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dc.contributor.authorJørstad, HTen
dc.contributor.authorBoekholdt, SMen
dc.contributor.authorWareham, Nicholasen
dc.contributor.authorKhaw, Kay-Teeen
dc.contributor.authorPeters, RJGen
dc.date.accessioned2017-08-16T10:08:47Z
dc.date.available2017-08-16T10:08:47Z
dc.date.issued2017-03en
dc.identifier.issn1568-5888
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/266469
dc.description.abstractINTRODUCTION: 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.
dc.description.sponsorshipThis work was not supported by any institution or individuals. EPIC-Norfolk is supported by program grants from the Medical Research Council UK (MRC G0401527, MRC G0701863, MRC G1000143) and Cancer Research UK (CRUK 8257).
dc.languageengen
dc.language.isoenen
dc.publisherMediselect B.V.
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectCardiovascular diseaseen
dc.subjectEpidemiologyen
dc.subjectRisk assessmenten
dc.subjectRisk predictionen
dc.titleThe Dutch SCORE-based risk charts seriously underestimate the risk of cardiovascular disease.en
dc.typeArticle
prism.endingPage180
prism.issueIdentifier3en
prism.publicationDate2017en
prism.publicationNameNetherlands Heart Journalen
prism.startingPage173
prism.volume25en
dc.identifier.doi10.17863/CAM.10066
dcterms.dateAccepted2016-10-19en
rioxxterms.versionofrecord10.1007/s12471-016-0927-2en
rioxxterms.versionVoRen
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/en
rioxxterms.licenseref.startdate2017-03en
dc.contributor.orcidWareham, Nicholas [0000-0003-1422-2993]
dc.contributor.orcidKhaw, Kay-Tee [0000-0002-8802-2903]
dc.identifier.eissn1876-6250
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idMRC (MC_PC_13048)
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (NF-SI-0512-10135)
pubs.funder-project-idMRC (MC_UU_12015/1)
pubs.funder-project-idMEDICAL RESEARCH COUNCIL (MR/N003284/1)
pubs.funder-project-idMRC (G1000143)
pubs.funder-project-idMRC (G0401527)
pubs.funder-project-idMedical Research Council (G0701863)
pubs.funder-project-idMedical Research Council (MC_U106179471)
cam.issuedOnline2016-12-09en
dc.identifier.urlhttps://link.springer.com/article/10.1007%2Fs12471-016-0927-2#aboutcontenten
rioxxterms.freetoread.startdate2018-08-24


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International