Prediction of Cardiovascular Disease Risk Accounting for Future Initiation of Statin Treatment
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Peer-reviewed
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Abstract
Cardiovascular disease (CVD) risk prediction models are used to identify high-risk individuals and guide statin-initiation. However, these models are usually derived from individuals who may initiate statins during follow-up. We present a simple approach to address statin-initiation to predict “statin-naïve” CVD risk. We analyzed primary care data (2004-2017) from the UK Clinical Practice Research Datalink for 1,678,727 individuals (40-85 years) without CVD or statin treatment history at study entry. We derived age- and sex-specific prediction models including conventional risk factors and a time-dependent effect of statin-initiation constrained to 25% risk reduction (from trial results). We compared predictive performance and measures of public-health impact (e.g., numbers-needed-to-screen to prevent one case) against models ignoring statin-initiation. During a median follow-up of 8.9 years, 103,163 individuals developed CVD. In models accounting for versus ignoring statin initiation, 10-year CVD risk predictions were slightly higher; predictive performance was moderately improved. However, few individuals were reclassified to a high-risk threshold, resulting in negligible improvements in numbers-needed-to-screen to prevent one case. In conclusion, incorporating statin effects from trial results into risk prediction models enables statin-naïve CVD risk estimation, provides moderate gains in predictive ability, but had a limited impact on treatment decision-making under current guidelines in this population.
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1476-6256
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British Heart Foundation (RG/18/13/33946)
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
British Heart Foundation (CH/12/2/29428)
British Heart Foundation (SP/18/3/33801)
National Institute for Health and Care Research (IS-BRC-1215-20014)
Medical Research Council (MR/K014811/1)
British Heart Foundation (FS/18/56/34177)