Korean J Occup Environ Med.  2012 Dec;24(4):365-374.

Risk Assessment for Cardiovascular Diseases in Male Workers: Comparing KOSHA Guidelines and the Framingham Risk Score System

Affiliations
  • 1Department of Occupational & Environmental Medicine, Gachon University Gil Medical Center, Korea. hansh@gachon.ac.kr

Abstract


OBJECTIVES
This study aimed to investigate the 10-year risk of cardiovascular disease (CVD) by Framingham risk score (FRS) who classified as "healthy group" by Korean Occupational Safety and Health Agent (KOSHA)' s cardiovascular risk assessment.
METHODS
The subjects of this study were 1,781 male workers in a large steel company. Health status was obtained periodically through medical examinations and questionnaires. We assessed cardiovascular risk using KOSHA guidelines and calculated the 10-year risk of cardiovascular disease using the Framingham risk score for those categorized to the "healthy group" by KOSHA guideline. A closer examination of cardiovascular risk factors was performed in 62 subjects paradoxically placed in the "healthy group" by KOSHA guidelines and the "high-risk group" by FRS.
RESULTS
Among the "healthy group" by KOSHA's cardiovascular risk assessment, 230(15.8%) subjects had more than 3 CVD risk factors and 62(4.2%) subjects were high risk group (more than 20%) in 10-years risk of CVD by Framingham risk score. Modifiable risk factors included cigarette smoking (96.8%), high serum total cholesterol (82.3%), high serum triglyceride (66.1%), insufficient physical activity (66.1%), and obesity (58.1%).
CONCLUSIONS
Among subjects with normal blood pressure, it seems that KOSHA guidelines underestimate CVD risk, identified by the Framingham risk score. For the effective prevention and management of CVD, modifiable risk factors, such as cigarette smoking, dyslipidemia, and obesity, need to be constructively controlled.

Keyword

Cardiovascular diseases; KOSHA's cardiovascular risk assessment; Framingham risk score

MeSH Terms

Blood Pressure
Cardiovascular Diseases
Cholesterol
Dyslipidemias
Humans
Male
Motor Activity
Obesity
Occupational Health
Questionnaires
Risk Assessment
Risk Factors
Smoking
Steel
Cholesterol
Steel

