Psychological factors beyond the SMART2 model for predicting recurrent events in atherosclerotic cardiovascular disease patients
Authors' conclusion
SMART2 model reliably estimates recurrent CV event risk in patients with psychological factors. Psychological factors have no added value to CV risk prediction when integrated on top of the SMART2 risk score.
Study context
- Population
- Patients aged 40–80 with atherosclerotic CVD2,987 with recurrent cardiovascular (CV) events
- Participants
- 20,050 patients
- Exposure
- SMART2 plus psychological factors vs SMART2 alone
- Outcome
- Added value of psychological factors (depression, anxiety, insomnia) on top of SMART2 for recurrent CV events, by ΔC-statistic and calibration
- Follow-up
- 10-year risk
Methodological detailsprediction model evaluation, multicohort (UCC-SMART, HUNT3, HUNT4, NORCOR, Nor-COAST), Fine and Gray models with SMART2 coefficients as offset
- Prediction model evaluation
- Multicohort (UCC-SMART, HUNT3, HUNT4, NORCOR, Nor-COAST)
- Fine and Gray models with SMART2 coefficients as offset
Main finding
As reported in the abstract
ΔC-statistic with psychological factors added to SMART2
ΔC-statistic, symptoms of depression (lowest)
−0.0003
95% CI −0.0005–0.0001
ΔC-statistic, prescribed anxiolytics (highest)
0.0011
95% CI 0.0011–0.0011
Observational data: associations, not effects.
Further findings
SMART2 performance in patients with psychological factors
- C-statistics (adequate)
- 0.61 to 0.70
Prevalence of psychological factors
- Diagnosis
- 3-9%
- Self-reported symptoms
- 3-45%
- Prescribed treatment
- 10-14%
Original publication
Psychological factors beyond the SMART2 model for predicting recurrent events in atherosclerotic cardiovascular disease patients. Eur J Prev Cardiol. Published 26 August 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →