The Dutch SCORE-based risk charts seriously underestimate the risk of cardiovascular disease

Introduction

Dutch cardiovascular disease (CVD) prevention guidelines recommend the use of modified SCORE risk charts to estimate 10-year risk of fatal and nonfatal CVD (myocardial infarction, cerebrovascular disease and congestive heart failure). This combined risk is derived from the SCORE mortality risk using multipliers. These multipliers have been shown to underestimate overall CVD risk. We aimed to compare the current Dutch risk charts with charts that estimate a broader range of clinically relevant CVD using updated multipliers.

Methods

We constructed new risk charts for 10-year CVD using updated, recently published multipliers from the EPIC-Norfolk study, based on ratios of fatal CVD to clinically relevant CVD (fatal plus nonfatal CVD requiring hospitalisation for ischaemic heart disease, cardiac failure, cerebrovascular disease, peripheral artery disease, and aortic aneurysm). Our primary outcome was the proportion of the three risk categories, i.?e. ‘high risk’ (>20% 10-year risk), ‘intermediate risk’ (10–19%) and ‘low risk’ (<10%) in the new risk charts as compared with the current risk charts.

Results

Applying the updated fatal CVD/clinical CVD multipliers led to a marked increase in the high-risk categories (109 (27%) vs. 244 (61%), (p < 0.001)), an absolute increase of 229%. Similarly, the number of low-risk categories decreased (190 (48%) vs. 81 (20%) (p < 0.001)).

Conclusion

The current Dutch risk charts seriously underestimate the risk of clinical CVD, even in the first 10 years. Even when analyses are restricted to CVD events that required hospitalisation, true 10-year risks are more than double the currently estimated risks. Future guidelines may be revised to reflect these findings.

     

Prevalence of dermal pathway dominance in risk assessment of contaminated soils: A survey of superfund risk assessments, 1989–1992

Exposure to soil‐borne contaminants can occur through ingestion, inhalation and/or dermal absorption. A study was undertaken to assess the relative frequency with which dermal exposures are predicted to pose the greatest risk attributable to contaminated soils in Superfund risk assessments. Screening of over 200 risk assessments from the period 1989–1992 resulted in identification of 37 sites at which projected lifetime excess cancer risks attributed to dermal contact with soil were greater than the nominal regulatory threshold of 1.10^‐4. At 19 of these sites, the dermal/soil pathway is estimated to contribute the largest carcinogenic risk associated with surface soil contamination, and may therefore drive cleanup of that medium. At 9 of the sites, the dermal/soil pathway is predicted to present a higher carcinogenic risk than any other pathway. Chemical contaminant type and estimates of soil adherence and surface area exposed appear to be the primary factors that distinguish sites at which dermal/soil pathway carcinogenic risk estimates are elevated relative to other exposure pathways. Quantification of exposure parameters, especially those related to behavior, remains a significant need.     

Does copulation increase the risk of predation?

Studies of mating behaviour have assumed that individuals are at greater risk when paired than when engaged in other activities. Recently, four experimental studies of insects and crustaceans have tested this assumption using predators from divergent taxa. Three of these studies indicate that mating carries no additional risk to the participants. Indeed, the findings suggest decreased vulnerability, relative to other activities, due to decreased predation on one or the other of the mating pair.     

Is mating of copepods associated with increased risk of predation?

In laboratory experiments, we tested whether the cyclopoid copepodCyclops vicinus is more vulnerable to predation by juvenile(young-of-the-year) roach (Rutilus rutilus) and/or larvae ofthe phantom midge Chaoborus flavicans during mating than individualadult copepods of the same species. We also tested whether C.vicinusavoided mating, displayed shorter mating times and/or loweractivity when a predator (Chaoborus) was present, or when exposedto water in which predators (Chaoborus) were previously held.Fish ate the same quantity of pairs in copulation and individualegg-bearing females but significantly fewer females withouteggs. Chaoborus ate similar quantities of pairs and femalesbut fewer males. Pairs in copulation and egg-bearing femaleswere detected earlier by fish than individual non-ovigerousfemales or males, and pairs in copulation were captured mosteasily by fish. Cyclops vicinus mated less often when Chaoboruslarvae were present than in water in which Chaoborus was previouslyheld, or in pure tap water. However, predator presence or exposureto predator-treated water had no effect on (i.e. did not reduce)mating duration. Activity of C.vicinus pairs during copulationwas significantly lower when a predator was present, or in predator-treatedwater, than in pure tap water, and activity of pairs decreasedwith increasing activity of the predator. Although our experimentswere carried out under artificial conditions which cannot betransferred to the complex conditions in the field, they suggestthat mating in copepods is dangerous and that copepods haveevolved particular strategies to reduce the risk of predationduring mating.     

