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Falls and Fear of Falling After Stroke: A Case-Control Study

Goh HT, Nadarajah M, Hamzah NB, Varadan P, Tan MP

PM R, 2016 12;8(12):1173-1180.
PMID: 27268565 DOI: 10.1016/j.pmrj.2016.05.012

BACKGROUND: Falls are common after stroke, with potentially serious consequences. Few investigations have included age-matched control participants to directly compare fall characteristics between older adults with and without stroke. Further, fear of falling, a significant psychological consequence of falls, has only been examined to a limited degree as a risk factor for future falls in a stroke population.
OBJECTIVE: To compare the fall history between older adults with and without a previous stroke and to identify the determinants of falls and fear of falling in older stroke survivors.
DESIGN: Case-control observational study.
SETTING: Primary teaching hospital.
PARTICIPANTS: Seventy-five patients with stroke (mean age ± standard deviation, 66 ± 7 years) and 50 age-matched control participants with no previous stroke were tested.
METHODS: Fall history, fear of falling, and physical, cognitive, and psychological function were assessed. A χ2 test was performed to compare characteristics between groups, and logistic regression was performed to determine the risk factors for falls and fear of falling.
MAIN OUTCOME MEASURES: Fall events in the past 12 months, Fall Efficacy Scale-International, Berg Balance Scale, Functional Ambulation Category, Fatigue Severity Scale, Montreal Cognitive Assessment, and Patient Healthy Questionnaire-9 were measured for all participants. Fugl-Meyer Motor Assessment was used to quantify severity of stroke motor impairments.
RESULTS: Twenty-three patients and 13 control participants reported at least one fall in the past 12 months (P = .58). Nine participants with stroke had recurrent falls (≥2 falls) compared with none of the control participants (P < .01). Participants with stroke reported greater concern for falling than did nonstroke control participants (P < .01). Female gender was associated with falls in the nonstroke group, whereas falls in the stroke group were not significantly associated with any measured outcomes. Fear of falling in the stroke group was associated with functional ambulation level and balance. Functional ambulation level alone explained 22% of variance in fear of falling in the stroke group.
CONCLUSIONS: Compared with persons without a stroke, patients with stroke were significantly more likely to experience recurrent falls and fear of falling. Falls in patients with stroke were not explained by any of the outcome measures used, whereas fear of falling was predicted by functional ambulation level. This study has identified potentially modifiable risk factors with which to devise future prevention strategies for falls in patients with stroke.
LEVEL OF EVIDENCE: III.

Matched MeSH terms: Risk Factors
Position of document holder and work related risk factors for neck pain among computer users: a narrative review

Ambusam S, Baharudin O, Roslizawati N, Leonard J

Clin Ter, 2015 Nov-Dec;166(6):256-61.
PMID: 26794814 DOI: 10.7417/CT.2015.1898

Document holder is used as a remedy to address occupational neck pain among computer users. An understanding on the effects of the document holder along with other work related risk factors while working in computer workstation requires attention. A comprehensive knowledge on the optimal location of the document holder in computer use and associated work related factors that may contribute to neck pain reviewed in this article. A literature search has been conducted over the past 14 years based on the published articles from January 1990 to January 2014 in both Science Direct and PubMed databases. Medical Subject Headings (MeSH) keywords for search were neck muscle OR head posture OR muscle tension' OR muscle activity OR work related disorders OR neck pain AND/OR document location OR document holder OR source document OR copy screen holder.Document holder placed lateral to the screen was most preferred to reduce neck discomfort among occupational typists. Document without a holder was placed flat on the surface is least preferred. The head posture and muscle activity increases when the document is placed flat on the surface compared to when placed on the document holder. Work related factors such as static posture, repetitive movement, prolong sitting and awkward positions were the risk factors for chronic neck pain. This review highlights the optimal location for document holder for computer users to reduce neck pain. Together, the importance of work related risk factors for to neck pain on occupational typist is emphasized for the clinical management.

