Prediction of cardiovascular events in a European high-risk population by an easily measured metabolic index

Purpose: Hyperglycemia enhances the risk of cardiovascular events (CVE), while high-density lipoprotein cholesterol (HDLc) is protective. We applied a cardiometabolic risk index (CMRI) based on HDLc and fasting glucose (FG) adjusting for age, identifying patients at high risk of future fatal and non-fatal CVE in a European high-risk population. The properties of the CMRI as a predictor of CVE and all-cause mortality have previously been established in a European population with known coronary artery disease (European Heart Survey on Diabetes and the Heart) and a multi-ethnic US population (NHANES III). Methods: IMPROVE is a European, multicenter, longitudinal cohort study, which enrolled individuals aged 54 to 80 years with at least 3 CV risk factors and no history of CV disease from 7 centers in Finland, Sweden, Netherlands, France, and Italy. The individuals were followed for 3 years regarding fatal and non-fatal CVE. The impact of risk factors on CVE was analyzed using crude and adjusted Cox regression. Results: HDLc (mmol/L; median and interquartile range) was 1.3 (1.1–1.6) in women and 1.1 (0.9–1.3) in men, while FG was 5.7 (4.8–6.0) and 6.2 (5.2–6.6). According to the CMRI, 596 individuals out of 3325 were at high risk, and 190 actually had a CVE. FG was borderline related to CVE (HR; 95%CI: 1.08; 1.00– 1.16; p=0.050) whereas HDLc was protective (0.47; 0.30–0.73; p=0.001). The CMRI was related to CVE both in crude analysis (1.98; 1.31–2.99; p=0.001) (see Figure), after adjustment for sex and age (1.70; 1.11–2.61; p=0.014), and after further adjustment for other established CV risk factors (1.59; 1.04–2.44; p=0.034). Figure 1. Kaplan-Meier curve cardiovascular events Conclusion: In the IMPROVE European high-risk population, CVE were accurately predicted by the new, easily applied risk index, independently of established CV risk factors.