Original Article
Estimation of Lifetime Risk of Cardiovascular Disease (IBERLIFERISK): A New Tool for Cardiovascular Disease Prevention in Primary CareEstimación del riesgo cardiovascular de por vida (IBERLIFERISK): una herramienta nueva en prevención primaria de las enfermedades cardiovasculares

https://doi.org/10.1016/j.rec.2018.05.028Get rights and content

Abstract

Introduction and objectives

To develop a predictive function of lifetime cardiovascular risk, including morbidity and mortality, in a healthy working population in Spain.

Methods

Retrospective cohort study. We selected healthy workers, aged 18 to 65 years, with no history of cardiovascular disease, who underwent a health assessment between 2004 and 2007. We used 70% of the cohort to develop the risk equation, and the remaining 30% to validate the equation. Four Cox proportional hazards models were constructed using cardiovascular events and competing events as dependent variables. The same models were replicated for men and women separately. Fatal and nonfatal events were assessed until 2014.

Results

A total of 762 054 individuals were selected. The mean age was 35.48 years and 71.14% were men. Significant risk variables in the model included manual occupations, being a smoker or exsmoker, diabetes mellitus, antihypertensive treatment, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and lipid-lowering treatment; in men, the model also included alcohol consumption, body mass index, a family history of early coronary disease in first-degree relatives, renal failure, and diastolic blood pressure. The area under the curve receiver operating characteristic was 0.84 (95%CI, 0.82-0.85) in men and 0.73 (95%CI, 0.66-0.80) in women. Calibration showed underestimation in low-risk deciles and overestimation in high-risk deciles.

Conclusions

The new lifetime cardiovascular risk model has satisfactory discrimination and calibration, with better results in men than in women.

Resumen

Introducción y objetivos

Desarrollar una función predictiva del riesgo cardiovascular de por vida de eventos cardiovasculares, mortales y no mortales en población laboral española.

Métodos

Estudio de cohortes retrospectivo. Se seleccionó a trabajadores de entre 18 y 65 años sin antecedentes de enfermedad cardiovascular que realizaron un examen de salud entre los años 2004 y 2007. El 70% de la cohorte se utilizó para desarrollar la ecuación de riesgo y el 30%, para validar la ecuación. Se construyeron 4 modelos de riesgos proporcionales de Cox en los que se utilizaron como variables dependientes la aparición de eventos cardiovasculares y la aparición de eventos competitivos; se usaron los mismos modelos en varones y mujeres. Los eventos mortales y no mortales se evaluaron hasta el año 2014.

Resultados

Se incluyó a 762.054 sujetos, con una media de edad de 35,48 años (el 71,14% varones). Resultaron factores significativos en el modelo la ocupación manual, el tabaquismo, la diabetes mellitus, el tratamiento antihipertensivo, la presión arterial sistólica, el colesterol total, el colesterol unido a lipoproteínas de alta densidad y el tratamiento hipolipemiante; en varones, el consumo de alcohol, el índice de masa corporal, los antecedentes de enfermedad coronaria precoz en familiares de primer grado, la enfermedad renal y la presión arterial diastólica. El área bajo la curva c fue 0,84 (IC95%, 0,82-0,85) en varones y 0,73 (IC95%, 0,66-0,80) en mujeres. La calibración mostró una subestimación en los deciles de bajo riesgo y sobrestimación en los de alto riesgo.

Conclusiones

El modelo de riesgo cardiovascular de por vida tiene una discriminación y una calibración satisfactorias, con mejores resultados para varones que para mujeres.

Section snippets

INTRODUCTION

Cardiovascular diseases continue to be a major cause of morbidity, mortality, and disability.1

Primary prevention of these diseases aims to lower the risk of cardiovascular disease by combining different strategies. To maximize cost-effectiveness, these efforts mainly focus on persons considered to be at high risk, in order. Patients at higher cardiovascular risk are usually identified by cardiovascular risk (CVR) population calculations. Consequently, CVR calculators are an essential tool for

METHODS

This study was based on a retrospective cohort design with 7 to 10 years of follow-up. To conduct the study, we selected employees aged 18 to 65 years who were working for member companies of a large nationwide occupational insurance firm (Ibermutuamur), who had no history of cardiovascular disease, and who had passed an occupational health assessment at the Sociedad de Prevención de Ibermutuamur (now Cualtis) between 2004 and 2007. Informed consent was obtained from all participants prior to

Study Population Characteristics

A total of 762 054 participants aged 18 to 65 (mean, 35.48 ± 10.56) years who met the inclusion criteria were selected. Of these, 71.14% were men. The referral cohort included 533 439 participants randomly selected from all participants; a total of 2694 cardiovascular events were recorded among men and 266 among women, with a total follow-up of 2 444 546.1 and 1 025 303.3 person-years, respectively, and 4706 and 610 competing events in men and women. The validation cohort had 1187

DISCUSSION

The present study obtained a model to calculate the lifetime CVR (IBERLIFERISK) from age 18 to 75 years in the Spanish working population.

The study found that use of the lifetime risk identifies more high-risk patients and reclassifies others from moderate risk to high risk. A study comparing the lifetime risk of the American College of Cardiology/American Heart Association model and of QRISK observed that 1.61% (95%CI, 1.55-1.66) patients were reclassified from moderate risk to high risk

CONCLUSIONS

This study has obtained a model to calculate lifetime CVR (IBERLIFERISK) in the Spanish working population aged 18 to 75 years. The model showed satisfactory discrimination and calibration, but was better in men than in women.

FUNDING

Project coordinated and funded by the Fondo de Investigaciones Sanitarias (Health Research Fund) (PI14/01177), Carlos III Health Institute, Ministry of Economy and Competitiveness.

CONFLICTS OF INTEREST

None declared.

WHAT IS KNOWN ABOUT THE TOPIC?

  • The lifetime CVR may be a useful tool for patients with a moderate 10-year CVR.

  • Two methods are used to calculate lifetime CVR, one developed in the United Kingdom (QRISK) and the other in the United States (American College of Cardiology/American Heart Association).

WHAT DOES THIS STUDY ADD?

  • A lifetime CVR equation has been developed in the Spanish working population and may be useful for patients with a low-to-moderate short-term absolute CVR but high lifetime CVR, particularly to encourage more intense

Acknowledgments

We would like express our appreciation to Dr Joan Vila from the IMIM (Institut Hospital del Mar d’Investigacions Mèdiques [Hospital del Mar Institute for Medical Research]) for his review of the study methodology.

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