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Development and validation of a cardiovascular disease risk-prediction model using population health surveys: the Cardiovascular Disease Population Risk Tool (CVDPoRT).
Manuel, Douglas G; Tuna, Meltem; Bennett, Carol; Hennessy, Deirdre; Rosella, Laura; Sanmartin, Claudia; Tu, Jack V; Perez, Richard; Fisher, Stacey; Taljaard, Monica.
Affiliation
  • Manuel DG; Ottawa Hospital Research Institute (Manuel, Tuna, Bennett, Perez, Fisher, Taljaard); Institute for Clinical Evaluative Sciences (Manuel, Tuna, Bennett), Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Tu), Toronto, Ont.; Institute for Clinical Evaluative Sciences (Perez), Hamilton, Ont.; S
  • Tuna M; Ottawa Hospital Research Institute (Manuel, Tuna, Bennett, Perez, Fisher, Taljaard); Institute for Clinical Evaluative Sciences (Manuel, Tuna, Bennett), Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Tu), Toronto, Ont.; Institute for Clinical Evaluative Sciences (Perez), Hamilton, Ont.; S
  • Bennett C; Ottawa Hospital Research Institute (Manuel, Tuna, Bennett, Perez, Fisher, Taljaard); Institute for Clinical Evaluative Sciences (Manuel, Tuna, Bennett), Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Tu), Toronto, Ont.; Institute for Clinical Evaluative Sciences (Perez), Hamilton, Ont.; S
  • Hennessy D; Ottawa Hospital Research Institute (Manuel, Tuna, Bennett, Perez, Fisher, Taljaard); Institute for Clinical Evaluative Sciences (Manuel, Tuna, Bennett), Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Tu), Toronto, Ont.; Institute for Clinical Evaluative Sciences (Perez), Hamilton, Ont.; S
  • Rosella L; Ottawa Hospital Research Institute (Manuel, Tuna, Bennett, Perez, Fisher, Taljaard); Institute for Clinical Evaluative Sciences (Manuel, Tuna, Bennett), Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Tu), Toronto, Ont.; Institute for Clinical Evaluative Sciences (Perez), Hamilton, Ont.; S
  • Sanmartin C; Ottawa Hospital Research Institute (Manuel, Tuna, Bennett, Perez, Fisher, Taljaard); Institute for Clinical Evaluative Sciences (Manuel, Tuna, Bennett), Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Tu), Toronto, Ont.; Institute for Clinical Evaluative Sciences (Perez), Hamilton, Ont.; S
  • Tu JV; Ottawa Hospital Research Institute (Manuel, Tuna, Bennett, Perez, Fisher, Taljaard); Institute for Clinical Evaluative Sciences (Manuel, Tuna, Bennett), Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Tu), Toronto, Ont.; Institute for Clinical Evaluative Sciences (Perez), Hamilton, Ont.; S
  • Perez R; Ottawa Hospital Research Institute (Manuel, Tuna, Bennett, Perez, Fisher, Taljaard); Institute for Clinical Evaluative Sciences (Manuel, Tuna, Bennett), Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Tu), Toronto, Ont.; Institute for Clinical Evaluative Sciences (Perez), Hamilton, Ont.; S
  • Fisher S; Ottawa Hospital Research Institute (Manuel, Tuna, Bennett, Perez, Fisher, Taljaard); Institute for Clinical Evaluative Sciences (Manuel, Tuna, Bennett), Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Tu), Toronto, Ont.; Institute for Clinical Evaluative Sciences (Perez), Hamilton, Ont.; S
  • Taljaard M; Ottawa Hospital Research Institute (Manuel, Tuna, Bennett, Perez, Fisher, Taljaard); Institute for Clinical Evaluative Sciences (Manuel, Tuna, Bennett), Ottawa, Ont.; Institute for Clinical Evaluative Sciences (Tu), Toronto, Ont.; Institute for Clinical Evaluative Sciences (Perez), Hamilton, Ont.; S
CMAJ ; 190(29): E871-E882, 2018 07 23.
Article de En | MEDLINE | ID: mdl-30037888
ABSTRACT

BACKGROUND:

Routinely collected data from large population health surveys linked to chronic disease outcomes create an opportunity to develop more complex risk-prediction algorithms. We developed a predictive algorithm to estimate 5-year risk of incident cardiovascular disease in the community setting.

METHODS:

We derived the Cardiovascular Disease Population Risk Tool (CVDPoRT) using prospectively collected data from Ontario respondents of the Canadian Community Health Surveys, representing 98% of the Ontario population (survey years 2001 to 2007; follow-up from 2001 to 2012) linked to hospital admission and vital statistics databases. Predictors included body mass index, hypertension, diabetes, and multiple behavioural, demographic and general health risk factors. The primary outcome was the first major cardiovascular event resulting in hospital admission or death. Death from a noncardiovascular cause was considered a competing risk.

RESULTS:

We included 104 219 respondents aged 20 to 105 years. There were 3709 cardiovascular events and 818 478 person-years follow-up in the combined derivation and validation cohorts (5-year cumulative incidence function, men 0.026, 95% confidence interval [CI] 0.025-0.028; women 0.018, 95% 0.017-0.019). The final CVDPoRT algorithm contained 12 variables, was discriminating (men C statistic 0.82, 95% CI 0.81-0.83; women 0.86, 95% CI 0.85-0.87) and was well-calibrated in the overall population (5-year observed cumulative incidence function v. predicted risk, men 0.28%; women 0.38%) and in nearly all predefined policy-relevant subgroups (206 of 208 groups).

INTERPRETATION:

The CVDPoRT algorithm can accurately discriminate cardiovascular disease risk for a wide range of health profiles without the aid of clinical measures. Such algorithms hold potential to support precision medicine for individual or population uses. Study registration ClinicalTrials.gov, no. NCT02267447.
Sujet(s)

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Algorithmes / Maladies cardiovasculaires / Enquêtes de santé / Modèles statistiques / Appréciation des risques / Santé de la population Type d'étude: Etiology_studies / Incidence_studies / Prognostic_studies / Risk_factors_studies Limites: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Pays/Région comme sujet: America do norte Langue: En Journal: CMAJ Sujet du journal: MEDICINA Année: 2018 Type de document: Article

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Algorithmes / Maladies cardiovasculaires / Enquêtes de santé / Modèles statistiques / Appréciation des risques / Santé de la population Type d'étude: Etiology_studies / Incidence_studies / Prognostic_studies / Risk_factors_studies Limites: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Pays/Région comme sujet: America do norte Langue: En Journal: CMAJ Sujet du journal: MEDICINA Année: 2018 Type de document: Article