Can risk be predicted? An umbrella systematic review of current risk prediction models for cardiovascular diseases, diabetes and hypertension

Abstract

ObjectiveTo provide an overview of the currently available risk prediction models (RPMs) for cardiovascular diseases (CVDs), diabetes and hypertension, and to compare their effectiveness in proper recognition of patients at risk of developing these diseases.DesignUmbrella systematic review.Data sourcesPubMed, Scopus, Cochrane Library.Eligibility criteriaSystematic reviews or meta-analysis examining and comparing performances of RPMs for CVDs, hypertension or diabetes in healthy adult (18–65 years old) population, published in English language.Data extraction and synthesisData were extracted according to the following parameters: number of studies included, intervention (RPMs applied/assessed), comparison, performance, validation and outcomes. A narrative synthesis was performed. Data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Study selection3612 studies were identified. After title/abstract screening and removal of duplicate articles, 37 studies met the eligibility criteria. After reading the full text, 13 were deemed relevant for inclusion. Three further papers from the reference lists of these articles were then added.Study appraisalThe methodological quality of the included studies was assessed using the AMSTAR tool.Risk of bias in individual studiesRisk of Bias evaluation was carried out using the ROBIS tool.ResultsSixteen studies met the inclusion criteria: six focused on diabetes, two on hypertension and eight on CVDs. Globally, prediction models for diabetes and hypertension showed no significant difference in effectiveness. Conversely, some promising differences among prediction tools were highlighted for CVDs. The Ankle-Brachial Index, in association with the Framingham tool, and QRISK scores provided some evidence of a certain superiority compared with Framingham alone.LimitationsDue to the significant heterogeneity of the studies, it was not possible to perform a meta-analysis. The electronic search was limited to studies in English and to three major international databases (MEDLINE/PubMed, Scopus and Cochrane Library), with additional works derived from the reference list of other studies; grey literature with unpublished documents was not included in the search. Furthermore, no assessment of potential adverse effects of RPMs was carried out.ConclusionsConsistent evidence is available only for CVD prediction: the Framingham score, alone or in combination with the Ankle-Brachial Index, and the QRISK score can be confirmed as the gold standard. Further efforts should not be concentrated on creating new scores, but rather on performing external validation of the existing ones, in particular on high-risk groups. Benefits could be further improved by supplementing existing models with information on lifestyle, personal habits, family and employment history, social network relationships, income and education.PROSPERO registration numberCRD42018088012.

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“…This revealed that clear evidence is present only for the prediction of CVD; the Framingham score, by itself or in association with the Ankle-Brachial Index, and QRISK score can be considered as the gold standard. Further efforts must not be focused on the production of new scores but should, instead, focus on the external validation of existing scores, particularly in groups at high risk (Lucaroni et al, 2019). Results of this study and similar studies should add to the validation and/or modification of the RPMs that are currently available.…”

Genetically Informed Regression Analysis: Application to Aggression Prediction by Inattention and Hyperactivity in Children and Adults

“…inattention (InA) and hyperactivity (HA). These types of questions of a best genetic predictor of an outcome trait or disease may come up in multiple contexts, such as the prediction of educational attainment by cognitive ability and non-cognitive skills (Demange et al 2020 ) or hypertension and cardiovascular outcomes by multiple correlated factors (Lucaroni et al 2019 ).…”

Interleukin-6-174G/C polymorphism is associated with a decreased risk of type 2 diabetes in patients with chronic hepatitis C virus

“…In the present study, in addition to IL-6 SNP, arterial hypertension was associated with type 2 diabetes mellitus. Studies have demonstrated that cardiovascular diseases, hypertension and diabetes are strongly correlated to each other[ 73 ]. Their powerful relationship have also been observed in patients chronically infected with HCV[ 74 , 75 ].…”