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. 2020 Mar 14;41(11):1190-1199.
doi: 10.1093/eurheartj/ehz239.

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

Nicole E M Jaspers  1 , Michael J Blaha  2 , Kunihiro Matsushita  3 , Yvonne T van der Schouw  4 , Nicholas J Wareham  5 , Kay-Tee Khaw  6 , Marie H Geisel  7 , Nils Lehmann  7 , Raimund Erbel  7 , Karl-Heinz Jöckel  7 , Yolanda van der Graaf  4 , W M Monique Verschuren  4   8 , Jolanda M A Boer  8 , Vijay Nambi  9   10 , Frank L J Visseren  1 , Jannick A N Dorresteijn  1
Affiliations

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

Nicole E M Jaspers et al. Eur Heart J. .

Erratum in

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: Apparently healthy people; Cardiovascular disease prevention; Lifetime prediction; Therapy-benefit.

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Figures

Figure 1
Figure 1
Internal calibration of predicted vs. observed 10-year risk with 95% confidence intervals in the Multi-Ethnic Study of Atherosclerosis validation cohort for (A) cause-specific cardiovascular disease-event risk, (B) cause-specific non-cardiovascular disease mortality risk, and (C) cardiovascular disease-event and non-cardiovascular disease mortality risk combined (i.e. the LIFE-CVD model).
Figure 2
Figure 2
External calibration of predicted vs. observed 10-year risk of cardiovascular disease-event and non-cardiovascular disease mortality risk combined (i.e. the LIFE-CVD model) with 95% confidence intervals in (A) the Atherosclerosis Risk in Communities Study (ARIC), (B) the Heinz Nixdorf Recall (HNR), (C) the European Prospective Investigation into Cancer-Netherlands (EPIC-NL), and (D) the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk).
Figure 3
Figure 3
Therapy-benefit from atorvastatin 40 mg and achieving an systolic blood pressure of 130 mmHg in three non-diabetic, former-smoking, European males with a body mass index of 28 kg/m2.
Figure 4
Figure 4
Distribution of individual (A) 10-year ARR%, (B) lifetime ARR%, and (C) gain in life-expectancy for the 6526 individuals in the Multi-Ethnic Study of Atherosclerosis validation cohort associated with the initiation of atorvastatin 40 mg and achieving a systolic blood pressure of 130 mmHg stratified by baseline 10-year risk and age. Smoking status and aspirin use were not altered.
Take home figure
Take home figure
Development and clinical implementation of a model to estimate lifetime therapy-effects illustrated with two patient examples.
None
See this image and copyright information in PMC

Comment in

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