Características de la microvascularización retiniana y marcadores de riesgo cardiovascular

La enfermedad cardiovascular es una de las principales causas de morbimortalidad a nivel global y en Colombia. Actualmente existen diversos métodos para identificar el riesgo cardiovascular a nivel individual que permiten guiar políticas públicas y decisiones clínicas. Sin embargo los métodos no son...

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Autores:
Viteri Solórzano, Eduardo Javier
Tipo de recurso:
Fecha de publicación:
2020
Institución:
Universidad Autónoma de Bucaramanga - UNAB
Repositorio:
Repositorio UNAB
Idioma:
spa
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oai:repository.unab.edu.co:20.500.12749/13966
Acceso en línea:
http://hdl.handle.net/20.500.12749/13966
Palabra clave:
Medical sciences
Health sciences
Ophthalmology
Retinal microvascularization
Cardiovascular disease
Blood circulation disorders
Medical statistics
Public health
Retinal diseases
Oftalmología
Ciencias médicas
Trastornos de la circulación sanguínea
Estadísticas médicas
Salud pública
Enfermedades de la retina
Ciencias de la salud
Microvascularización retiniana
Enfermedad cardiovascular
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openAccess
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http://creativecommons.org/licenses/by-nc-nd/2.5/co/
id UNAB2_61b07d412b969c8bd809a364d1b87669
oai_identifier_str oai:repository.unab.edu.co:20.500.12749/13966
network_acronym_str UNAB2
network_name_str Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv Características de la microvascularización retiniana y marcadores de riesgo cardiovascular
dc.title.translated.spa.fl_str_mv Characteristics of retinal microvascularization and cardiovascular risk markers
title Características de la microvascularización retiniana y marcadores de riesgo cardiovascular
spellingShingle Características de la microvascularización retiniana y marcadores de riesgo cardiovascular
Medical sciences
Health sciences
Ophthalmology
Retinal microvascularization
Cardiovascular disease
Blood circulation disorders
Medical statistics
Public health
Retinal diseases
Oftalmología
Ciencias médicas
Trastornos de la circulación sanguínea
Estadísticas médicas
Salud pública
Enfermedades de la retina
Ciencias de la salud
Microvascularización retiniana
Enfermedad cardiovascular
title_short Características de la microvascularización retiniana y marcadores de riesgo cardiovascular
title_full Características de la microvascularización retiniana y marcadores de riesgo cardiovascular
title_fullStr Características de la microvascularización retiniana y marcadores de riesgo cardiovascular
title_full_unstemmed Características de la microvascularización retiniana y marcadores de riesgo cardiovascular
title_sort Características de la microvascularización retiniana y marcadores de riesgo cardiovascular
dc.creator.fl_str_mv Viteri Solórzano, Eduardo Javier
dc.contributor.advisor.none.fl_str_mv Tello Hernández, Alejandro
Camacho López, Paul Anthony
dc.contributor.author.none.fl_str_mv Viteri Solórzano, Eduardo Javier
dc.contributor.cvlac.spa.fl_str_mv Tello Hernández, Alejandro [0001009125]
Camacho López, Paul Anthony [0000323578]
dc.contributor.googlescholar.spa.fl_str_mv Camacho López, Paul Anthony [OvqUoOAAAAAJ&hl=es&oi=ao]
dc.contributor.orcid.spa.fl_str_mv Tello Hernández, Alejandro [0000-0001-5081-0720]
Camacho López, Paul Anthony [0000-0002-6233-9582]
dc.contributor.researchgate.spa.fl_str_mv Tello Hernández, Alejandro [Alejandro-Tello]
dc.contributor.apolounab.none.fl_str_mv Camacho López, Paul Anthony [paul-anthony-camacho-lópez]
dc.contributor.linkedin.none.fl_str_mv Camacho López, Paul Anthony [paulcamachomdepi]
dc.subject.keywords.spa.fl_str_mv Medical sciences
Health sciences
Ophthalmology
Retinal microvascularization
Cardiovascular disease
Blood circulation disorders
Medical statistics
Public health
Retinal diseases
topic Medical sciences
Health sciences
Ophthalmology
Retinal microvascularization
Cardiovascular disease
Blood circulation disorders
Medical statistics
Public health
Retinal diseases
Oftalmología
Ciencias médicas
Trastornos de la circulación sanguínea
Estadísticas médicas
Salud pública
Enfermedades de la retina
Ciencias de la salud
Microvascularización retiniana
Enfermedad cardiovascular
dc.subject.lemb.spa.fl_str_mv Oftalmología
Ciencias médicas
Trastornos de la circulación sanguínea
Estadísticas médicas
Salud pública
Enfermedades de la retina
dc.subject.proposal.spa.fl_str_mv Ciencias de la salud
Microvascularización retiniana
Enfermedad cardiovascular
description La enfermedad cardiovascular es una de las principales causas de morbimortalidad a nivel global y en Colombia. Actualmente existen diversos métodos para identificar el riesgo cardiovascular a nivel individual que permiten guiar políticas públicas y decisiones clínicas. Sin embargo los métodos no son perfectos y pueden beneficiarse de información adicional para mejorar sus predicciones. Nuevas tecnologías en análisis de imagen de exámenes oftalmológicos actualmente disponibles como la tomografía por coherencia óptica (OCT) permiten un análisis cuantitativo de la microvascularización retiniana. Debido diversos reportes en la literatura que asocian cambios en los plexos vasculares retinianos con presencia o desenlaces de enfermedad cardiovascular se plantea un estudio para analizar si los datos objetivos y cuantificables que ofrece el OCT con angiografía se asocian con otros marcadores individuales o puntuaciones globales de riesgo cardiovascular ya establecidos y que se estudian actualmente en cohortes dentro de la institución. Este análisis observacional realizado por primera vez en nuestro medio busca explorar la existencia de posibles biomarcadores retinianos que brinden información adicionalsobre el riesgo cardiovascular y/o permitan una referencia temprana a servicios especializados.
