Key result
Updated LIFE-CVD model maintains good external discrimination, extending lifetime cardiovascular risk prediction to age 89.
Why the study?
There was an unmet need to apply the original LIFE-CVD model in people younger than 45 years and to accurately estimate treatment effects in patients with a life expectancy exceeding 90 years.
Observational (n=69,523)
Yes
The updated LIFE-CVD model extends cardiovascular risk and lifetime benefit prediction to individuals aged 35 to 89 years with maintained discrimination and calibration.
Supports expanded lifetime CVD risk estimation in adults aged 35-89; leaves open prospective trials of benefit-guided therapy.
Introduction The previously developed LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model can be used to predict lifetime cardiovascular disease risk, CVD-free life expectancy, and lifetime benefit from cardiovascular risk factor treatment in apparently healthy people aged 45 to 80 years. However, there was an unmet need to be able to apply the model in patients younger than 45 years, and to accurately estimate treatment effects in patients with a life expectancy exceeding 90 years. Aim Update the LIFE-CVD model to enable application of the model in people aged 35 to 89 years, and to allow more accurate estimation of treatment effects in patients with a life expectancy exceeding 90 years. Methods The study was conducted using data from the same studies as were used for derivation and validation of the original model, including the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, Atherosclerosis Risk in Communities Study (ARIC) cohort, and the European Prospective Investigation into Cancer-Netherlands (EPIC-NL) and EPIC-Norfolk cohort studies. Age-specific baseline survivals were smoothed by predicting the progression of baseline survivals with age, using a local polynomial regression function and a exponential function for CVD, and non-CVD mortality baseline survivals respectively. Using these functions, baseline survivals were then extrapolated to the age range of 35 to 100 years. External validation using the newly updated baseline survivals was performed. Results Performance of the updated model was not dissimilar from the original model, with C-statistics for discrimination ranging from 0.70-0.76 in the external study populations. Calibration plots showed a good agreement between predicted and observed 10-year CVD risks. Estimation of treatment effects in patients with a life expectancy exceeding 90 years was improved. Conclusion This update of the LIFE-CVD model improves the clinical usability of the model by increasing the age range and improving the method of estimation of lifetime treatment effects.
No takes yet. Share an insight, caveat, or question.
Vries et al. (2021) conducted an observational in Apparently healthy people (cardiovascular risk prediction) (n=69,523). Updated LIFE-CVD model vs. Original LIFE-CVD model was evaluated on Model discrimination (C-statistic) in external study populations. The updated LIFE-CVD model maintained good discrimination with C-statistics ranging from 0.70 to 0.76 in external validation, extending accurate lifetime cardiovascular risk prediction to ages 35 to 89.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: