Distribution of Estimated 10-Year Risk of Recurrent Vascular Events and Residual Risk in a Secondary Prevention Population

Kaasenbrood, Lotte; Boekholdt, S. Matthijs; Graaf, Yolanda van der; Ray, Kausik K.; Peters, Ron J.G.; Kastelein, John J.P.; Amarenco, Pierre; LaRosa, John C.; Cramer, Maarten J.; Westerink, Jan; Kappelle, L. Jaap; Borst, Gert J. de; Visseren, Frank L.J.

doi:10.1161/circulationaha.116.021314

Cited by 197 publications

(147 citation statements)

References 38 publications

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“…Additional scores developed for secondary prevention in patients with established cardiovascular disease (CVD) do not include obstructive CAD as a variable, but were developed in populations dominated by obstructive CAD,63, 65, 66, 67, 68, 69, 70, 71 and therefore are of unknown appropriateness for stable INOCA patients.…”

Section: Secondary Prevention Risk Scoresmentioning

confidence: 99%

“…The Second Manifestation of Arterial Disease (SMART),69 Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TIMI‐TRS2 o P),70 and A Coronary Disease Trial Investigating Outcome with Nifedipine (ACTION) risk66 scores, all showed substantial variability in risk among patients with stable CVD, but more importantly that aggressive guideline treatment in high‐risk patients decreased their risk 69. Similarly, the PREDICT CVD (New Zealand Primary Care Cohort Study) score developed for patients with previous CVD recognizes patient‐specific risks of future events and how they may be reduced through therapeutic and behavioral strategies 68…”

Section: Secondary Prevention Risk Scoresmentioning

confidence: 99%

“…Comparison of primary, secondary prevention risk versus observed risk in an example of stable INOCA patient is presented in Figure 2 40, 47, 56, 63, 65, 66, 67, 68, 69, 70, 71. The primary prevention scores, developed in asymptomatic populations, predicted that risks vary between 1% and ≈5% and underestimate the observed INOCA risk.…”

Section: Primary and Secondary Prevention Risk Versus Observed Inoca mentioning

confidence: 99%

“…To date, limited data exist about the effectiveness of therapy in stable patients with no CAD and high prevalence of CMD. Nevertheless, prior work in obstructive CAD has demonstrated that atherosclerotic progression can be slowed and MACE reduced with optimal medical therapy,69 while surrogate outcome trials in CMD patients indicate improvement in endothelial function, CFR, and angina with optimal medical therapy, as well 87. Patients with INOCA deserve to receive optimal treatment as per current guidelines while awaiting future dedicated trials.…”

Section: Cardiovascular Treatment Rates In Inoca Patientsmentioning

confidence: 99%

See 3 more Smart Citations

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Herscovici

Sedlak

Wei

et al. 2018

JAHA

139

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Section: Secondary Prevention Risk Scoresmentioning

confidence: 99%

Section: Secondary Prevention Risk Scoresmentioning

confidence: 99%

Section: Primary and Secondary Prevention Risk Versus Observed Inoca mentioning

confidence: 99%

Section: Cardiovascular Treatment Rates In Inoca Patientsmentioning

confidence: 99%

See 2 more Smart Citations

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Herscovici

Sedlak

Wei

et al. 2018

JAHA

139

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“…Patients with a clinical manifestation of cardiovascular disease show substantial variation in cardiovascular prognosis 1. Similar to the primary prevention setting, decisions on initiation or intensification of preventive treatment should be based on anticipated clinical benefit derived from prediction models, rather than based on the level of individual cardiovascular risk factors.…”

Section: Introductionmentioning

confidence: 99%

Estimated Life Expectancy Without Recurrent Cardiovascular Events in Patients With Vascular Disease: The SMART‐REACH Model

