Prediction of individualized lifetime benefit from cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation in apparently healthy people.
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Authors
Jaspers, Nicole EM
Blaha, Michael J
Matsushita, Kunihiro
van der Schouw, Yvonne T
Khaw, Kay-Tee
Geisel, Marie H
Lehmann, Nils
Erbel, Raimund
Jöckel, Karl-Heinz
van der Graaf, Yolanda
Verschuren, WM Monique
Boer, Jolanda MA
Nambi, Vijay
Visseren, Frank LJ
Dorresteijn, Jannick AN
Publication Date
2020-03-14Journal Title
Eur Heart J
ISSN
0195-668X
Publisher
Oxford University Press (OUP)
Volume
41
Issue
11
Pages
1190-1199
Language
eng
Type
Article
This Version
AM
Physical Medium
Print
Metadata
Show full item recordCitation
Jaspers, N. E., Blaha, M. J., Matsushita, K., van der Schouw, Y. T., Wareham, N., Khaw, K., Geisel, M. H., et al. (2020). Prediction of individualized lifetime benefit from cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation in apparently healthy people.. Eur Heart J, 41 (11), 1190-1199. https://doi.org/10.1093/eurheartj/ehz239
Abstract
AIMS: The benefit an individual can expect from preventive therapy varies based on risk-factor burden, competing risks, and treatment duration. We developed and validated the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model for the estimation of individual-level 10 years and lifetime treatment-effects of cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation in apparently healthy people. METHODS AND RESULTS: Model development was conducted in the Multi-Ethnic Study of Atherosclerosis (n = 6715) using clinical predictors. The model consists of two complementary Fine and Gray competing-risk adjusted left-truncated subdistribution hazard functions: one for hard cardiovascular disease (CVD)-events, and one for non-CVD mortality. Therapy-effects were estimated by combining the functions with hazard ratios from preventive therapy trials. External validation was performed in the Atherosclerosis Risk in Communities (n = 9250), Heinz Nixdorf Recall (n = 4177), and the European Prospective Investigation into Cancer and Nutrition-Netherlands (n = 25 833), and Norfolk (n = 23 548) studies. Calibration of the LIFE-CVD model was good and c-statistics were 0.67-0.76. The output enables the comparison of short-term vs. long-term therapy-benefit. In two people aged 45 and 70 with otherwise identical risk-factors, the older patient has a greater 10-year absolute risk reduction (11.3% vs. 1.0%) but a smaller gain in life-years free of CVD (3.4 vs. 4.5 years) from the same therapy. The model was developed into an interactive online calculator available via www.U-Prevent.com. CONCLUSION: The model can accurately estimate individual-level prognosis and treatment-effects in terms of improved 10-year risk, lifetime risk, and life-expectancy free of CVD. The model is easily accessible and can be used to facilitate personalized-medicine and doctor-patient communication.
Keywords
Humans, Cardiovascular Diseases, Cholesterol, Fibrinolytic Agents, Risk Factors, Prospective Studies, Smoking Cessation, Blood Pressure, Aged, Middle Aged, Netherlands
Sponsorship
Medical Research Council (MC_UU_12015/1)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
Medical Research Council (MR/N003284/1)
Medical Research Council (G0401527)
Medical Research Council (G1000143)
Identifiers
External DOI: https://doi.org/10.1093/eurheartj/ehz239
This record's URL: https://www.repository.cam.ac.uk/handle/1810/295386
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