Matched MeSH terms: Risk Factors
Anatomical variants of surgically important landmarks in the sphenoid sinus: a radiologic study in Southeast Asian patients

Anusha B, Baharudin A, Philip R, Harvinder S, Shaffie BM, Ramiza RR

Surg Radiol Anat, 2015 Dec;37(10):1183-90.
PMID: 25990686 DOI: 10.1007/s00276-015-1494-8

Failure of a surgeon to understand the local variations of the anatomical landmarks of the sphenoid sinus is a potential risk factor to cause damage to the optic nerve (ON) or internal carotid artery (ICA) that lies on the walls of the sphenoid sinus. The aim of this study was to identify the anatomical variants of the sphenoid sinus and its related surrounding structures among the Southeast Asian (SEA) population, based on computed tomography (CT) scans.

Matched MeSH terms: Risk Factors
Gastro-oesophageal reflux disease in Asia

Goh KL, Chang CS, Fock KM, Ke M, Park HJ, Lam SK

J Gastroenterol Hepatol, 2000 Mar;15(3):230-8.
PMID: 10764021

Gastro-oesophageal reflux disease (GORD) occurs more frequently in Europe and North America than in Asia but its prevalence is now increasing in many Asian countries. Many reasons have been given for the lower prevalence of GORD in Asia. Low dietary fat and genetically determined factors, such as body mass index and maximal acid output, may be important. Other dietary factors appear to be less relevant. Increased intake of carbonated drinks or aggravating medicines may influence the increasing rates of GORD in some Asian countries but no strong evidence links other factors, such as the age of the population, smoking or alcohol consumption, to GORD. The management of GORD in Asia is similar to that in Europe and North America but the lower incidence of severe oesophagitis in Asia may alter the approach slightly. Also, because Asians tend to develop stomach cancer at an earlier age, endoscopy is used routinely at an earlier stage of investigation. Gastro-oesophageal reflux disease is essentially a motility disorder, so short-term management of the disease can usually be achieved using prokinetic agents (or histamine (H2)-receptor antagonists). More severe and recurrent GORD may require proton pump inhibitors (PPI) or a combination of prokinetic agents and PPI. The choice of long-term treatment may be influenced by the relative costs of prokinetic agents and PPI.

Matched MeSH terms: Risk Factors
Fulltext Is snoring a health risk?

Liam CK

Med J Malaysia, 1999 Mar;54(1):155-9; quiz 160.
PMID: 10972023
Matched MeSH terms: Risk Factors
Fulltext Effects of palm oil on cardiovascular risk

Chong YH, Ng TKW

Med J Malaysia, 1991 Mar;46(1):41-50.
PMID: 1836037

A major public health concern of affluent nations is the excessive consumption of dietary fats which are now closely linked to coronary heart disease. Against this scenario, the tropical oils and palm oil in particular, have been cast as major villains in the U.S.A., despite the fact that palm oil consumption there is negligible. The unsuspecting public may not realise that the call to avoid palm oil is nothing more than a trade ploy since in recent years palm oil has been very competitive and has gained a major share of the world's edible oils and fats market. Many also lose sight of the fact that, palm oil, like other edible oils and fats, is an important component of the diet. The allegation that palm oil consumption leads to raised blood cholesterol levels and is therefore atherogenic is without scientific foundation. Examination of the chemical and fatty acid composition of palm oil or its liquid fraction should convince most nutritionists that the oil has little cholesterol-raising potential. The rationale for these are: it is considered cholesterol free. its major saturated fatty acid, palmitic acid (16:0) has recently been shown to be neutral in its cholesterolaemic effect, particularly in situations where the LDL receptors have not been down-regulated by dietary means or through a genetic effect. palm oil contains negligible amounts (less than 1.5%) of the hypercholesterolemic saturated fatty acids, namely lauric acid (12:0) and myristic acid (14:0). it has moderately rich amounts of the hypocholesterolaemic, monounsaturated oleic acid (18:1, omega-9) and adequate amounts of linoleic acid. (18:2, omega-6). It contains minor components such as the vitamin E tocotrienols which are not only powerful antioxidants but are also natural inhibitors of cholesterol synthesis. Feeding experiments in various animal species and humans also do not support the allegation that palm oil is atherogenic. On the contrary, palm oil consumption reduces blood cholesterol in comparison with the traditional sources of saturated fats such as coconut oil, dairy and animal fats. In addition, palm oil consumption may raise HDL levels and reduce platelet aggregability. As with all nutrients, there is a need to obtain a balance of different fatty acids found in fats in edible oils and other food sources. There is no single ideal source of fat that answers to the recent American Heart Association's call to reflect a 1:1:1 ratio of saturated, monounsaturated and polyunsaturated fats in relation to the recommended dietary fat intake of 30% of calories or less.(ABSTRACT TRUNCATED AT 400 WORDS)