publishDate 2020
dc.date.issued.none.fl_str_mv 2020-05-28
dc.date.accessioned.none.fl_str_mv 2021-08-23T21:58:25Z
dc.date.available.none.fl_str_mv 2021-08-23T21:58:25Z
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
dc.type.redcol.none.fl_str_mv http://purl.org/redcol/resource_type/TM
http://purl.org/redcol/resource_type/TM
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12749/13966
dc.identifier.instname.spa.fl_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
dc.identifier.repourl.spa.fl_str_mv repourl:https://repository.unab.edu.co
url http://hdl.handle.net/20.500.12749/13966
identifier_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
reponame:Repositorio Institucional UNAB
repourl:https://repository.unab.edu.co
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv 1. Noncommunicable diseases country profiles 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO
2. Goto, S. Katsuki, H. Ikui, K. Kimoto, T. Mimatsu. Pathological studies on the intracerebral and retinal arteries in cerebrovascular and non cerebrovascular diseases. Stroke, 6 (1975), pp. 263- 269
3. Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci 1974;268:336—45
4. Wong T. Retinal Microvascular abnormalities and their Relationship with Hypertension. Cardiovascular Disease and Mortality. Survey Ophtalmol 2001;46:56—80
5. Saari, JC. Metabolism and photochemistry in the retina. In: Moses, RA.; Hart, WM., editors. Adler's Physiology of the Eye Clinical Application. Mosby; St Louis: 1987. p. 356-373.
6. Alder VA, Ben-Nun J, Cringle SJ. PO2 profiles and oxygen consumption in cat retina with an occluded retinal circulation. Invest Ophthalmol Vis Sci. 1990; 31:1029–1034. [PubMed: 2354908
7. Buttery RG, Hinrichsen CF, Weller WL, Haight JR. How thick should a retina be? A comparative study of mammalian species with and without intraretinal vasculature. Vis Res. 1991; 31:169– 18. [PubMed: 2017880]
8. Hughes S, Yang H, Chan-Ling T. Vascularization of the human fetal retina: roles of vasculogenesis and angiogenesis. Invest Ophthalmol Vis Sci. 2000; 41:1217–1228.
9. Chan-Ling, T. Blood–Brain Barriers. Wiley-VCH Verlag GmbH & Co; KgaA: 2006. The blood retinal interface: similarities and contrasts with the blood-brain interface; p. 701-724.
10. Hollander H, Makarov F, Dreher Z, Van Driel D, Chan-Ling T, Stone J. Structure of the macroglia of the retina: the sharing and division of labour between astrocytes and Muller cells. J Comp Neurol. 1991; 313:587–603
11. Keeler CR. The Ophthalmoscope in the Lifetime of Hermann von Helmholtz. Arch Ophthalmol. 2002;120(2):194–201. doi:10.1001/archopht.120.2.194
12. Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography. Science. 1991;254:1178– 1181
13. Drexler W, Fujimoto JG. State-of-the-art retinal optical coherence tomography. Prog Retin Eye Res. 2008;27:45–88
14. Campbell, J. P. et al. Detailed Vascular Anatomy of the Human Retina by Projection- Resolved Optical Coherence Tomography Angiography. Sci. Rep. 7, 42201.
