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STRATIFYING CVD RISK IN FAMILIAL HYPERCHOLESTEROLEMIA: THE IRCM-FH-SCORE
Abstracts
significant advantage in promoting efficient EPC maximization on vascular prosthesis in-vivo due to the reported scarcity of circulating EPCs. The direct contribution of RGD to enhance surface endothelialisation through integrin signaling is currently under investigation. CONCLUSION: These results emphasizes the potential of RGDfunctionalised surfaces in engineering vascular substitutes with enhanced patency rates and long-term performance.
S121
predict CVD events in FH patients. This score could be helpful to identify FH patients that could further benefit from additional LDL-C lowering therapies in addition to statinsndeed, more expensive LDL-C lowering therapies such as PCSK9 inhibitors should be targeted to higher risk individuals to show the greatest benefit.
Canadian Institute of Health Research 097 STRATIFYING CVD RISK IN FAMILIAL HYPERCHOLESTEROLEMIA: THE IRCM-FHSCORE M Paquette, R Dufour, A Baass Montréal, Québec BACKGROUND:
Familial hypercholesterolemia (FH) is the most prevalent autosomal dominant genetic disease worldwide (1/250) and is characterized by very high plasma LDLC, ectopic deposition of cholesterol in tendons (xanthomas) and in arteries (atherosclerotic plaques) leading to premature cardiovascular disease. Even though FH is a strong cardiovascular risk factor, not all FH patients will develop CVD. Classical risk stratification tools such as the Framingham Risk Score do not apply to FH subjects. The objectives of this cross-sectional cohort study are to identify the strongest predictors of CVD in patients with FH and to develop a clinical score associated with higher frequency of CVD events in these patients. METHODS/RESULTS: We screened 20 434 patients from the Nutrition, Metabolism and Atherosclerosis Clinic of the Institut de recherches cliniques de Montréal (IRCM) database in order to identify FH subjects. A total of 724 subjects with a known mutation in the LDL receptor (LDLR) gene were included in the present study. Cardiovascular events included angina, myocardial infarction, stroke, angioplasty, coronary bypass, claudication, peripheral arterial surgery, transient ischemic attack and carotid endarterectomy. We designed a multivariate model associated with CVD events in FH and developed a clinical score (IRCM-FH-SCORE) with these significant variables to predict CVD outcomes. We identified 231 patients (32%) who had already experienced at least 1 CVD event. The IRCM-FH-SCORE was a good predictor of CVD events in FH with an area under the curves (AUC) of 0.794 (0.746-0.842) that was significantly different from 0.5 (P < 0.0001). Patients in the highest tertile for the IRCMFH-SCORE had a 9-fold higher frequency of CVD events compared to the lowest tertile (49.6% vs 5.4% respectively, p<0.0001) (Figure 1). CONCLUSION: Even though FH are at a greater CVD risk than the average population, not all FH subjects present the same risk. We have developed a novel clinically useful score to help
Luducq Foundation
098 UTILITY OF SCREENING ELECTROCARDIOGRAM IN PATIENT MANAGEMENT DECISIONS IN A TERTIARY BARIATRIC PROGRAM: A RETROSPECTIVE COHORT STUDY D Goubran, J Shiau, R Dent, T James, D So Ottawa, Ontario BACKGROUND: ECGs findings in patients with obesity are often abnormal. In tertiary bariatric programs, screening ECGs are routinely conducted before surgical interventions or commencement of meal replacement plans. OBJECTIVES: To document common ECG changes in this population and to evaluate whether screening ECGs delay or alter patient management. METHODS: Screening ECGs of consecutive patients enrolled in the Weight Management Clinic at The Ottawa Hospital were analyzed by two independent reviewers for baseline ECG abnormalities. The primary outcome was the incidence of ”subsequent” cardiac diagnostic testing ordered as a result of abnormal ECGs (defined as an echocardiogram, stress test, cardiac CT, cardiac MR, coronary angiography or a Holter monitor). The findings of subsequent tests were further reviewed to determine whether it would delay or alter management within the bariatric program. RESULTS: From November 2008 to November 2011, 538 patients received screening ECGs. Baseline demographics include: 67% female gender, mean age 47.7 11.8 years old, BMI 44.1 7.9 kg/m2. Overall, 395 ECGs (73.4%) demonstrated abnormalities. Prevalent ECG findings include: q
significant advantage in promoting efficient EPC maximization on vascular prosthesis in-vivo due to the reported scarcity of circulating EPCs. The direct contribution of RGD to enhance surface endothelialisation through integrin signaling is currently under investigation. CONCLUSION: These results emphasizes the potential of RGDfunctionalised surfaces in engineering vascular substitutes with enhanced patency rates and long-term performance.
