Cardiovascular Disease Risk Assessment
We sought to develop an integrated method to predict thrombosis and progression of atherosclerosis. Our goal was to combine the measurements of relevant blood parameters into a single measure of higher specificity and sensitivity than that of the individual parameters. An algebraic combination of normalized levels of fibrinogen, HDL cholesterol, triglycerides, the platelet count and aggregation was developed and tested in a study involving more than 1,000 male subjects. The algebraic combination yielded a single numeric value, a clinical atherosclerosis predisposition (CAP) factor. The details of CAP factor development are presented in the paper "Kaplan A, Kaplan S, Marcoe KF, Sauvage LR, Hammond WP. Identification of potential predisposition to clinical atherosclerosis: A concept based on integration of significant blood parameters with platelet aggregation scores. Clin Appl Thrombosis/Hemostasis, 1997, 3(3) :174-182."
In the prospective study of 306 apparently healthy men (mean age 52.4±12.8 years), performed in collaboration with the Hope Heart Institute, the predictive power of the CAP factor was evaluated. We collected data over an 11-year period with mean follow-up 6.9±2.3 years. The occurrence of cardiovascular events was used to estimate the predictive potential of the CAP factor. For CAP factor assessment fibrinogen levels, lipid profiles, and platelet counts and reactivity quantified by a platelet aggregation score were obtained for each participant. Distribution of participants among CAP risk zones were as follows: 75 men (24.5%) in the low (CAP<2), 166 men (54.3%) in the medium (CAP factor 2 to 4), and 65 men (21.2%) in high zone (CAP>4). Nineteen men, mean age 58.5±8.2 years, developed coronary heart disease: 18 bypass and /or angioplasty procedures and 1 heart attack confirmed by angioplasty were recorded. No events occurred in the low CAP risk zone, 3 (1.8%) were identified in the medium and 16 (24.6%) in the high. The chi-square test demonstrated that these events were predicted by the CAP factor (calculated x² = 44.6 vs. tabulated x² = 10.6 for df=2 and p=0.005).
These prospective study results were reported in the 5th International Symposium Multiple Risk Factors in cardiovascular disease: global assessment and intervention. Venice (Italy), October 28-31, 1999.