15. Tan, P. E. Z. et al. Quantitative Confocal Imaging of the Retinal Microvasculature in the Human Retina. Invest. Ophthalmol. Vis. Sci. 53, 5728–9 (2012).
16. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980e2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet 2017;390:1151–210
17. K.N. Karmali et al. “Risk scoring for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2017;3:Cd006887.
18. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts), developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37:2315–81
19. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2889–934.
20. World Health Organization. WHO Prevention of Cardiovascular Disease: Guidelines for Assessment and Management of Cardiovascular Risk. Geneva, Switzerland: World Health Organization; 2007
21. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (May 1998). "Prediction of coronary heart disease using risk factor categories". Circulation. 97 (18): 1837–47
22. Mahmood, Levy; Vasan, Wang (2013). "The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective" Lancet. 383 (9921): 999–1008
23. P Brindle, A McConnachie, M Upton, et al “The accuracy of the Framingham risk-score in different socioeconomic groups: a prospective study
24. Cortes-Bergoderi M, Thomas RJ, Albuquerque FN, Batsis JA, Burdiat G, Perez-Terzic C, et al. Validity of cardiovascular risk prediction models in Latin America and among Hispanics in the United States of America: a systematic review. Rev Panam Salud Publica. 2012;32(2):131–9.
25. Rodrigo M. Carrillo-Larco et al. Cardiovascular Disease Prognostic Models in Latin America and the Caribbean A Systematic Review GLOBAL HEART, VOL. 14, NO. 1, 2019 81 March 2019: 81-93
26. Muñoz OM, García AA, Fernández-Ávila D, Higuera A, Ruiz AJ, Ascher P. Guía de práctica clínica para la prevención, detección temprana, diagnóstico, tratamiento y seguimiento de las dislipidemias: evaluación del riesgo cardiovascular. Rev Colomb Cardiol. 2015;22:263
27. Muñoz OM et al. Concordancia entre los modelos de SCORE y Framingham y las ecuaciones AHA/ACC como evaluadores de riesgo cardiovascular. Rev Colomb Cardiol. 2017;24(2):110--- 116
28. Bazo-alvarez JC, Quispe R, Peralta F, Poterico JA, Valle GA, Burroughs M, et al. Agreement between cardiovascular disease risk scores in resource-limited settings: evidence from 5 peruvian sites. Crit Pathways Cardiol. 2015;14:74---80.
29. US Preventive Services Task Force, et al. “Risk Assessment for Cardiovascular Disease With Nontraditional Risk Factors: US Preventive Services Task Force Recommendation Statement.” JAMA, vol. 320, no. 3, July 2018, p. 272, doi:10.1001/jama.2018.8359
30. Barry E, Roberts S, Oke J, et al. Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions. BMJ. 2017;356:i6538
31. Collins, Gary S; Altman, Douglas G (21 June 2012). "Predicting the 10 year risk of cardiovascular disease in the United Kingdom: independent and external validation of an updated version of QRISK2". BMJ. 344: e4181
32. Wong TY, Klein R, Nieto FJ, et al. Retinal microvascular abnormalities and 10-year cardiovascular mortality: population-based case-control study. Ophthalmology. 2003;110(5):933e940
33. McGeechan K, Liew G, Macaskill P, et al. Prediction of incident stroke events based on retinal vessel caliber: a systematic review and individual-participant meta-analysis. Am J Epidemiol. 2009;170(11):1323e1332
34. Chew SK, Xie J, Wang JJ. Retinal arteriolar diameter and the prevalence and incidence of hypertension: a systematic review and meta-analysis of their association. Curr Hypertens Rep. 2012;14(2):144e151
35. Sabanayagam C, Lye WK, Klein R, et al. Retinal microvascular calibre and risk of diabetes mellitus: a systematic review and participant-level meta-analysis. Diabetologia. 2015;58(11):2476e2485
36. Pontikos NWS, Faes L,Kortuem K, FaslerK, Balaskas K, Keane PA. Comment on: Trends in retina specialist imaging utilization from 2012 to 2016 in the United States Medicare fee-for- service population. Am J Ophthalmol. In press.
37. Enoch J, McDonald L, Jones L, Jones PR, Crabb DP. Evaluating whether sight is the most valued sense [published online October 3, 2019]. JAMA Ophthalmol.