Matched MeSH terms: Risk Factors
Fulltext The risk of neonatal infection following prolonged rupture of the fetal membranes

Boo NY

Med J Malaysia, 1989 Mar;44(1):35-40.
PMID: 2626112

Over a seven month period in 1986, 164 (1.1%) of a total 15,131 neonates delivered in the Maternity Hospital, Kuala Lumpur were born to mothers with prolonged rupture of the fetal membranes. Septic work-ups were performed on 163 of these babies shortly after birth, 77 of them had no bacteriological, radiological or other clinical evidence of infection. The remaining 86 had additional history of illness. Nine of these 86 babies had proven infection: four with septicemia, one with meningitis and four others with congenital pneumonia. This study showed that neonates had risk of infection only when maternal history of prolonged rupture of the fetal membranes was associated with other clinical evidence of infection. However, even in this group of neonates at risk, 89.5% of them were not infected. Therefore, there is still a need to develop a simple, rapid, reliable and cheap laboratory method to help early identification of the infected from the non-infected neonates in order to prevent unnecessary antibiotic treatment and hospital stay.

Matched MeSH terms: Risk Factors
Fulltext Plasma cholesterol and coronary artery disease: how big a heartache?

Lyn PCW

Med J Malaysia, 1987 Mar;42(1):22-30.
PMID: 3323859

Coronary atheroma is the principal cause of ischaemic heart disease. Among the factors considered to predispose to atheroma formation is raised plasma cholesterol and although it is regarded as a minor risk factor by some, others see its contribution as one of major importance. Whichever the view, the debate on plasma cholesterol and coronary heart disease (CHD) has long moved out of the exclusive domain of the scientific journal to the public arena and is reflected in the increasing frequency with which doctors are consulted by patients on the subject. The incidence of CHD in South-East Asian countries is also rising. For the practising clinician, the problem resolves itself into deciding if the evidence incriminating plasma cholesterol as a predisposing factor is strong enough, and if it is, what prophylactic and therapeutic steps are of value in reducing the incidence of CH D. An updated and brief review of lipid metabolism and the relationship of lipids to CHD is now necessary in view of the rapid accumulation of data from recent trials and prospective studies.

Matched MeSH terms: Risk Factors
Fulltext Clinical and conceptual comments on "Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis"

Jayaraj R, Kumarasamy C, Shetty SS, Ram M R, Shaw P

J Infect, 2020 10;81(4):647-679.
PMID: 32407756 DOI: 10.1016/j.jinf.2020.05.011
Matched MeSH terms: Risk Factors
Modifiable risk factors and overall cardiovascular mortality: Moderation of urbanization

Sajid MR, Muhammad N, Zakaria R, Bukhari SAC

J Public Health Res, 2020 Oct 14;9(4):1893.
PMID: 33244464 DOI: 10.4081/jphr.2020.1893