How does scientific risk assessment of GM crops fit within the wider risk analysis?

The debate concerning genetically modified crops illustrates confusion between the role of scientists and that of wider society in regulatory decision making. We identify two fundamental misunderstandings, which, if rectified, would allow progress with confidence. First, scientific risk assessment needs to test well-defined hypotheses, not simply collect data. Second, risk assessments need to be placed in the wider context of risk analysis to enable the wider 'non-scientific' questions to be considered in regulatory decision making. Such integration and understanding is urgently required because the challenges to regulation will escalate as scientific progress advances.     

Does avian predation risk depress reproduction of voles?

Reproductive output and the growth of captive voles were quantified under high and low avian predation risk in a semi-natural experiment. Voles were exposed to Eurasian kestrels (Falco tinnunculus), the main avian predator of vole species studied (Clethrionomys glareolus, Microtus agrestis and M. rossiaemeridionalis). Vole pairs were housed in cages settled under nest-boxes occupied by breeding kestrels or in control cages settled under empty nest-boxes for 2 weeks. The experiment was conducted in mid-summer when kestrels had half-grown nestlings, because in that time hunting adults and begging nestlings produce noise and scats which may indicate significant predation threat to voles housed underneath the nest-boxes. The risk of kestrel predation did not have any obvious impact on pregnancy rates, mean litter sizes, or growth rates of kestrel-exposed voles compared with control voles studied. These results indicate that the risk of avian predation does not depress the reproductive investment of voles. Received: 3 November 1997 / Accepted: 16 February 1998     

Are Brazilian cervids at risk of prion diseases?

Prion diseases are neurodegenerative fatal disorders that affect human and non-human mammals. Chronic Wasting Disease (CWD) is a prion disease of cervids regarded as a public health problem in North America, and polymorphisms at specific codons in the PRNP gene are associated with this disease. To assess the potential CWD susceptibility of South American free-ranging deer, the presence of these polymorphisms was examined in Mazama gouazoubira, Ozotoceros bezoarticus and Blastocerus dichotomus. Despite the lack of CWD reports in Brazil, the examined codons (95, 96, 116, 132, 225, and 226) of the PRNP gene showed potential CWD susceptibility in Brazilian deer. Low abundancy of deer in Brazil possibly difficult both CWD proliferation and detection, however, CWD surveillance may not be neglected.     

Quantifying the risk of mis-estimating correlation significance of climate–tree growth relationships

In dendroecology, sampling effort has a strong influence of both regional chronology properties and climate–tree growth relationships assessment. Recent studies evidenced that decreasing sample size leads to a weakening of the bootstrapped correlation coefficients ( ${\text{BCC}}$ BCC ). The present analysis focused on the risk of mis-estimating the significance of population ${\text{BCC}}\,\left( {{\text{BCC}}_{\text{POP}} } \right)$ BCC ( BCC POP ) from a sample of N trees, and then proposed an approach to detect and correct mis-estimations using the properties of the sample. The sample size effect and the limits of the correction were illustrated from 840 individual growth chronologies of Corsican pine (Pinus nigra Arnold ssp. laricio Poiret var. Corsicana) sampled in Western France. The 840 trees were used to assess the population characteristics, and the effect of sampling effort was investigated through a simulation approach based on a resampling procedure of N trees amongst 840 (N ? [5; 50]). Our results evidenced that the risk strongly varied amongst the climatic regressors. The highest risks were evidenced for significant ${\text{BCC}}_{\text{POP}}$ BCC POP , with a percentage of mis-estimation ranging from 25 to 80. On the contrary, small samples allowed providing an reliable estimation of the significance of non-significant ${\text{BCC}}_{\text{POP}}$ BCC POP . To a lesser extent, the risk slightly decreased with increasing N, according to a negative exponential trend. The detection and correction method was found relevant to detect mis-estimation only for significant ${\text{BCC}}_{\text{POP}}$ BCC POP ; otherwise, the ${\text{BCC}}_{\text{POP}}$ BCC POP significance was generally overestimated.     