38. Robson J, Dostal I, Sheikh A, et al. The NHS Health Check in England: an evaluation of the first 4 years. BMJ Open. 2016;6:e008840
39. The State of the National Eye Health 2017: A Year in Review. RNIB (2018). Available at https://www.rnib.org.uk/sites/default/files/APDF%20The%20State%20of%20the%20Nation%2 0Eye%20Health %202017%20A%20Year%20in%20Review.pdf. Accessed January 5, 2020
40. Arnould L, Guenancia C, Azemar A, et al. The EYE-MI pilot study: a prospective acute coronary syndrome cohort evaluated with retinal optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2018;59:4299–4306. https:// doi.org/10.1167/iovs.18-24090
41. Carlo TE de, Chin AT, Bonini Filho MA, et al. Detection of microvascular changes in eyes of patients with diabetes but not clinical diabetic retinopathy using optical coherence tomography angiography. Retina. 2015;35:2364–2370
42. Tang FY, Ng DS, Lam A, et al. Determinants of quantitative optical coherence tomography angiography metrics in patients with diabetes. Sci Rep. 2017;7:2575.
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dc.publisher.faculty.spa.fl_str_mv Facultad Ciencias de la Salud
dc.publisher.program.spa.fl_str_mv Especialización en Oftalmología
institution Universidad Autónoma de Bucaramanga - UNAB
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spelling Tello Hernández, Alejandro7ae428b7-0b9b-4aff-9bbf-6940dcfd7cb5-1Camacho López, Paul Anthonye46d0c19-2faf-4964-80c2-bc6b94bb4127-1Viteri Solórzano, Eduardo Javierb7d55d01-0e35-440a-9393-332eb4678aae-1Tello Hernández, Alejandro [0001009125]Camacho López, Paul Anthony [0000323578]Camacho López, Paul Anthony [OvqUoOAAAAAJ&hl=es&oi=ao]Tello Hernández, Alejandro [0000-0001-5081-0720]Camacho López, Paul Anthony [0000-0002-6233-9582]Tello Hernández, Alejandro [Alejandro-Tello]Camacho López, Paul Anthony [paul-anthony-camacho-lópez]Camacho López, Paul Anthony [paulcamachomdepi]Santander, (Colombia)UNAB Campus Bucaramanga2021-08-23T21:58:25Z2021-08-23T21:58:25Z2020-05-28http://hdl.handle.net/20.500.12749/13966instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coLa enfermedad cardiovascular es una de las principales causas de morbimortalidad a nivel global y en Colombia. Actualmente existen diversos métodos para identificar el riesgo cardiovascular a nivel individual que permiten guiar políticas públicas y decisiones clínicas. Sin embargo los métodos no son perfectos y pueden beneficiarse de información adicional para mejorar sus predicciones. Nuevas tecnologías en análisis de imagen de exámenes oftalmológicos actualmente disponibles como la tomografía por coherencia óptica (OCT) permiten un análisis cuantitativo de la microvascularización retiniana. Debido diversos reportes en la literatura que asocian cambios en los plexos vasculares retinianos con presencia o desenlaces de enfermedad cardiovascular se plantea un estudio para analizar si los datos objetivos y cuantificables que ofrece el OCT con angiografía se asocian con otros marcadores individuales o puntuaciones globales de riesgo cardiovascular ya establecidos y que se estudian actualmente en cohortes dentro de la institución. Este análisis observacional realizado por primera vez en nuestro medio busca explorar la existencia de posibles biomarcadores retinianos que brinden información adicionalsobre el riesgo cardiovascular y/o permitan una referencia temprana a servicios especializados.EspecializaciónCardiovascular disease is one of the main causes of morbidity and mortality globally and in Colombia. Currently there are various methods to identify cardiovascular risk at the individual level that allow guiding public policies and clinical decisions. However the methods are not perfect and you can benefit from additional information to improve your predictions. New technologies in image analysis of ophthalmological examinations currently available such as optical coherence tomography (OCT) allow a quantitative analysis of retinal microvascularization. Due to various reports in the literature that associate changes in the retinal vascular plexuses with the presence or outcomes of cardiovascular disease, a study is proposed to analyze whether the objective and quantifiable data offered by OCT with angiography are associated with other individual markers or global risk scores cardiovascular disease already established and currently being studied in cohorts within the institution. This observational analysis carried out for the first time in our setting seeks to explore the existence of possible retinal biomarkers that provide additional information on cardiovascular risk and / or allow an early referral to specialized services. The World Health Organization (WHO) indicates that cardiovascular disease represents 31% of all causes of death globally. In Colombia, it stands out as the main cause of death and is an important contributor to premature mortality (30-70 years), as in other low- and lower-middle-income countries. In most patients, pathophysiological processes are present long before the disease and the development of simple tests that identify them are