Background: Modifiable risk factors are associated with cardiovascular mortality (CVM) which is a leading form of global mortality. However, diverse nature of urbanization and its objective measurement can modify their relationship. This study aims to investigate the moderating role of urbanization in the relationship of combined exposure (CE) of modifiable risk factors and CVM. Design and Methods: This is the first comprehensive study which considers different forms of urbanization to gauge its manifold impact. Therefore, in addition to existing original quantitative form and traditional two categories of urbanization, a new form consisted of four levels of urbanization was duly introduced. This study used data of 129 countries mainly retrieved from a WHO report, Non-Communicable Diseases Country Profile 2014. Factor scores obtained through confirmatory factor analysis were used to compute the CE. Age-income adjusted regression model for CVM was tested as a baseline with three bootstrap regression models developed for the three forms of urbanization. Results: Results revealed that the CE and CVM baseline relationship was significantly moderated through the original quantitative form of urbanization. Contrarily, the two traditional categories of urbanization could not capture the moderating impact. However, the four levels of urbanization were objectively estimated the urbanization impact and subsequently indicated that the CE was more alarming in causing the CVM in levels 2 and 3 urbanized countries, mainly from low-middle-income countries. Conclusion: This study concluded that the urbanization is a strong moderator and it could be gauged effectively through four levels whereas sufficiency of two traditional categories of urbanization is questionable.

Matched MeSH terms: Risk Factors
Fulltext Diagnosing Perioperative Cardiovascular Risks in Noncardiac Surgery Patients

Li P, Lei Y, Li Q, Lakshmipriya T, Gopinath SCB, Gong X

J Anal Methods Chem, 2019;2019:6097375.
PMID: 31534814 DOI: 10.1155/2019/6097375

Every year, over 200 million adults are undergoing noncardiac surgery. These noncardiac surgery patients may face the risk of cardiac mortality and morbidity during the perioperative and recovery periods. Around ten million patients who underwent noncardiac surgery experience cardiac complications within the first 30 days of the postoperative period; the complications are myocardial infarction, cardiac death, and cardiac arrest. This cardiovascular risk is mostly faced by the patients having cerebrovascular or cardiac disease and the patients with the age greater than 50 years. Monitoring and treating cardiac diseases with a suitable biomarker during the perioperative period is necessary for the early recovery of noncardiac surgery patients. This review discussed the risk factors and the key guidelines to avoid the cardiovascular risks during the perioperative period of noncardiac surgery patients. In addition, the biomarkers and identification strategies for cardiac diseases are discussed.

Matched MeSH terms: Risk Factors
Fulltext Diabetes Mellitus as a Risk Factor of Interval Colon Cancer

Brož J, Salih FMA

Dig Dis, 2020;38(1):31.
PMID: 31336373 DOI: 10.1159/000501550
Matched MeSH terms: Risk Factors
Review: Epidemiology of Helicobacter pylori infection

Leja M, Grinberga-Derica I, Bilgilier C, Steininger C

Helicobacter, 2019 Sep;24 Suppl 1:e12635.
PMID: 31486242 DOI: 10.1111/hel.12635

This review summarizes recent publications on the epidemiology of Helicobacter pylori. Two major systemic analyses, from Malaysia and Ethiopia, were published. The Brazilian Consensus Conference has stated that H pylori infection is an infectious disease with an indication for antimicrobial therapy. A continuous decrease in H pylori prevalence was reported from many regions worldwide, including Korea, China, Iran, and Austria. A cross-sectional H pylori prevalence study conducted in the United Arab Emirates found 41% prevalence in a group of healthy children and adults. Several studies from Asia addressed H pylori prevalence in adults undergoing regular checkup. The largest of such studies, performed in Korea, involved 24 471 subjects and reported 41.5% seroprevalence. A relatively smaller study from East China on 3252 subjects reported 27.5% prevalence. In contrast, a study from Spain reported 87.2% seroprevalence. A report on the association between smoking and H pylori seropositivity was published on behalf of the Stomach Cancer Pooling (StoP) Project-a consortium of epidemiological studies of gastric cancer. Also, other potential risk factors, including occupational risk factors, water supply, and food were analyzed. Gastroesophageal reflux and sexual partners has been associated with a higher risk for H pylori acquisition, and gut microbiota was suggested to play a role in intrafamilial transmission of H pylori. Finally, in a few studies (from Mexico and Japan), the catalytic model for predicting the potential risk of acquiring H pylori infection in the future was used. As anticipated, a further decline in H pylori-related disease was demonstrated by applying the modeling.

