Estimated Life Expectancy Without Recurrent Cardiovascular Events in Patients With Vascular Disease: The SMART-REACH Model

• Type of Material: Article
• Authors: Lotte Kaasenbrood, University Medical Centre Utrecht; Deepak L. Bhatt, Harvard Medical School; Jannick A. N. Dorresteijn, University Medical Centre Utrecht; Peter Wilson, Emory University; Ralph B. D'Agostino, Boston University; Joseph M. Massaro, Boston University; Yolanda van der Graaf, University Medical Centre Utrecht; Maarten J. M. Cramer, University Medical Centre Utrecht; L. Jaap Kappelle, University Medical Centre Utrecht; Gert J. de Borst, University Medical Centre Utrecht; Ph. Gabriel Steg, Université Paris‐Diderot; Frank L. J. Visseren, University Medical Centre Utrecht
• Language: English
• Date: 2018-08-21
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.118.009217
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 7
• Issue: 16
• Start Page: e009217
• End Page: e009217
• Grant/Funding Information: The SMART study was financially supported by a grant from the University Medical Center Utrecht, The Netherlands. The REACH Registry was supported by Sanofi‐Aventis and Bristol‐Myers Squibb and is endorsed by the World Heart Federation. For the present study, the above supporting sources had no involvement in study design, analysis, interpretation, or writing of the results or the decision to submit the report for publication.
• Keywords: ARTERIAL-DISEASE; DENSITY-LIPOPROTEIN CHOLESTEROL; Science & Technology; METAANALYSIS; CORONARY; PROGNOSTIC MODELS; risk stratification; treatment effect; prognosis; HEART-DISEASE; Life Sciences & Biomedicine; Cardiovascular System & Cardiology; life expectancy; PRIMARY PREVENTION; LARGE COHORTS; RISK-FACTORS; secondary prevention; Cardiac & Cardiovascular Systems; OUTPATIENTS
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background-In patients with vascular disease, risk models may support decision making on novel risk reducing interventions, such as proprotein convertase subtilisin/kexin type 9 inhibitors or anti-inflammatory agents. We developed and validated an innovative model to estimate life expectancy without recurrent cardiovascular events for individuals with coronary, cerebrovascular, and/or peripheral artery disease that enables estimation of preventive treatment effect in lifetime gained. Methods and Results-Study participants originated from prospective cohort studies: the SMART (Secondary Manifestations of Arterial Disease) cohort and REACH (Reduction of Atherothrombosis for Continued Health) cohorts of 14 259 (REACH Western Europe), 19 170 (REACH North America) and 6959 (SMART, The Netherlands) patients with cardiovascular disease. The SMARTREACH model to estimate life expectancy without recurrent events was developed in REACH Western Europe as a Fine and Gray competing risk model incorporating cardiovascular risk factors. Validation was performed in REACH North America and SMART. Outcomes were (1) cardiovascular events (myocardial infarction, stroke, cardiovascular death) and (2) noncardiovascular death. Predictors were sex, smoking, diabetes mellitus, systolic blood pressure, total cholesterol, creatinine, number of cardiovascular disease locations, atrial fibrillation, and heart failure. Calibration plots showed high agreement between estimated and observed prognosis in SMART and REACH North America. C-statistics were 0.68 (95% confidence interval, 0.67-0.70) in SMART and 0.67 (95% confidence interval, 0.66-0.68) in REACH North America. Performance of the SMART-REACH model was better compared with existing risk scores and adds the possibility of estimating lifetime gained by novel therapies. Conclusions-The externally validated SMART-REACH model could be used for estimation of anticipated improvements in life expectancy without recurrent cardiovascular events in individual patients with cardiovascular disease in Western Europe and North America.