Predicting lifetime cardiovascular risk and benefits of preventive treatment in patients with established atherosclerotic cardiovascular disease: the SMART-REACH2 model.
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Holtrop Joris, Gynnild Mari N, Deo Salil V, Lim Carl-Emil, Logothetis Stelios Boulitsakis, Läll Kristi, Oksanen Minna, Dalen Håvard, Munkhaugen John, Ueda Peter, Jernberg Tomas, Tuñón José, Mahíllo Fernández Ignacio, Saltvedt Ingvild, Ellekjær Hanne, Teraa Martin, van der Meer Manon G, Ruigrok Ynte M, Võsa Urmo, Chlabicz Małgorzata, Kaminski Karol, Steg Ph Gabriel, Burazor Ivana, Mägi Reedik, Tillmann Taavi, Wood David A, Ray Kausik K, de Bacquer Dirk, Martikainen Janne, McEvoy John William, Kaptoge Stephen, Visseren Frank L J, Di Angelantonio Emanuele, Bhatt Deepak L, Wood Angela, Hageman Steven H J, Dorresteijn Jannick A N
Аннотация
METHODS: SMART-REACH2 was derived in 8708 individuals aged 40-90 years with coronary, cerebrovascular, peripheral artery disease and/or abdominal aortic aneurysm from the UCC-SMART cohort. Sex-stratified, cause-specific Cox models for recurrent CV events and non-CV death were fitted using age as timescale and routinely available predictors. Recurrent CV events were defined as a composite of myocardial infarction, stroke, or CV death. Recalibration was based on representative cohorts per risk region. External validation was performed in 2 085 780 patients from 54 countries; model performance was assessed by calibration plots and Harrell's C-statistic.
RESULTS: In the derivation cohort, 2057 recurrent CV events occurred over a median follow-up of 8.5 years (25th-75th: 4.3-13.0). In external validation, 307 706 events occurred. The pooled C-statistic was 0.68 (95% confidence interval 0.66-0.69) and ranged from 0.66 (0.64-0.69) for European low-risk region up to 0.72 (0.66-0.78) for Latin America, with adequate calibration across risk regions. Performance was consistent across sexes and CV disease subtypes. Using SMART-REACH2, estimated potential gains in CV disease-free life expectancy for a 50-year-old example patient receiving intensified preventive treatment (15 mmHg systolic blood pressure and 1.0 mmol/L low-density lipoprotein cholesterol reduction) ranged from 2 years in the low-risk region to 4.4 years in the very-high-risk region.
CONCLUSIONS: The updated SMART-REACH2 model accounts for geographical and sex-specific variations and allows estimation of short-term and lifetime risk of recurrent CV events and treatment benefits, facilitating shared decision-making as recommended by guidelines.