Matched MeSH terms: Risk Factors
Fulltext Understanding the tuberculosis disease progression and future directions of research in tuberculosis: a mini review

Siti, H.N., Syarifah-Noratiqah, S.B., Zulfarina, M.S., Isa, N.M., Kamisah, Y.

Medicine & Health, 2018;13(1):20-28.
MyJurnal

Eradication of tuberculosis seems to be a long way off especially with the growing of drug resistance tuberculosis and HIV co-infection tuberculosis. The gaps in our knowledge and the limited sensitive and specific biomarkers especially for latent tuberculosis infection make it defensive. The fate of tuberculosis treatment ranged from cured to failure and there are many risk factors involved apart from the immune state and age. Therefore, this review focuses on the understanding of tuberculosis disease progression and the associated risk factors of the events in the disease progression. This article also highlights the diagnostic and predictive marker that may predict the disease progression. In addition, this review highlights the potential use of rifabutin in tuberculosis treatment regimen. It is hoped that this review could give an overview on future directions of research in tuberculosis.

Matched MeSH terms: Risk Factors
Correlation of cognitive impairment with constipation and renal failure

Eshkoor SA, Tengku Aizan Hamid, Chan YM

Sains Malaysiana, 2016;45:1357-1361.

The improvement of health care support has greatly extended the average life expectancy over the last 50 years, which
has increased the rate of cognitive decline consequently. The avoidance of risk factors such as toxins, stress and somatic
diseases can be protective against the reduction of cognitive function in the elderly. This study aimed to determine the
effects of socio-demographic factors, constipation and renal failure on cognitive status among 2322 samples who were
the non-institutionalized Malaysian elderly. The multiple logistic regression analysis was applied to estimate the risk of
such factors on cognitive decline in subjects. Approximately, 77.54% of samples experienced cognitive impairment. The
results showed that advanced age (odds ratio (OR) = 1.03), Malay ethnic (OR = 2.15), constipation (OR = 3.31) and renal
failure (OR= 4.42), significantly increased the risk of cognitive impairment in subjects (p<0.05). In addition, education
(OR = 0.38) significantly reduced the risk. However, we concluded that age, Malay ethnic, constipation and renal failure
increased the risk of cognitive impairment in subjects but education reduced the risk.

Matched MeSH terms: Risk Factors
Fulltext The Effects of Different Outdoor Environments, Sunglasses and Hats on Light Levels: Implications for Myopia Prevention

Lanca C, Teo A, Vivagandan A, Htoon HM, Najjar RP, Spiegel DP, et al.

Transl Vis Sci Technol, 2019 Jul;8(4):7.
PMID: 31360613 DOI: 10.1167/tvst.8.4.7

Purpose: Lack of outdoor time is a known risk factor for myopia. Knowledge of the light levels reaching the eye and exposure settings, including sun-protective measures, is essential for outdoor programs and myopia. We evaluated the impact of sun-protective strategies (hat and sunglasses) on maintaining high illuminance levels to prevent myopia.
Methods: A child-sized mannequin head was developed to measure light illuminance levels with and without sun-protective equipment, across a wide range of environments in Singapore, outdoors (open park, under a tree, street) and indoors (under a fluorescent illumination with window, under white LED-based lighting without window). A comparison was made between indoor and outdoor light levels that are experienced while children are involved in day-to-day activities.
Results: Outdoor light levels were much higher (11,080-18,176 lux) than indoors (112-156 lux). The higher lux levels protective of myopia (>1000 lux) were measured at the tree shade (5556-7876 lux) and with hat (4112-8156 lux). Sunglasses showed lux levels between 1792 and 6800 lux. Although with sunglasses readings were lower than tree shade and hat, light levels were still 11 to 43 times higher than indoors.
Conclusions: Recommendations on spending time outdoors for myopia prevention with adequate sun protection should be provided while partaking in outdoor activities, including protection under shaded areas, wearing a hat or sunglasses, sunscreen, and adequate hydration.
Translational Relevance: Light levels outdoors were higher than indoors and above the threshold illuminance for myopia prevention even with adequate sun-protective measures.

