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Published on: September 26, 2018
Predicting cardiovascular disease risk across the atherosclerotic disease continuum
Katrina K Poppe1,2, Sue Wells1, Rod Jackson1
1Section of Epidemiology and Biostatistics, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
Insights
A new cardiovascular disease (CVD) risk equation (PREDICT-2°) was developed for secondary prevention, complementing primary prevention scores. This highlights a CVD risk continuum, showing limitations of a one-size-fits-all approach for those with existing atherosclerotic CVD.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) guidelines typically separate primary and secondary prevention strategies.
- Existing risk equations primarily focus on primary prevention, leaving a gap in assessing risk for individuals with established atherosclerotic cardiovascular disease (ASCVD).
- A nuanced understanding of CVD risk distribution is crucial for effective population health management.
Purpose of the Study:
- To develop a novel risk equation (PREDICT-2°) for estimating the 5-year risk of CVD event recurrence in patients with known ASCVD.
- To complement existing primary prevention risk equations (PREDICT-1°).
- To describe the distribution of CVD risk across the general population, particularly highlighting differences between those with and without ASCVD.
Main Methods:
- Utilized data from a large primary care cohort (PREDICT) including adults aged 30-79 years who underwent routine CVD risk assessment between 2007-2016.
- Developed a new Cox regression model for PREDICT-2° to calculate 5-year CVD event recurrence risk in patients with ASCVD.
- Calculated 5-year CVD risk for individuals without ASCVD using established PREDICT-1° equations.
Main Results:
- The study identified 475,161 patients, with 12% having a history of ASCVD.
- For individuals without ASCVD, median 5-year CVD risks were 2.2% for women and 3.5% for men.
- For individuals with ASCVD, the new PREDICT-2° equation showed significantly higher median 5-year risks: 21% for women and 23% for men.
Conclusions:
- Developed PREDICT-2° risk scores for individuals with ASCVD, enhancing current risk assessment tools.
- Demonstrated that median CVD risk is approximately eight-fold higher in individuals with ASCVD compared to those without.
- Highlighted a CVD risk continuum and the inadequacy of a 'one-size-fits-all' approach for managing ASCVD patients, emphasizing the need for tailored risk assessment.
Aims:
Cardiovascular disease (CVD) guidelines dichotomize populations into primary and secondary prevention. We sought to develop a risk equation for secondary prevention of CVD that complements existing equations for primary prevention of CVD, and to describe the distributions of CVD risk across the population.
Methods And Results:
Adults aged 30-79 years who had routine CVD risk assessment in 2007-16 were identified from a large primary care cohort (PREDICT) with linkage to national and regional datasets. The 5-year risk of developing CVD among people without atherosclerotic CVD (ASCVD) was calculated using published equations (PREDICT-1°). A new risk equation (PREDICT-2°) was developed from Cox regression models to estimate the 5-year risk of CVD event recurrence among patients with known ASCVD. The outcome for both equations was hospitalization for a CVD event or cardiovascular death. Of the 475 161 patients, 12% (57 061) had ASCVD. For those without ASCVD, median (interquartile range) 5-year risks with the PREDICT-1° score were women 2.2% (1.2-4.2%), men 3.5% (2.0-6.6%), and whole group 2.9% (1.6-5.5%). For those with ASCVD, the 5-year risks with the new PREDICT-2° equation were women 21% (15-33%), men 23% (16-35%), and whole group 22% (16-34%).
Conclusion:
We developed CVD risk scores for people with ASCVD (PREDICT-2°) to complement the PREDICT-1° scores. Median CVD risk is eight-fold higher among those with ASCVD than those without; however, there was overlap and the widest distribution of CVD risk was among people with ASCVD. This study describes a CVD risk continuum and the limitations of a 'one size fits all' approach to assessing risk in people with ASCVD.
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