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' conclusion
The flexible add-on of guideline-outlined factors on top of SMART2 enables more personalised and improved estimation of recurrent CV event risk in patients with established ASCVD.
Study context
- Population
- Patients aged 40–80 with established atherosclerotic CVD (atherosclerotic CV disease (ASCVD))
- Participants
- 179,382 patients11 cohorts
- Comparison
- SMART2 plus add-on predictors vs SMART2 alone
- Outcome
- Recurrent CV events:
- Non-fatal MI or stroke
- Cardiovascular (CV) death
Methodological detailsindividual participant data from 11 cohorts, cohort cross validation, Fine-Gray models with SMART2 coefficients as offset, decision curve analysis
- Individual participant data from 11 cohorts
- Cohort cross validation
- Fine-Gray models with SMART2 coefficients as offset
- Decision curve analysis
Performance
As reported in the abstract
Added predictive value of add-on factors beyond SMART2
Subdistribution HR, employment status
0.77
95% CI 0.75–0.80
Subdistribution HR, HF history
1.69
1.63–1.76
ΔC-statistic, NT-proBNP
0.0127
0.0060–0.0193
ΔC-statistic, troponin I
0.0100
0.0020–0.0181
Original publication
Improving 10-year cardiovascular risk prediction in patients with established cardiovascular disease: flexible addition of risk predictors on top of the SMART2 risk score. Eur J Prev Cardiol. Published 9 February 2026. doi:10.
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