Matched MeSH terms: Risk Factors
Current Perspectives on Nasopharyngeal Carcinoma

Lee HM, Okuda KS, González FE, Patel V

Adv Exp Med Biol, 2019;1164:11-34.
PMID: 31576537 DOI: 10.1007/978-3-030-22254-3_2

Of the ~129,079 new cases of nasopharyngeal carcinoma (NPC) and 72,987 associated deaths estimated for 2018, the majority will be geographically localized to South East Asia, and likely to show an upward trend annually. It is thought that disparities in dietary habits, lifestyle, and exposures to harmful environmental factors are likely the root cause of NPC incidence rates to differ geographically. Genetic differences due to ethnicity and the Epstein Barr virus (EBV) are likely contributing factors. Pertinently, NPC is associated with poor prognosis which is largely attributed to lack of awareness of the salient symptoms of NPC. These include nose hemorrhage and headaches and coupled with detection and the limited therapeutic options. Treatment options include radiotherapy or chemotherapy or combination of both. Surgical excision is generally the last option considered for advanced and metastatic disease, given the close proximity of nasopharynx to brain stem cell area, major blood vessels, and nerves. To improve outcome of NPC patients, novel cellular and in vivo systems are needed to allow an understanding of the underling molecular events causal for NPC pathogenesis and for identifying novel therapeutic targets and effective therapies. While challenges and gaps in current NPC research are noted, some advances in targeted therapies and immunotherapies targeting EBV NPCs are discussed in this chapter, which may offer improvements in outcome of NPC patients.

Matched MeSH terms: Risk Factors
Fulltext Incidence and predictors of early seizures in intracerebral haemorrhage and the effect of tranexamic acid

Law ZK, England TJ, Mistri AK, Woodhouse LJ, Cala L, Dineen R, et al.

Eur Stroke J, 2020 Jun;5(2):123-129.
PMID: 32637645 DOI: 10.1177/2396987320901391

Introduction: Seizures are common after intracerebral haemorrhage. Tranexamic acid increases the risk of seizures in non-intracerebral haemorrhage population but its effect on post-intracerebral haemorrhage seizures is unknown. We explored the risk factors and outcomes of seizures after intracerebral haemorrhage and if tranexamic acid increased the risk of seizures in the Tranexamic acid for IntraCerebral Haemorrhage-2 trial.
Patients and methods: Seizures were reported prospectively up to day 90. Cox regression analyses were used to determine the predictors of seizures within 90 days and early seizures (≤7 days). We explored the effect of early seizures on day 90 outcomes.
Results: Of 2325 patients recruited, 193 (8.3%) had seizures including 163 (84.5%) early seizures and 30 (15.5%) late seizures (>7 days). Younger age (adjusted hazard ratio (aHR) 0.98 per year increase, 95% confidence interval (CI) 0.97-0.99; p = 0.008), lobar haematoma (aHR 5.84, 95%CI 3.58-9.52; p risk of seizure within 90 days. Early seizures were associated with worse modified Rankin Scale (adjusted odds ratio (aOR) 1.79, 95%CI 1.12-2.86, p = 0.015) and increased risk of death (aOR 3.26, 95%CI 1.98-5.39; p risk of post-intracerebral haemorrhage seizures in the first 90 days. Early seizures resulted in worse functional outcome and increased risk of death.

Matched MeSH terms: Risk Factors
Gestational diabetes mellitus in primigravidae: a mild disease

Ismail NA, Aris NM, Mahdy ZA, Ahmad S, Naim NM, Siraj HH, et al.

