| Title: |
Improving 10-year cardiovascular risk prediction in patients with established cardiovascular disease: flexible addition of risk predictors on top of the SMART2 risk score |
| Authors: |
Holtrop, Joris; Gynnild, Mari N; Richards, Matthew; Lim, Carl-Emil; Lääperi, Mitja; Deo, Salil V; Dalen, Håvard; Ueda, Peter; Rajagopalan, Sanjay; Chlabicz, Małgorzata; Kaminski, Karol; Mahíllo-Fernández, Ignacio; Saltvedt, Ingvild; Dazard, Jean-Eudes; Ellekjær, Hanne; Steg, Philippe Gabriel; Tuñón, José; Omland, Torbjørn; Sinisalo, Juha; Munkhaugen, John; Jernberg, Tomas; Bhatt, Deepak L; Wood, Angela; Visseren, Frank L J; Hageman, Steven H J; Dorresteijn, Jannick A N |
| Contributors: |
UCC-SMART; University Medical Centre Utrecht |
| Source: |
European Journal of Preventive Cardiology ; ISSN 2047-4873 2047-4881 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2026 |
| Description: |
Aims Guidelines recommend using the SMART2 model, estimating the risk of recurrent cardiovascular (CV) events, to support treatment decisions in patients with established atherosclerotic CV disease (ASCVD). They further outline that adding biomarkers, comorbidities, anthropometric, and social factors may improve these predictions. This study aims to investigate the added predictive value of guideline-outlined factors including biomarkers, comorbidities, anthropometric, and social factors on top of the SMART2 model using an approach enabling their use as add-on predictors. Methods and results Patients aged 40–80 with ASCVD were included from 11 cohorts (n = 179 382 with 25 789 recurrent CV events). Additional factors included biomarkers [troponin I, N-terminal pro-B-type natriuretic peptide (NT-proBNP), albuminuria], comorbidities (heart failure, atrial fibrillation, coronary multivessel disease), anthropometric measurements [body mass index (BMI), waist and hip circumference], social (employment, education), and other factors (former smoking, parental CV history). Cross-cohort availability of these factors ranged from two cohorts for albuminuria to all cohorts for BMI. These factors were assessed as add-on predictors to the SMART2 model using Fine–Gray models with SMART2 coefficients as offset with recurrent CV events as the primary outcome (non-fatal myocardial infarction or stroke, or CV death). Added predictive value was assessed through cohort cross-validation by change (Δ) in C-statistic, calibration, and net benefit through decision curve analysis. Subdistribution hazard ratios for additional factors ranged from 0.77 (95% confidence interval 0.75–0.80) for employment status to 1.69 (1.63–1.76) for heart failure history. ΔC-statistic was largest for NT-proBNP [0.0127 (0.0060–0.0193)] and troponin I [0.0100 (0.0020–0.0181)], with statistically significant but smaller ΔC-statistics for employment, heart failure, and atrial fibrillation. Calibration was adequate before and after integration of ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/eurjpc/zwag086 |
| DOI: |
10.1093/eurjpc/zwag086/66810756/zwag086.pdf |
| Availability: |
https://doi.org/10.1093/eurjpc/zwag086; https://academic.oup.com/eurjpc/advance-article-pdf/doi/10.1093/eurjpc/zwag086/66810756/zwag086.pdf |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.828D269E |
| Database: |
BASE |