Dirk De Bacquer1, Peter Ueda2,3, Željko Reiner3, Johan De Sutter4,5, Delphine De Smedt1, Dragan Lovic6, Nina Gotcheva7, Zlatko Fras8,9, Nana Pogosova10, Erkin Mirrakhimov11,12, Seppo Lehto13, Tomas Jernberg14, Kornelia Kotseva15,16, Lars Rydén2, David Wood15,16, Guy De Backer1. 1. Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000 Gent, Belgium. 2. Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. 3. Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia. 4. Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium. 5. Department of Cardiology, AZ Maria Middelares Ghent, Ghent, Belgium. 6. Cardiology Department, School of Medicine, Clinic for Internal Disease Intermedica, Hypertensive Centre, Singidunum University, Nis, Serbia. 7. Department of Cardiology, National Heart Hospital, Sofia, Bulgaria. 8. Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia. 9. Medical Faculty, University of Ljubljana, Ljubljana, Slovenia. 10. National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia. 11. Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan. 12. National Centre of Cardiology and Internal Medicine named after academician Mirrakhimov MM, Bishkek, Kyrgyzstan. 13. Varkaus Hospital, Varkaus, Finland. 14. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. 15. National Heart and Lung Institute, Imperial College London, London, UK. 16. National University of Ireland, Galway, Ireland.
Abstract
AIMS: Most patients with established atherosclerotic cardiovascular disease (CVD) are at very high risk for developing recurrent events. Since this risk varies a lot between patients there is a need to identify those in whom an even more intensive secondary prevention strategy should be envisaged. Using data from the EUROASPIRE IV and V cohorts of coronary heart disease (CHD) patients from 27 European countries, we aimed at developing and internally and externally validating a risk model predicting recurrent CVD events in patients aged < 75 years. METHODS AND RESULTS: Prospective data were available for 12 484 patients after a median follow-up time of 1.7 years. The primary endpoint, a composite of fatal CVD or new hospitalizations for non-fatal myocardial infarction (MI), stroke, heart failure, coronary artery bypass graft, or percutaneous coronary intervention (PCI), occurred in 1424 patients. The model was developed based on data from 8000 randomly selected patients in whom the association between potential risk factors and the incidence of the primary endpoint was investigated. This model was then validated in the remaining 4484 patients. The final multivariate model revealed a higher risk for the primary endpoint with increasing age, a previous hospitalization for stroke, heart failure or PCI, a previous diagnosis of peripheral artery disease, self-reported diabetes and its glycaemic control, higher non-high-density lipoprotein cholesterol, reduced renal function, symptoms of depression and anxiety and living in a higher risk country. The model demonstrated excellent internal validity and proved very adequate in the validation cohort. Regarding external validity, the model demonstrated good discriminative ability in 20 148 MI patients participating in the SWEDEHEART register. Finally, we developed a risk calculator to estimate risks at 1 and 2 years for patients with stable CHD. CONCLUSION: In patients with CHD, fatal and non-fatal rates of recurrent CVD events are high. However, there are still opportunities to optimize their management in order to prevent further disease or death. The EUROASPIRE Risk Calculator may be of help to reach this goal. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Most patients with established atherosclerotic cardiovascular disease (CVD) are at very high risk for developing recurrent events. Since this risk varies a lot between patients there is a need to identify those in whom an even more intensive secondary prevention strategy should be envisaged. Using data from the EUROASPIRE IV and V cohorts of coronary heart disease (CHD) patients from 27 European countries, we aimed at developing and internally and externally validating a risk model predicting recurrent CVD events in patients aged < 75 years. METHODS AND RESULTS: Prospective data were available for 12 484 patients after a median follow-up time of 1.7 years. The primary endpoint, a composite of fatal CVD or new hospitalizations for non-fatal myocardial infarction (MI), stroke, heart failure, coronary artery bypass graft, or percutaneous coronary intervention (PCI), occurred in 1424 patients. The model was developed based on data from 8000 randomly selected patients in whom the association between potential risk factors and the incidence of the primary endpoint was investigated. This model was then validated in the remaining 4484 patients. The final multivariate model revealed a higher risk for the primary endpoint with increasing age, a previous hospitalization for stroke, heart failure or PCI, a previous diagnosis of peripheral artery disease, self-reported diabetes and its glycaemic control, higher non-high-density lipoprotein cholesterol, reduced renal function, symptoms of depression and anxiety and living in a higher risk country. The model demonstrated excellent internal validity and proved very adequate in the validation cohort. Regarding external validity, the model demonstrated good discriminative ability in 20 148 MI patients participating in the SWEDEHEART register. Finally, we developed a risk calculator to estimate risks at 1 and 2 years for patients with stable CHD. CONCLUSION: In patients with CHD, fatal and non-fatal rates of recurrent CVD events are high. However, there are still opportunities to optimize their management in order to prevent further disease or death. The EUROASPIRE Risk Calculator may be of help to reach this goal. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Steven H J Hageman; Ailsa J McKay; Peter Ueda; Laura H Gunn; Tomas Jernberg; Emil Hagström; Deepak L Bhatt; Ph Gabriel Steg; Kristi Läll; Reedik Mägi; Mari Nordbø Gynnild; Hanne Ellekjær; Ingvild Saltvedt; José Tuñón; Ignacio Mahíllo; Álvaro Aceña; Karol Kaminski; Malgorzata Chlabicz; Emilia Sawicka; Taavi Tillman; John W McEvoy; Emanuele Di Angelantonio; Ian Graham; Dirk De Bacquer; Kausik K Ray; Jannick A N Dorresteijn; Frank L J Visseren Journal: Eur Heart J Date: 2022-05-07 Impact factor: 35.855