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Abstract
Background Current cardiovascular disease (CVD) risk prediction models tailored for older adults are inadequate. This study aimed to validate, update and assess the utility of widely used CVD risk prediction models including American College of Cardiology/American Heart Association, 2008 Framingham, GloboRisk, National Vascular Disease Prevention Alliance and Predict1 originally developed for middle-aged population, as well as an age-specific Systematic COronary Risk Evaluation 2-Older Person model, in Australian and the US community-dwelling older adults.
Methods Participants, without history of CVD events, dementia or physical disability, enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) clinical trial and ASPREE-eXTention observational post-trial follow-up, were considered for CVD risk prediction. The main outcome was predicted CVD risk from adjudicated CVD events. The performance of the original, recalibrated (adjusting models’ intercept and slope) and updated (adjusting models’ coefficients) models was evaluated by discrimination (C statistic), calibration (calibration plots) and clinical utility (decision curves). Models were extended by incorporating predictors including serum creatinine, depression and socioeconomic status index (Index of Relative Socio-economic Advantage and Disadvantage, IRSAD) into models’ equation, and the changes in discrimination were evaluated.
Results Among 15 618 adults (mean age 75 (4.4) years), 520 men and 498 women experienced CVD events over a median follow-up of 6.3 (IQR: 5.2–7.7) years. Following updating, the discrimination power of models increased for both sexes (C statistics ranged 0.62–0.64 for men and 0.68–0.69 for women). Updated models indicated good calibration, with an added net benefit at the risk thresholds ranging from 4%–10% for women to 5%–12% for men. Incorporating IRSAD, depression and serum creatinine did not improve CVD risk discrimination of updated models.
Conclusions Updating models, by adjusting model coefficients to better reflect the characteristics and risk factors of older adults, improves CVD risk prediction in a large cohort of relatively healthy Caucasian population aged 70+. Further external validation in diverse older populations including those with frailty and multimorbidity is recommended before clinical implementation.
- Cardiovascular Diseases
- Risk Assessment
Data availability statement
Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. The datasets generated and/or analysed (analysis codes) during the current study are not publicly available due to legal and ethical reasons but are available from the corresponding author on reasonable request. More information can be found at https://aspree.org/aus/for-researchers/.
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Data availability statement
Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. The datasets generated and/or analysed (analysis codes) during the current study are not publicly available due to legal and ethical reasons but are available from the corresponding author on reasonable request. More information can be found at https://aspree.org/aus/for-researchers/.
Footnotes
SG and ML are joint first authors.
X @profcmreid
SG and ML contributed equally.
Contributors SG: conceptualisation, methodology, software, data curation, formal analysis, visualisation and writing–original draft. ML: conceptualisation, methodology, software, data curation, formal analysis, validation, writing–review and editing. AT: writing–review and editing. MRN: writing–review and editing. CMR: writing–review and editing. JJMN: writing–review and editing. RW: writing–review and editing. EKC: writing–review and editing. RLW: writing–review and editing. MB: writing–review and editing. MM: conceptualisation, methodology, supervision, validation, writing–review and editing. SG is responsible for the overall content as guarantor. All authors read and approved the final manuscript.
Funding ASPREE is registered on the International Standard Randomized Controlled Trial Number Register (ISRCTN83772183). The ASPREE project, comprising two components of ASPREE and ASPREE-XT, was led by Monash University in Australia and the Berman Centre for Outcomes and Clinical Research in the USA. Funding for the ASPREE project was provided by Australian and US governments; the Australian National Health and Medical Research Council (NHMRC) (grants 334047 and 1127060); the National Institute on Aging; the National Cancer Institute at the US National Institutes of Health (grants U01AG029824 and U19AG062682); Monash University (Australia) and the Victorian Cancer Agency (Australia). MB is supported by an NHMRC Leadership 3 Investigator grant (GNT2017131). JJM is supported by an NHMRC Leadership 3 Investigator grant (IG1173690). SG is supported by the Alfred Deakin Postdoctoral Research Fellowship.
Disclaimer The funders had no role in study design, data collection and analysis, and decision to publish.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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