SPC365

Risk modifiers in cardiovascular prevention: prevalence and clinical impact in a Portuguese community-based study

Session: Sessão de Posters 14 - Tratar o risco: sucessos e falhas na gestão lipídica
Speaker: Pedro Miguel Mangas Neto da Palma

Congress: CPC 2026
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Pedro Mangas Palma; Luana Alves; Sílvia O. Diaz; Helena Moreira; Emanuel Oliveira; Bernardo Cruz; Francisca Saraiva; Giulia Rinaldi; Marta Tavares Silva; Mariana Vasconcelos; Adelino Leite Moreira; Rui André Rodrigues

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Background&nbsp;</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">The 2021 ESC Guidelines on cardiovascular disease prevention recommend estimating 10-year ASCVD risk using SCORE2 or SCORE2-OP and emphasise the incorporation of modifiers to refine individualised risk assessment. However, clinical practice remains largely centred on traditional risk factors, and modifiers are frequently overlooked. This may lead to systematic underestimation of cardiovascular risk, with implications for preventive strategies and patient outcomes.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Aim</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">To determine the prevalence of cardiovascular risk modifiers in a Portuguese population sample and evaluate their impact on risk reclassification.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Methods</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">A cross-sectional screening programme was conducted in three localities in Portugal. Eligible participants were volunteers aged &ge;40 years. A standardised protocol was followed, including anthropometric measurements, blood pressure assessment, a lifestyle and clinical questionnaire, point-of-care capillary lipid profiling, and high-sensitivity C-reactive protein (hs-CRP) testing. Optional venous blood sampling was performed according to individual preference.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Ten-year ASCVD risk was estimated in accordance with ESC Guidelines. Recorded risk modifiers were family history of premature cardiovascular disease, obesity, sedentarism, chronic inflammatory disease, major psychiatric disorders, elevated hs-CRP and elevated lipoprotein(a). Borderline cases were moved up one risk category if any modifier was present.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Results</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">We included 198 patients (median age 67 years [IQR 56&ndash;73]; 64 [32%] men). Traditional risk factors were common: 19% had diabetes, 47% hypertension and 56% dyslipidaemia; 49% were overweight or obese and 40% were current or former smokers. Most patients (92%) had at least one cardiovascular risk modifier and 38% had multiple.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Sedentary lifestyle, obesity and elevated Lp(a) were the most frequent unique modifiers, whereas elevated hs-CPR was least frequent. Incorporating modifiers into risk estimation produced a marked upward shift in risk estimation: low&ndash;moderate, high and very high risk categories changed from 23%, 49% and 28% to 2%, 26% and 72%, respectively. Upward reclassification occurred in 91% of patients initially at low&ndash;moderate risk and 90% at high risk.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Conclusion&nbsp;</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Cardiovascular risk modifiers were highly prevalent and led to substantial upward reclassification, with most patients shifting to very high risk and clear implications for preventive treatment decisions. Elevated Lp(a) was both frequent and influential, in contrast to the limited contribution of hs-CRP. These findings may help guide biomarker testing in primary prevention in this population and improve the cost-effectiveness of cardiovascular risk stratification.</span></span></span></span></span></p>

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