useful to define high-risk populations in primary or secondary care. (1) Retinal microvascularization, easily accessible with non-invasive methods, seems to share similar physiological and anatomical characteristics with cerebral and coronary microvascularization (2). The abnormalities of these retinal plexuses could therefore reflect those observed in other vascular beds that are currently recognized as key sites in the pathophysiology of cardiovascular diseases. Optical coherence tomography angiography (OCT-A) allows objective quantification of retinal microvascularization through computerized image analysis. This new diagnostic method is an extension of the capabilities of the software in a widely diffused equipment in current ophthalmology practice. Its use allows estimating the vascular density of retinal capillary beds in an objective and numerical way, which facilitates establishing correlations with ocular or systemic pathologies. Establishing associations between characteristics of the retinal microvasculature obtained by a non- invasive examination and known cardiovascular risk factors for our population may allow ophthalmologists to identify patients at higher risk that merit preventive actions.Modalidad Presencialapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Atribución-NoComercial-SinDerivadas 2.5 ColombiaCaracterísticas de la microvascularización retiniana y marcadores de riesgo cardiovascularCharacteristics of retinal microvascularization and cardiovascular risk markersEspecialista en OftalmologíaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Oftalmologíainfo:eu-repo/semantics/masterThesisTesishttp://purl.org/redcol/resource_type/TMhttp://purl.org/redcol/resource_type/TMMedical sciencesHealth sciencesOphthalmologyRetinal microvascularizationCardiovascular diseaseBlood circulation disordersMedical statisticsPublic healthRetinal diseasesOftalmologíaCiencias médicasTrastornos de la circulación sanguíneaEstadísticas médicasSalud públicaEnfermedades de la retinaCiencias de la saludMicrovascularización retinianaEnfermedad cardiovascular1. Noncommunicable diseases country profiles 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO2. Goto, S. Katsuki, H. Ikui, K. Kimoto, T. Mimatsu. Pathological studies on the intracerebral and retinal arteries in cerebrovascular and non cerebrovascular diseases. Stroke, 6 (1975), pp. 263- 2693. Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci 1974;268:336—454. Wong T. Retinal Microvascular abnormalities and their Relationship with Hypertension. Cardiovascular Disease and Mortality. Survey Ophtalmol 2001;46:56—805. Saari, JC. Metabolism and photochemistry in the retina. In: Moses, RA.; Hart, WM., editors. Adler's Physiology of the Eye Clinical Application. Mosby; St Louis: 1987. p. 356-373.6. Alder VA, Ben-Nun J, Cringle SJ. PO2 profiles and oxygen consumption in cat retina with an occluded retinal circulation. Invest Ophthalmol Vis Sci. 1990; 31:1029–1034. [PubMed: 23549087. Buttery RG, Hinrichsen CF, Weller WL, Haight JR. How thick should a retina be? A comparative study of mammalian species with and without intraretinal vasculature. Vis Res. 1991; 31:169– 18. [PubMed: 2017880]8. Hughes S, Yang H, Chan-Ling T. Vascularization of the human fetal retina: roles of vasculogenesis and angiogenesis. Invest Ophthalmol Vis Sci. 2000; 41:1217–1228.9. Chan-Ling, T. Blood–Brain Barriers. Wiley-VCH Verlag GmbH & Co; KgaA: 2006. The blood retinal interface: similarities and contrasts with the blood-brain interface; p. 701-724.10. Hollander H, Makarov F, Dreher Z, Van Driel D, Chan-Ling T, Stone J. Structure of the macroglia of the retina: the sharing and division of labour between astrocytes and Muller cells. J Comp Neurol. 1991; 313:587–60311. Keeler CR. The Ophthalmoscope in the Lifetime of Hermann von Helmholtz. Arch Ophthalmol. 2002;120(2):194–201. doi:10.1001/archopht.120.2.19412. Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography. Science. 1991;254:1178– 118113. Drexler W, Fujimoto JG. State-of-the-art retinal optical coherence tomography. Prog Retin Eye Res. 2008;27:45–8814. Campbell, J. P. et al. Detailed Vascular Anatomy of the Human Retina by Projection- Resolved Optical Coherence Tomography Angiography. Sci. Rep. 7, 42201.15. Tan, P. E. Z. et al. Quantitative Confocal Imaging of the Retinal Microvasculature in the Human Retina. Invest. Ophthalmol. Vis. Sci. 53, 5728–9 (2012).16. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980e2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet 2017;390:1151–21017. K.N. Karmali et al. “Risk scoring for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2017;3:Cd006887.18. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts), developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37:2315–8119. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2889–934.20. World Health Organization. WHO Prevention of Cardiovascular Disease: Guidelines for Assessment and Management of Cardiovascular Risk. Geneva, Switzerland: World Health Organization; 200721. 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