Predicting lifetime cardiovascular risk and benefits of preventive treatment in patients with established atherosclerotic cardiovascular disease: the SMART-REACH2 model
Authors' conclusion
The updated SMART-REACH2 model accounts for geographical and sex-specific variations and allows estimation of short-term and lifetime risk of recurrent CV events and treatment benefits, facilitating shared decision-making as recommended by guidelines.
Study context
- Population
- Patients aged 40–90 years with established atherosclerotic CVD (coronary, cerebrovascular, PAD and/or AAA)derivation
- Participants
- 8,708 patients
- Outcome
- Recurrent CV events (MI, stroke or CV death); model performance by calibration and Harrell's C-statistic
Methodological detailssex-stratified cause-specific Cox models, recalibration to risk regions
- Sex-stratified cause-specific Cox models
- Recalibration to risk regions
Performance
As reported in the abstract
Pooled C-statistic
0.68
95% CI 0.66–0.69
C-statistic, European low-risk region (0.64-0.69)
0.66
C-statistic, Latin America (0.66-0.78)
0.72
Further findings
Derivation cohort recurrent cardiovascular (CV) events · median follow-up 8.5 years (25th-75th: 4.3-13.0)
- Recurrent CV events
- 2057
Performance by sex and CVD subtype
- Performance consistent across sexes and CVD subtypes
Estimated gain in CVD-free life expectancy with intensified prevention (15 mmHg SBP and 1.0 mmol/L LDL-C reduction), 50-year-old example patient
Years
- Low-risk region
- 2
- Very-high-risk region
- 4.4
Original publication
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