Kaasenbrood

Bhatt

Dorresteijn

et al. 2018

JAHA

Self Cite

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BackgroundIn patients with vascular disease, risk models may support decision making on novel risk reducing interventions, such as proprotein convertase subtilisin/kexin type 9 inhibitors or anti‐inflammatory agents. We developed and validated an innovative model to estimate life expectancy without recurrent cardiovascular events for individuals with coronary, cerebrovascular, and/or peripheral artery disease that enables estimation of preventive treatment effect in lifetime gained.Methods and ResultsStudy participants originated from prospective cohort studies: the SMART (Secondary Manifestations of Arterial Disease) cohort and REACH (Reduction of Atherothrombosis for Continued Health) cohorts of 14 259 (REACH Western Europe), 19 170 (REACH North America) and 6959 (SMART, The Netherlands) patients with cardiovascular disease. The SMART‐REACH model to estimate life expectancy without recurrent events was developed in REACH Western Europe as a Fine and Gray competing risk model incorporating cardiovascular risk factors. Validation was performed in REACH North America and SMART. Outcomes were (1) cardiovascular events (myocardial infarction, stroke, cardiovascular death) and (2) noncardiovascular death. Predictors were sex, smoking, diabetes mellitus, systolic blood pressure, total cholesterol, creatinine, number of cardiovascular disease locations, atrial fibrillation, and heart failure. Calibration plots showed high agreement between estimated and observed prognosis in SMART and REACH North America. C‐statistics were 0.68 (95% confidence interval, 0.67–0.70) in SMART and 0.67 (95% confidence interval, 0.66–0.68) in REACH North America. Performance of the SMART‐REACH model was better compared with existing risk scores and adds the possibility of estimating lifetime gained by novel therapies.ConclusionsThe externally validated SMART‐REACH model could be used for estimation of anticipated improvements in life expectancy without recurrent cardiovascular events in individual patients with cardiovascular disease in Western Europe and North America.

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Use of risk scores to identify lower and higher risk subsets among COMPASS‐eligible patients with chronic coronary syndromes. Insights from the CLARIFY registry

Darmon

Ducrocq

Jasilek

et al. 2020

Clinical Cardiology

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BackgroundThe COMPASS trial showed a reduction of ischemic events with low‐dose rivaroxaban and aspirin in chronic coronary syndromes (CCS) compared with aspirin alone, at the expense of increased bleeding.HypothesisThe CHA2DS2VaSc Score, REACH Recurrent Ischemic (RIS), and REACH Bleeding Risk Score (BRS) could identify patients with a favorable trade‐off between ischemic and bleeding events, among COMPASS‐eligible patients.MethodsWe identified the COMPASS‐eligible population within the CLARIFY registry (>30.000 patients with CCS). High‐bleeding risk patients (REACH BRS > 10) were excluded, as in the COMPASS trial. Patients were categorized as low (0–1) or high (≥ 2) CHA2DS2VaSc; low (0–12) or intermediate (13–19) REACH RIS, and low (0–6) or intermediate (7–10) REACH BRS. Ischemic outcome was the composite of cardiovascular death, myocardial infarction or stroke. Bleeding was defined as serious bleeding (haemorrhagic stroke, hospitalization for bleeding, transfusion).ResultsThe COMPASS‐eligible population comprised 5.142 patients with ischemic and bleeding outcome of 2.3 (2.1–2.5) and 0.5 (0.4–0.6) per 100 patient‐years, respectively. Patients with intermediate REACH RIS (n = 1934 [37.6%]) had the higher ischemic risk (3.0 [2.6–3.4]) with similar bleeding risk (0.5 [0.4–0.7]) as the overall population. Patients with low CHA2DS2VaSc (n = 229 [4.4%]) had a very low ischemic risk (0.6 [0.3–1.3]) with similar bleeding risk (0.5 [0.2–1.1]).ConclusionsIntermediate REACH RIS identified potential optimal candidates for adjunction of low‐dose rivaroxaban while patients with low CHA2DS2VaSc score .appears unlikely to benefit from the COMPASS regimen. None of the three risk scores predicted the occurrence of serious bleeding.

show abstract

Distribution of Estimated 10-Year Risk of Recurrent Vascular Events and Residual Risk in a Secondary Prevention Population

Cited by 197 publications

References 38 publications

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Estimated Life Expectancy Without Recurrent Cardiovascular Events in Patients With Vascular Disease: The SMART‐REACH Model

Use of risk scores to identify lower and higher risk subsets among COMPASS‐eligible patients with chronic coronary syndromes. Insights from the CLARIFY registry

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