Risk score for predicting death, myocardial infarction, and stroke in patients with stable angina, based on a large randomised trial cohort of patients

Dear Editor,

Clayton and his team have formed a risk score for predicting death,
myocardial infarction and stroke in patients with stable angina. [1]
The score seems be useful in identification of the groups of patients for
divers treatment orientations.

We are studying a group of patients with cardiovascular disease and
we used, for grading of cumulating atherosclerosis risk factors, the
Pocock’s score (published in B.M.J.) for predicting the risk of death by
cardiovascular disease based on data from randomized controlled trials [2]

After reading of Clayton’s and all paper, we tried to compare
Clayton’s score with older Pocock’s score. On a little number of patients
who fulfilled all conditions for the both scores calculations, we stated a
very good correlation between Pocock’s and Clayton’s scores: r=0.617,
p<_0.0001 pearson="pearson" correlation="correlation" number="number" of="of" cases="cases" _-="_-" _66.="_66." this="this" high="high" significant="significant" coefficient="coefficient" shows="shows" that="that" both="both" scores="scores" have="have" very="very" close="close" values="values" in="in" predicting="predicting" death="death" stroke="stroke" or="or" myocardial="myocardial" infarction.="infarction." p="p"/> Practically, we think that all these works on the role of
atherosclerosis risk factors in prognosis appreciation of cardiovascular
disease have importance and must be continued.

On the other hand, we sustain that, in analysis of atherosclerosis
risk factors, is necessary to retain for analysis the “new”
atherosclerosis risk factors such as: low level non specific inflammation
(with markers C reactive protein, fibrinogen, 6-interleukine, etc.) and
dental state appreciation. These “new” risk factors may intervene in
atherogenesis and may have weight in any prognostic score.[3.4.5]
In Clayton’s score, the authors mention that they have retained white
blood cells number
only, not C reactive protein or others.

We think any risk score in predicting death, coronary obstruction or
stroke must use the “new” atherosclerosis risk factors, too.

References:

1.Clayton TC, Lubsen J, Pocock SJ et al: Risk score for predicting
death, myocardial infarction, and stroke in patients with stable angina,
based on a large randomized trial cohort of patients. BMJ 2005;331:869-
872.

2. Pocock SJ, McCormack V, Gueyffier F et al: A score for predicting
risk of death from cardiovascular disease in adults with raised blood
pressure, based on individual patient data from randomized controlled
trials. BMJ 2001;323:75-81.

3. Hansson GK: Mechanisms of Disease: Inflammation, Atherosclerosis,
and Coronary Artery Disease. N Engl J Med 2005; 352:1685-1695.

4. Janket SJ, Qvarnstroem M, Meurman JK, et all: Asymptotic Dental
Score and Prevalent Coronary Heart Disease. Circulation 2004;109:1095-
1109.

5. Desvariuex M, Demmer RT, Rundek T, et all: Relationship Between
Periodontal Disease, Tooth Loss, and Carotid Artery Plaque. The Oral
Infections and Vascular Disease Epidemiology Study (INVEST). Stroke
2003;34:2120-2125.

Competing interests:
None declared