those in the highest tertile (6+) experienced 1.3 events per 100 PY ( p  < .001). Sensitivity analysis, assuming a neutral effect of DS on projected events in subjects not followed, did not alter statistical significance. Risk assessment using the Framingham risk score (FRS) also predicted morbid events but the two methods differed in identifying individuals at high risk. The net reclassification index was improved by 0.11 ( p  = 0.01) when DS was added to FRS.

CONCLUSIONS: Assessing the biological disease process in the arteries and heart of asymptomatic adults provides a guide to the risk of a future cardiovascular morbid event. Larger and longer studies are needed to determine whether risk factor algorithms, the severity of the biological process or some combination is the optimal method for identifying individuals in need of intervention to delay morbid events.

Original languageEnglish (US)
Pages (from-to)1214-1221
Number of pages8
JournalEuropean Journal of Preventive Cardiology
Issue number11
Early online dateFeb 4 2020
StatePublished - Nov 1 2021

Bibliographical note

Publisher Copyright:
© 2020 Published on behalf of the European Society of Cardiology. All rights reserved.


  • Artery structure and function
  • cardiac structure and function
  • cardiovascular morbid events
  • risk factors

PubMed: MeSH publication types

  • Journal Article


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