S121
predict CVD events in FH patients. This score could be helpful to identify FH patients that could further benefit from additional LDL-C lowering therapies in addition to statinsndeed, more expensive LDL-C lowering therapies such as PCSK9 inhibitors should be targeted to higher risk individuals to show the greatest benefit.
Canadian Institute of Health Research 097 STRATIFYING CVD RISK IN FAMILIAL HYPERCHOLESTEROLEMIA: THE IRCM-FHSCORE M Paquette, R Dufour, A Baass Montréal, Québec BACKGROUND:
Familial hypercholesterolemia (FH) is the most prevalent autosomal dominant genetic disease worldwide (1/250) and is characterized by very high plasma LDLC, ectopic deposition of cholesterol in tendons (xanthomas) and in arteries (atherosclerotic plaques) leading to premature cardiovascular disease. Even though FH is a strong cardiovascular risk factor, not all FH patients will develop CVD. Classical risk stratification tools such as the Framingham Risk Score do not apply to FH subjects. The objectives of this cross-sectional cohort study are to identify the strongest predictors of CVD in patients with FH and to develop a clinical score associated with higher frequency of CVD events in these patients. METHODS/RESULTS: We screened 20 434 patients from the Nutrition, Metabolism and Atherosclerosis Clinic of the Institut de recherches cliniques de Montréal (IRCM) database in order to identify FH subjects. A total of 724 subjects with a known mutation in the LDL receptor (LDLR) gene were included in the present study. Cardiovascular events included angina, myocardial infarction, stroke, angioplasty, coronary bypass, claudication, peripheral arterial surgery, transient ischemic attack and carotid endarterectomy. We designed a multivariate model associated with CVD events in FH and developed a clinical score (IRCM-FH-SCORE) with these significant variables to predict CVD outcomes. We identified 231 patients (32%) who had already experienced at least 1 CVD event. The IRCM-FH-SCORE was a good predictor of CVD events in FH with an area under the curves (AUC) of 0.794 (0.746-0.842) that was significantly different from 0.5 (P < 0.0001). Patients in the highest tertile for the IRCMFH-SCORE had a 9-fold higher frequency of CVD events compared to the lowest tertile (49.6% vs 5.4% respectively, p<0.0001) (Figure 1). CONCLUSION: Even though FH are at a greater CVD risk than the average population, not all FH subjects present the same risk. We have developed a novel clinically useful score to help
Luducq Foundation
098 UTILITY OF SCREENING ELECTROCARDIOGRAM IN PATIENT MANAGEMENT DECISIONS IN A TERTIARY BARIATRIC PROGRAM: A RETROSPECTIVE COHORT STUDY D Goubran, J Shiau, R Dent, T James, D So Ottawa, Ontario BACKGROUND: ECGs findings in patients with obesity are often abnormal. In tertiary bariatric programs, screening ECGs are routinely conducted before surgical interventions or commencement of meal replacement plans. OBJECTIVES: To document common ECG changes in this population and to evaluate whether screening ECGs delay or alter patient management. METHODS: Screening ECGs of consecutive patients enrolled in the Weight Management Clinic at The Ottawa Hospital were analyzed by two independent reviewers for baseline ECG abnormalities. The primary outcome was the incidence of ”subsequent” cardiac diagnostic testing ordered as a result of abnormal ECGs (defined as an echocardiogram, stress test, cardiac CT, cardiac MR, coronary angiography or a Holter monitor). The findings of subsequent tests were further reviewed to determine whether it would delay or alter management within the bariatric program. RESULTS: From November 2008 to November 2011, 538 patients received screening ECGs. Baseline demographics include: 67% female gender, mean age 47.7 11.8 years old, BMI 44.1 7.9 kg/m2. Overall, 395 ECGs (73.4%) demonstrated abnormalities. Prevalent ECG findings include: q