Reference

1. Poirier P. Healthy lifestyle: even if you are doing everything right, extra weight carries an excess risk of acute coronary events. Circulation. 2008. 117(24):3057–3059.
2. Mozaffarian D, Wilson PW, Kannel WB. Beyond established and novel risk factors: lifestyle risk factors for cardiovascular disease. Circulation. 2008. 117(23):3031–3038.
3. Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, Franklin BA, Goldstein LB, Greenland P, Grundy SM, Hong Y, Miller NH, Lauer RM, Ockene IS, Sacco RL, Sallis JF Jr, Smith SC Jr, Stone NJ, Taubert KA. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reductionfor adult patients without coronary or other atheroscleroticvascular diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation. 2002. 106(3):388–391.
4. Koh SB, Chang SJ, Park JK, Park JH, Son DK, Hyun SJ, Cha BS. Occupational stress and risk factors for cardiovascular diseases. Korean J Occup Environ Med. 2005. 17(3):186–198. (Korean).
5. Korea National Statical Office. Annual Report on the Cause of Death Statics 2010. 2011. Daejeon: Korea National Statical Office;6–26. (Korean).
6. ccupational Accidents and Diseases statistics. Korea Occupational Safety and Health Agency. cited 17 August 2012. Korea Occupational Safety and Health Agency;Available: http://www.kosha.or.kr/index.jsp.
7. Risk assessment for the prevention of cardio-cerebrovascular disease at workplace (KOSHA Code H-1-2010). Korea Occupational Safety and Health Agency. cited 17 August 2012. Korea Occupational Safety and Health Agency;Available: http://www.kosha.or.kr/index.jsp. (Korean).
8. Whitworth JA. World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension(ISH) statement on management of hypertension. J Hypertens. 2003. 21(11):1983–1992.
9. D'Agostino , Vasan , Pencina , Wolf , Cobain , Massaro , Kannel . General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008. 117(6):743–753.
10. Ahn KA, Yun JE, Cho ER, Nam CM, Jang Y, Jee SH. Framingham equation model overestimates risk of ischemic heart disease in korean men and women. Korean J Epidemiol. 2006. 28(2):162–170. (Korean).
11. Kim KH, Hyun DW, Kim WS, Yang JK, Kwon TG, Bae JH. Carotid Intima Media Thickness is Associated with the Framingham Risk Score in Korean Patients with Coronary Arteriosclerosis. Korean Circ J. 2007. 37:425–431. (Korean).
12. Kim MB, Park WJ, Jang KH, Lee DK, Chae HJ, Moon JD. Comparison of cardiovascular disease risk assessment tools by using coronary CT angiography. Korean J Occup Environ Med. 2010. 22(2):102–113. (Korean).
13. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation. 2002. 105(3):310–315.
14. Keil U, Njølstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM. Estimation of ten-year risk of fatal cardiovascular disease in Europe: The SCORE project. Eur Heart J. 2003. 24(11):987–1003.
15. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. 1979. 300(24):1350–1358.
16. Versteylen MO, Joosen IA, Shaw LJ, Narula J, Hofstra L. Comparison of Framingham, PROCAM, SCORE, and Diamond Forrester to predict coronary atherosclerosis and cardiovascular events. J Nucl Cardiol. 2011. 18(5):904–911.
17. Jee SH, Song JW, Cho HK, Kim SY, Jang YS, Kim JH. Development of the individualized health risk appraisal model of ischemic heart disease risk in Korea. Korean J Lipid. 2004. 14(2):153–168. (Korean).
18. Yi KJ, Heo HT, Kim DW, Kim IA, Kim SY, Rho JR, Mun JH. A Comparison of KOSHA’s cardiovascular disease risk assessment and the predicted 10-year risk of cardiovascular disease developed by Jee for a male workers at a wallpaper and floor covering manufacturer. Korean J Occup Environ Med. 2009. 21(2):174–183.
19. Ohtsuka S, Kakihana M, Watanabe H, Sugishita Y. Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction. J Am Coll Cardiol. 1994. 24(5):1406–1414.
20. Kohara K, Tabara Y, Oshiumi A, Miyawaki Y, Kobayashi T, Miki T. Radial augmentation index: a useful and easily obtainable parameter for vascular aging. Am J Hypertens. 2005. 18(1 Pt 2):11S–14S.
21. Sangiorgi G, Rumberger JA, Severson A, Edwards WD, Gregoire J, Fitzpatrick LA, Schwartz RS. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol. 1998. 31(1):126–133.
22. Kim D, Choi SY, Choi EK, Suh JW, Lee W, Kim YS, Yoon DH, Chung JW, OH BH. Distribution of coronary artery calcification in an asymptomatic Korean population: Association with risk factors of cardiovascular disease and metabolic syndrome. Korean Circ J. 2008. 38(1):29–35. (Korean).
23. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: An update. J Am Coll Cardiol. 2004. 43(10):1731–1737.
24. Jaakkola MS, Jaakkola JJ. Impact of smoke-free workplace legislation on exposures and health: possibilities for prevention. Eur Respir J. 2006. 28(2):397–408.
25. Wortley PM, Caraballo RS, Pederson LL, Pechacek TF. Exposure to secondhand smoke in the workplace: serum cotinine by occupation. J Occup Environ Med. 2002. 44(6):503–509.
26. Steenland K. Risk assessment for heart disease and workplace ETS exposure among nonsmokers. Environ Health Perspect. 1999. 107:Suppl 6. 859–863.
27. Hobbs FD. Type-2 diabetes mellitus related cardiovascular risk:New options for interventions to reduce risk and treatment goals. Atheroscler Suppl. 2006. 7(4):29–32.
28. Cui R, Iso H, Toyoshima H, Date C, Yamamoto A, Kikuchi S, Kondo T, Watanabe Y, Koizumi A, Inaba Y, Tamakoshi A. JACC Study Group. Serum total cholesterol levels and risk of mortality from stroke and coronary heart disease in Japanese: the JACC study. Atherosclerosis. 2007. 194(2):415–420.
29. Lozano JV, Pallarés V, Cea-Calvo L, Llisterri JL, Fernández-Pérez C, Martí-Canales JC, Aznar J, Gil-Guillén V, Redón J. Investigators of the PREV-ICTUS Study: Serum lipid profiles and their relationship to cardiovascular disease in the elderly: the PREV-ICTUS study. Curr Med Res Opin. 2008. 24(3):659–670.
30. Forti N, Diament J. High-density lipoproteins: Metabolic, clinical, epidemiological and therapeutic intervention aspects. An update for clinicians. Arq Bras Cardiol. 2006. 87(5):671–679.
31. Eckel RH, Krauss RM. American heart association call to action: Obesity as a major risk factor for coronary heart disease. Circulation. 1998. 97(21):2099–2100.
32. O'Hare JA, Minaker KL, Meneilly GS, Rowe JW, Pallotta JA, Young JB. Effect of insulin on plasma norepinephrine and 3,4-dihydroxyphenylalanine in obese men. Metabolism. 1989. 38(4):322–329.
33. Stem MP. Do non-insulin dependent diabetes mellitus and cardiovascular disease share common antecedents. Ann Intern Med. 1996. 124(1):110–116.
34. Rexrode KM, Manson JE, Hennekens CH. Obesity and cardiovascular disease. Curr Opin Cardiol. 1996. 11(5):490–495.
35. Denke MA, Sempos CT, Grundy SM. Excess body weight: An underrecognized contributor to high blood cholesterol levels in white American men. Arch Intern Med. 1993. 153(9):1093–1103.
36. Denke Ma, Sempos CT, Grundy SM. Excess body weight: An underrecognized contributor to dyslipidemia in white American women. Arch Intern Med. 1994. 154(4):401–410.
37. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995. 122(7):481–486.
38. Kong JO, Koh SB, Chang SJ, Cha BS, Chung HK, Choi HR, Jung-Choi KH, Jeon SJ. Relationship between job stress and pulse wave velocity as a cardiovascular risk factor. Korean J Occup Environ Med. 2004. 16(4):450–458. (Korean).
39. Cho J. Job stress and cardiovascular disease. J Korean Acad Fam Med. 2002. 23(7):841–854. (Korean).
40. Lallukka T, Martikainen P, Reunanen A, Roos E, Sarlio Lahteenkorva S, Lahelma E. Associations between working conditions and angina pectoris symptoms among employed women. Psychosom Med. 2006. 68(2):348–354.
41. Hwang CK, Koh SB, Chang SJ, Park CY, Cha BS, Hyun SJ, Park JH, Lee KM, Cha KT, Park WJ, Jhun HJ. Occupational stress in relation to cerebrovascular and cardiovascular disease: Longitudinal analysis from the NSDSOS project. Korean J Occup Environ Med. 2007. 19(2):105–114. (Korean).
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