A six question screen to facilitate primary cardiovascular disease prevention

Background: European guidelines on primary prevention of cardiovascular disease (CVD) recommend the SCORE risk charts for determining CVD risk, which include blood pressure and serum cholesterol as risk parameters. To facilitate cost-effective large-scale screening, we aimed to construct a risk score with 'non-invasive' parameters as a first screening step to identify persons at increased CVD risk requiring further risk assessment. Methods: We used data of Dutch employees from 25 organisations participating in a health risk assessment between August 2007 and January 2013. Backward multivariate logistic regression analysis was employed to select non-invasive, independent predictors of high CVD risk, defined as the 10-year risk of fatal CVD of >= 5 % based on the SCORE formula. The total CVD risk score was calculated as the summed coefficients of the retained variables. Results: Data of 6189 male participants was used for the development and validation of the risk score. Age, tobacco use, history of hypertension, alcohol consumption, BMI, and waist circumference were independent predictors of high CVD risk. Ten-fold cross-validation resulted in an area under the curve of 0.95 (SE 0.01, 95 % confidence interval 0.94-0.96). A cut-off score >= 45 on the CVD risk score yielded a sensitivity of 0.93, and a specificity of 0.85. Conclusions: We developed a simple, non-invasive risk score that accurately identifies persons at increased CVD risk according to the SCORE formula in a population of working men. The risk score enables a stepwise approach in large screening programmes, strongly reducing the number of persons that require full risk estimation including blood pressure and cholesterol measures

Effect of the exercise of walkers performed in public squares with spontaneous or prescribed intensity on post-exercise hypotension

OBJECTIVE To quantify the intensity adopted by walkers in public squares and check the occurrence and magnitude of post-exercise hypotension in the spontaneously adopted intensity and in a prescribed intensity. METHODS In 98 volunteers (38 of them being hypertensive), walkers in public squares of the city of João Pessoa, State of Paraíba, Brazil, we have identified the intensity of a usual training monitored by heart rate and we have investigated the occurrence and magnitude of post-exercise hypotension. Subsequently, participants were instructed to walk with moderate intensity. Blood pressure was measured after rest and during post-exercise recovery. RESULTS Of the total participants, 41% of the hypertensive and 36% of the normotensive individuals walked with light intensity. With the prescription, intensity increased to 55% and 52%, for the hypertensive and normotensive individuals, respectively. In the usual and prescribed intensity, the hypertensive individuals had post-exercise hypotension of -3.7±11.6 mmHg and -4.72±12.8 mmHg, respectively. There was no correlation between post-exercise hypotension and the initial systolic component of the hypertensive individuals (r2 = 0.2; p < 0.002). CONCLUSIONS Walkers in public squares choose light intensity for walking. When they exercise with the prescribed intensity, they increase the intensity, but the magnitude of the PEH is not increase with this guidance.OBJETIVO Quantificar a intensidade adotada por caminhantes em praças públicas e verificar a ocorrência e a magnitude da hipotensão pós-exercício na intensidade espontaneamente adotada e em uma intensidade prescrita. MÉTODOS Em 98 voluntários (38 hipertensos), caminhantes em praças públicas da cidade de João Pessoa, PB, identificamos a intensidade de um treino habitual monitorada por meio da frequência cardíaca e averiguamos a ocorrência e magnitude de hipotensão pós-exercício. Posteriormente, os participantes foram instruídos a caminhar com intensidade moderada. A pressão arterial foi aferida após o repouso e durante a recuperação pós-exercício. RESULTADOS Do total de participantes, 41% dos hipertensos e 36% dos normotensos caminhavam com intensidade leve. Com a prescrição, a intensidade aumentou para 55% e 52%, para hipertensos e normotensos. Na intensidade habitual e prescrita, os hipertensos obtiveram hipotensão pós-exercício de -3,7±11,6 mmHg e -4,72±12,8 mmHg. Houve correlação entre hipotensão pós-exercício e o componente sistólico inicial dos hipertensos (r2 = 0,2; p < 0,002). CONCLUSÕES Caminhantes em praças públicas selecionam intensidade leve para realização de caminhada. Quando realizam exercício com intensidade prescrita, aumentam discretamente a intensidade, mas não obtêm aumento da magnitude da HPE com esta orientação