Comparing five-year and ten-year predicted cardiovascular disease risk in Aotearoa New Zealand: national data linkage study of 1.7 million adults.

IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European journal of preventive cardiology Pub Date : 2024-11-07 DOI:10.1093/eurjpc/zwae361
Jingyuan Liang, Susan Wells, Rod Jackson, Yeunhyang Choi, Suneela Mehta, Claris Chung, Pei Gao, Katrina K Poppe
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Abstract

Aim: There is no consensus on the optimal time horizon for predicting cardiovascular disease (CVD) risk to inform treatment decisions. New Zealand and Australia recommend 5 years, whereas most countries recommend 10 years. We compared predicted risk and treatment-eligible groups using 5-year and 10-year equations.

Methods: Individual-level linked administrative datasets identified 1,746,665 New Zealanders without CVD, aged 30-74 years in 2006, with follow-up to 2018. Participants were randomly allocated to derivation and validation cohorts. Sex-specific 5-year and 10-year risk prediction models were developed in the derivation cohort and applied in the validation cohort.

Results: 28,116 (3.2%) and 62,027 (7.1%) first CVD events occurred during 5-years and 10-years follow-up respectively (cumulative risk, derivation cohort). Median predicted 10-year CVD risk (3.8%) was approximately 2.5 times 5-year risk (1.6%) and 95% of individuals in the top quintile of 5-year risk were also in the top quintile of 10-year risk, across age/gender groups (validation cohort). Using common guideline-recommended treatment thresholds (5% 5-year, 10% 10-year risk), approximately 14% and 28% of women and men respectively were identified as treatment-eligible applying 5-year equations compared to 17% and 32% of women and men applying 10-year equations. Older age was the major contributor to treatment eligibility in both sexes.

Conclusions: Predicted 10-year CVD risk was approximately 2.5 times 5-year risk. Both equations identified mostly the same individuals in the highest risk quintile. Conversely, commonly used treatment thresholds identified more treatment-eligible individuals using 10-year equations and both equations identified approximately twice as many treatment-eligible men as women. The treatment threshold, rather than the risk horizon, is the main determinant of treatment eligibility.

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比较新西兰奥特亚罗瓦五年和十年的心血管疾病预测风险:对 170 万成年人进行的全国数据链接研究。
目的:对于预测心血管疾病(CVD)风险以便为治疗决策提供依据的最佳时间跨度,目前尚未达成共识。新西兰和澳大利亚建议使用 5 年时间,而大多数国家建议使用 10 年时间。我们比较了使用 5 年和 10 年方程预测的风险和符合治疗条件的群体:个人层面的关联行政数据集确定了 1746665 名 2006 年年龄在 30-74 岁之间、无心血管疾病的新西兰人,并随访至 2018 年。参与者被随机分配到推导队列和验证队列中。结果:在5年和10年随访期间,分别有28,116人(3.2%)和62,027人(7.1%)首次发生心血管疾病(累积风险,衍生队列)。预测的 10 年心血管疾病风险中位数(3.8%)约为 5 年风险(1.6%)的 2.5 倍,在各年龄/性别组中,95% 的 5 年风险前五分之一的人也处于 10 年风险的前五分之一(验证队列)。使用常见指南推荐的治疗阈值(5% 的 5 年期风险、10% 的 10 年期风险),应用 5 年期方程时,分别有约 14% 和 28% 的女性和男性被确定为符合治疗条件,而应用 10 年期方程时,分别有 17% 和 32% 的女性和男性被确定为符合治疗条件。年龄较大是导致男女符合治疗条件的主要因素:结论:预测的 10 年心血管疾病风险约为 5 年风险的 2.5 倍。这两个方程都能识别出最高风险五分位数中的大部分相同个体。相反,常用的治疗阈值使用 10 年方程识别出了更多符合治疗条件的人,两种方程识别出的符合治疗条件的男性人数约为女性的两倍。治疗阈值而非风险范围是决定治疗资格的主要因素。
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来源期刊
European journal of preventive cardiology
European journal of preventive cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
12.50
自引率
12.00%
发文量
601
审稿时长
3-8 weeks
期刊介绍: European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.
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