Radon-associated lung cancer risk among French uranium miners: modifying factors of the exposure–risk relationship

Radon is classified as a known pulmonary carcinogen in humans. A better understanding of the effects of low exposure and time-dependent factors, modifying the lung cancer risk is of continued interest. We present analyses of the exposure–risk relationship in the French cohort of uranium miners updated until 1999 and including five additional years of follow-up. These new analyses provide a better opportunity to look at low radon exposures with longer follow-up intervals, and allow consideration of new modifying factors, such as physical activity, mine location and job type. The cohort includes 5,086 miners, and 159 lung cancer deaths have been observed among these over a follow-up of more than 30 years. The exposure–risk relationship was estimated using excess relative risk models, which allow investigation of several modifying factors such as period of exposure, time since exposure, age at exposure, duration of exposure, exposure rate, job type, mine type and physical activity. The analysis confirms the association between radon exposure and lung cancer risk (ERR per 100 WLM = 0.58, P < 0.01). Period of exposure and physical activity appear as major modifying factors. Higher risks are observed for hard physical activity works. The effect of hard physical activity persists when the period of exposure is taken into account (ERR per 100 WLM = 2.95, P < 0.01).     

Aquatic plants–based risk model for assessment of ecological safety of rivers

In order to ensure the ecological safety in river beds, each project affecting it must be subjected to an evaluation in terms of its implementation results on the river habitats. Technical activities in the river beds can cause irreversible changes in their biocenosis. However, due to the lack of a method that allows us to predict these changes, the decisions made by designers and contractors can be evaluated only after completing the investment. Therefore, it is necessary to elaborate a method to evaluate the environmental safety in regulated and maintenanced rivers. This article presents a model that allows us to predict the changes in vascular aquatic plant communities, which result from technical interference in the river bed. The model was elaborated based on the results of the study performed in 2007–2011 in natural and transformed lowland watercourses from Lower Silesia area (Poland). It takes into account the elements of the watercourse bed ecosystem, which significantly affect the magnitude of the changes in plant communities. Based on this model, it is possible to evaluate the level of ecological risk associated with the execution of maintenance and regulatory works.     

Cordia millenii: on the risk of local extinction?

Selective logging of valuable tropical timber trees is a conservation concern because it threatens the long-term sustainability of forests. However, there is insufficient information regarding the postlogging recovery of harvested species. Here, I assessed the seed dispersal patterns, recruitment and abundance of Cordia millenii , a valuable timber tree in two Ugandan tropical rain forests that have been subjected to varying disturbance regimes. The aim was to determine the vulnerability of Cordia in these forests. The rate of seed dispersal was lower in the heavily disturbed Mabira Forest compared with the less disturbed Budongo Forest. Frugivores in Mabira were small-bodied individuals that spat seeds beneath fruiting trees, whereas 90% of the fruit in Budongo was consumed by large-bodied chimpanzees that disperse seeds over long distances. Juveniles of Cordia were not found in the closed forest, although they were found in forest gaps in Budongo but not Mabira. Mature tree density was higher in Budongo compared with Mabira. Lack of effective seed dispersal coupled with the inability of seedlings of Cordia to establish under closed canopy account for the arrested recruitment in Mabira. Enrichment planting in felling gaps is necessary to avoid local extinction of Cordia in forests without large vertebrates.     

Are air-conditioning maintenance personnel at increased risk of Legionellosis?

We surveyed by use of medical questionnaires and blood tests 21 maintenance workers involved with cleaning and servicing cooling towers and evaporative condensers at a large company to determine the frequency of pneumonia and antibody levels against Legionella pneumophila serogroup 1. The 21 high-risk workers were compared with 27 low-risk workers, persons who were not directly involved in service or maintenance for the company. The overall prevalence of titers greater than or equal to 128 for the 21 high-risk workers was 19.0% compared with 22.2% for the low-risk group. There were no significant differences in the history of pneumonia between these groups. Possible explanations for these findings are discussed.     

Are comparative studies of extinction risk useful for conservation?

Large-scale, comparative studies of species extinction risk have become common in conservation science, but their influence on conservation practice appears limited. The link between such studies and the practice of conservation breaks down in two key places. First, results of comparative studies are often ambiguous, inconsistent and difficult to translate into policy. Second, conservation as currently practiced emphasizes the rescue and protection of currently threatened biodiversity, whereas comparative studies are often better suited to a proactive approach that anticipates and prevents future species declines. Scientists should make their research more accessible by addressing the first issue. Policymakers and managers, in turn, could make better use of comparative studies by moving towards more preventative approaches to conservation planning.     

Precautionary risk assessment of Bt maize: what uncertainties?

GM crops have become a test case for the conflicting slogans of 'the precautionary principle' versus 'sound science.' The issues can be illustrated by developments in regulatory science for Bt maize in the European Union. As this case study suggests, risk assessment is always framed by some account of the relevant uncertainties. These in turn depend upon how the environment is valued and how scientific questions are posed about cause-effect pathways of potential harm. The slogan of 'sound science' hides such judgements, by representing ignorance or value-judgements as 'science.' By contrast, precaution can challenge such judgements, identify new unknowns, generate different criteria for evidence, open up new scientific questions, and make these judgements more transparent. It is doubtful whether these complexities have been fully acknowledged by specialists, and thus whether the continued risk debate is due solely to a public misunderstanding of science.     

What is the risk of a deadly adenovirus pandemic?

Many of us had refresher courses in virology, immunology, and epidemiology in 2020, and we were reminded of the fact that Homo sapiens, the wiliest predator on the planet, has been hunting everything that moves for millennia. These repeated interspecies contacts inherently lead to recurrent zoonosis (nonhuman to human) and anthroponosis (human to nonhuman). Given the accelerating changes in our ecosystems since the neolithic revolution, it was not surprising to see a virus that spreads via aerosolization and liquid droplets cause a pandemic in a few months. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic begs the question—which viruses could cause a global threat? In this Opinion, the characteristics that make adenoviruses a risk, which include efficient intra- and interspecies transmission, thermostable particles, persistent/latent infections in diverse hosts, and the ability to readily recombine and escape herd immunity, are discussed.     

Refuge sites of voles under owl predation risk: priority of dominant individuals?

In an aviary experiment, we studied whether body size or habitatfamiliarity of field voles (Microtus agrestis) affected predationrisk by Tengmalm's owls (Aegolius funereus). In the field, wecompared the body size of field voles snap-trapped in good (covered)and poor (open) habitats in 1992 and 1994 to determine whetherthere were habitat-related differences in the body size of voles.In the aviary, large individuals occupied the good habitat significantlymore than small individuals both in the control (owl not present)and experimental treatments (owl present). Furthermore, habitat-familiarvoles inhabited the good habitat more than habitat-unfamiliarvoles did when an owl was present Our field data were consistentwith our aviary data: larger field voles were more frequentlyfound in good habitats than in poor habitats. In the aviary,Tengmalm's owl predation risk was higher for small and habitat-unfamiliarvoles. This suggests that large field voles may have priorityto sheltered habitats. Furthermore, habitat familiarity mayplay a central role in avoiding risky habitats.     

The cultural nature of risk: Can there be an anthropology of uncertainty?

In risk research, culture has been used mainly as a 'black box' of unknowns into which 'irregularities' of risk perceptions that could not be otherwise accounted for can be referred. In social anthropology it has been taken for granted that what is to be considered a 'risk' depends entirely on cultural settings and assumptions; risks are culturally defined and selected. This article takes a critical stance towards any such simplistic ideas about risk and culture. Culture is approached from a perspective of cognitive theory and is hence understood as shared schemata that define categories, relationships and contexts, making it possible to process meanings and order information. It is argued that if we are to succeed in investigating risk contextually, without ending up in a relativistic muddle which merely acknowledges myriads of diverse risk perceptions, it is necessary to problematize the assumed simplistic cultural nature of risk.