Acta Medica (Hradec Kralove), 2011;54(1):21-4.
PMID: 21542419 DOI: 10.14712/18059694.2016.12

This prospective observational study was done to analyse the prevalence of gestational diabetes mellitus (GDM) among primigravidae and its outcome. All healthy primigravidae with singleton pregnancies were offered universal glucose tolerance testing between 16 and 28 weeks gestation. GDM and non GDM groups were managed according to hospital protocol. The antenatal features and pregnancy outcomes were analysed. Out of 616 primigravidae, 113 (18.34%) were GDM with slightly older (27.9 +/- 4.2 versus 26.32 +/- 3.3, p < 0.001) age. The mean fasting and two hours postprandial blood glucose in both groups were 4.99 +/- 1.08 mmol/l, 8.86 +/- 1.41 mmol/l(GDM) and 4.36 +/- 0.43 mmol/l, 5.71 +/- 1.11 mmol/l (Non GDM), respectively. Maternal family history of diabetes mellitus, weight exceeding 80 Kg, polyhydramnios (2.65% versus 0.2%, p = 0.028) and neonatal hyperbilirubinaemia (9.73% versus 2.98%, p = 0.01) occurred significantly more frequent in the GDM group compared to normal. There was no significant difference in other pregnancy outcomes and complications between the two groups. In conclusion GDM in primigravidae was detected at a relatively young age with more frequent maternal family history of DM, weight exceeding 80 Kg, polyhydromnions and neonatal hyperbilirubinaemia. The degree of disease was mild and treatment led to no significant complication.

Matched MeSH terms: Risk Factors
How to improve CVD risk prediction in a low-risk population [abstract]

Chia YC

J Hypertens, 2016 Sep;34 Suppl 1 - ISH 2016 Abstract Book:e16-e17.
PMID: 27753834

Conference abstract SY04-4: Many cardiovascular disease (CVD) risk prediction tools have been developed in an attempt to identify those at highest risk in order for them to benefit from interventional treatment. The first CVD risk tool that was developed was the coronary heart disease risk tool by the Framingham Heart Study in 1998 (1). However the Framingham Risk Score could overestimate (or underestimate) risk in populations other than the US population. Hence several other risk engines have also been developed, primarily for a better fit in the communities in which the tools are to be used (2, 3). Having said that the Framingham Heart Study risk tool has been validated in several populations (4, 5) and found to work reasonably well after some recalibration.Most risk prediction tools predict short term risk ie over a period of 10 years but since more recently risk tools now attempt to predict life-time risk or at least risk over the next 30 years. (6-8). The practical use of these risk prediction tools is that it is able to separate those at high risk (ie > 20% risk of a CVD event fatal or non-fatal event in the next 10 years) from those with the lowest risk (< 10% risk over 10 years). It then helps practitioners to triage them to either receive preventive therapy (high risk group) or none at all (low risk group) respectively. However in those with medium risk ie between 10-20%, the decision to offer treatment or not is less clear. In such a situation, other CVD risk factors for example family history of premature coronary heart disease, other biomarkers like elevated hs-CRP, presence of chronic kidney disease or albuminuria can be employed to further stratify risk.It is known that risk prediction tools are very much age dependent and in a younger individual with mildly raised CVD risk factors, his global CVD risk may be grossly under-estimated. Here additional CVD risk factors beyond those traditionally used in risk engines should be sought in order to recalibrate that individual's seemingly low risk and earlier intervention introduced if indeed he is of higher risk than what has been predicted by the conventional risk tools. Here too the use of life-time risk is probably of more importance than the traditional 10 year risk tool, again in order to identify those seemingly at "low" risk 10 year risk to receive treatment if the life-time risk is greater compared to an individual of the same age with optimal parameters. Furthermore while it is known that those with highest risk benefit the most from intervention, it is the population at large with the low or lower risk which contributes most to total CV morbidity and mortality in a country or community.Hence while short term risk prediction to identify those at highest risk is useful particularly in the presence of limited resources, attention should also be paid to those with short term low risk if the aim is to reduce CVD morbidity and mortality in any substantial way.

Matched MeSH terms: Risk Factors

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