Individuele effecten van preventieve behandeling voor hart- en vaatziekten voorspellen*

Objective

The benefit an individual can expect from cardiovascular disease (CVD) prevention depends on multiple factors. We aimed to develop a 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.

Design

Combination of data from observational cohorts and trials.

Method

The model was developed in the Multi-Ethnic Study of Atherosclerosis (n = 6715) and externally validated in the Atherosclerosis Risk in Communities (n = 9250), Heinz Nixdorf Recall (n = 4177), European Prospective Investigation into Cancer and Nutrition (EPIC)-NL (n = 25.833) and EPIC-Norfolk (n = 23.548) studies. We created an algorithm using Fine and Gray competing-risk adjusted left-truncated subdistribution hazard functions. The algorithm predicts the 10-year risk, lifetime risk and CVD-free life expectancy. The algorithm is combined with the relative effects of prevention strategies from clinical trials into a single working model which can predict the effect of risk-factor reduction on an individual’s prognosis.

Results

The external calibration of the LIFE-CVD model was good and the c-statistics were 0,67-0,76. Short-term and long-term benefit can be compared using the model. For example, in two people aged 45 and 70 with otherwise identical risk factors, the older patient has a greater 10-year absolute risk reduction but a smaller gain in life-years free of CVD from the same therapy.

Conclusion

The model (available on www.U-Prevent.nl) can accurately predict the prognosis and therapy benefit for an individual and provides output in terms of 10-year risk, lifetime risk and life-expectancy free of CVD. The information can be used to facilitate personalized-medicine and doctor-patient communication.

Conflict of interest and financial support: potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.