Additional Biochemical Predictors of Cardiovascular Complications in Patients at Risk for SCORE < 5%: Ten-Year Follow-Up Data
In order to improve the results of predicting cardiovascular complications (CVC), it is necessary to examine not only classical, but also additional risk factors, including those determined by routine biochemical blood analysis. Purpose: to assess the contribution of the additional biochemical markers to the stratification of patients at risk of CVC according to SCORE < 5% according on ten-year follow-up data. Material and methods. 557patients (100 men) with a SCORE < 5% risk of CVC were examined in 2009 as part of the Program of Development of New Methods and Technologies for the Prevention, Diagnosis and Treatment of Cardiovascular Diseases Associated with Atherosclerosis in medical institutions of the Western Administrative District of Moscow. The patients underwent standard clinical examination, which included a biochemical blood test. In 2019 the telephone survey was conducted to identify CVC over the past time of death from cardiovascular diseases (CVD), acute myocardial infarction (AMI), acute cerebral circulatory disorders (ACCD), cases of revascularization, and hospitalization for cardiovascular reasons. Results. Over the past ten years, the study group had nine (1.6%), CVD, ten AMI, 11 cases of unstable angina, 28 revascularizations, 21 ACCD, and 154 hospitalizations for cardiovascular reasons. 116 (20.8%) patients had some type of CVC (CVC+). Patients with CVC+ initially had significantly higher levels of triglycerides (TG), aspartate aminotrasferase (AST), uric acid, and urea, as well as systolic blood pressure (SBP). A weak but reliable correlation was found between the number of CVC and the level of TG (r = 0.105;p = 0.01), AST (r = 0.106;p = 0.03), uric acid (r = 0.130; p = 0.005), urea (r = 0.128; p = 0.04) in the blood plasma, as well as the level of SBP (r = 0.104; p = 0.01). According to multivariate regression analysis, the levels of SBP, uric acid, and urea, as well as male gender, were an independent predictor of CVC development. In a logistic model that included gender, hypertension, urea, uric acid, and alanine aminotransferase/AST levels above normal values, the risk of CVC development increases with increasing urea levels (odds ratio (OR) 8.4 (95% confidence interval (CI) 1.12-10.1;p = 0.03) and uric acid (OR 3.4; 95% CI2.1-33.3;p = 0.002). Conclusion. Biochemical parameters such as uric acid and urea levels can be considered as additional risk factors for developing CVD in patients with low/moderate risk, calculated on standard scales.