Researchers from Europe and North America have developed the LIFEtime-perspective model for individualizing CardioVascular Disease prevention strategies in apparently healthy people (LIFE-CVD) model, a validated risk prediction tool that accurately estimates treatment effects, as well as 10-year risk for cardiovascular disease (CVD) in otherwise healthy individuals. Details about the model were published in the European Heart Journal.
Data from multiple North American and European cohorts were used for model development, including the Multi-Ethnic Study of Atherosclerosis (MESA, n=6715), Atherosclerosis Risk in Communities (n=9250), Heinz Nixdorf Recall (n=4177), the European Prospective Investigation into Cancer and Nutrition-Netherlands (n=25,833), and Norfolk (n=23,548) studies. The model was developed to estimate the 10-year and lifetime effects of cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation on CVD risk.
The clinically applicable predictors from the cohorts included sex, systolic blood pressure (SBP), non-high-density lipoprotein cholesterol (non-HDL-C), body mass index, smoking status (current, former, and never), presence of diabetes mellitus, and a positive history of premature (prior to age 60 years) myocardial infarction (MI) in either parent. Outcomes included CVD events, as well as death from any non-CVD cause.
The model, developed in the MESA cohort, was comprised of 2 complementary Fine and Gray competing-risk adjusted left-truncated subdistribution hazard functions. The first hazard function was included for hard CVD events, whereas the second one was included for non-CVD mortality.
There was good agreement between the 10-year predicted and 10-year observed risk for CVD-events, non-CVD mortality, and combined outcome of CVD-events and non-CVD mortality in the validation set. The C-statistics for discrimination of 10-year CVD-risk, non-CVD mortality risk, and combined risk were 0.73 (95% CI, 0.71-0.75), 0.76 (95% CI, 0.75-0.78), and 0.74 (95% CI, 0.73-0.75), respectively.
Good calibration was also found for the LIFE-CVD model, with a c-statistics range of 0.67 to 0.76. According to the developed model, an older patient with identical risk factors as a younger patient (ie, 70 vs 45 years of age, respectively) should have a greater 10-year absolute risk reduction of CVD (11.3% vs 1.0%, respectively) and a smaller gain in life-years without CVD (3.4 vs 4.5 years) using the same treatment.
A limitation of the model development includes the lack of a longer-term follow-up (ie, over the lifetime of a cohort).
The researchers concluded that the use of the LIFE-CVD model “may increase insight into therapy-benefit via the complementary use of 10-year and lifetime estimates and may facilitate individualized medicine and doctor–patient communication.”
Vijay Nambi, MD, PhD, is on the editorial board of Dynamed.
Jaspers NEM, Blaha MJ, Matsushita K, et al. Prediction of individualized lifetime benefit from cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation in apparently healthy people [published online May 18, 2019]. Eur Heart J. doi:10.1093/eurheartj/ehz239