Prediction of individualized lifetime benefit from cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation in apparently healthy people

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.

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

“…Models have been developed to calculate (disease-free) life-years gained for both for populations of people with and without DM. 15,16 For the time being, such alternative perspectives primarily facilitate communication with patients about treatment decisions, but if further studies validate this approach, life-time (disease-free) gained could become a more central criterion in formal treatment recommendations and in supporting the importance of even a moderate reduction in cardiovascular risk.…”

Elevated glycoprotein acetyl levels in adolescence and early adulthood predict adverse cardiometabolic profiles and risk of metabolic syndrome in up to 10 year follow-up

“…Inflammation is increasingly recognized as a hallmark for both type 2 diabetes and cardiovascular disease (20), and increasing evidence suggests that life-time rather than contemporary exposure likely poses the greatest risk for future disease prevalence and events (21). Despite a longhypothesized link between chronic inflammation and the early development of adverse cardiometabolic risk profiles, studies using the inflammatory biomarker CRP to link these factors have to-date produced equivocal results (4,22,23).…”

Treatment of hypercholesterolaemia in older adults calls for a patient-centred approach

“…To avoid overestimating an individual patient’s 10-year risk of CVD with traditional (older adults-specific) risk tools,22 26 27 we propose to use a competing risk adjusted, older adults-specific risk score 12. Contrary to traditional risk tools, this tool has been validated in studies that also included older patients and patients with several comorbidities 12 28. The tool is available free of charge on http://U-Prevent.com,29 and models the effect of medication changes in terms of 10-year absolute risk reduction (or number needed to treat).…”