TY - JOUR
T1 - Estimation of recurrent atherosclerotic cardiovascular event risk in patients with established cardiovascular disease
T2 - The updated SMART2 algorithm
AU - the UCC-SMART Study Group and the ESC Cardiovascular Risk Collaboration
AU - Hageman, Steven H.J.
AU - McKay, Ailsa J.
AU - Ueda, Peter
AU - Gunn, Laura H.
AU - Jernberg, Tomas
AU - Hagström, Emil
AU - Bhatt, Deepak L.
AU - Steg, Ph Gabriel
AU - Läll, Kristi
AU - Mägi, Reedik
AU - Gynnild, Mari Nordbø
AU - Ellekjær, Hanne
AU - Saltvedt, Ingvild
AU - Tuñón, José
AU - Mahíllo, Ignacio
AU - Aceña, Álvaro
AU - Kaminski, Karol
AU - Chlabicz, Malgorzata
AU - Sawicka, Emilia
AU - Tillman, Taavi
AU - McEvoy, John W.
AU - Di Angelantonio, Emanuele
AU - Graham, Ian
AU - De Bacquer, Dirk
AU - Ray, Kausik K.
AU - Dorresteijn, Jannick A.N.
AU - Visseren, Frank L.J.
AU - Asselbergs, F. W.
AU - Nathoe, H. M.
AU - De Borst, G. J.
AU - Bots, M. L.
AU - Geerlings, M. I.
AU - Emmelot, M. H.
AU - De Jong, P. A.
AU - Leiner, T.
AU - Lely, A. T.
AU - Van Der Kaaij, N. P.
AU - Kappelle, L. J.
AU - Ruigrok, Y. M.
AU - Verhaar, M. C.
AU - Visseren, F. L.J.
AU - Westerink, J.
AU - Halle, Martin
AU - Timmis, Adam D.
AU - Lettino, Maddalena
AU - Vardas, Panos E.
AU - De Bacquer, Dirk
AU - Di Angelantonio, Emanuele
AU - Visseren, Frank L.J.
AU - Graham, Ian M.
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2022/5/7
Y1 - 2022/5/7
N2 - Aims: The 10-year risk of recurrent atherosclerotic cardiovascular disease (ASCVD) events in patients with established ASCVD can be estimated with the Secondary Manifestations of ARTerial disease (SMART) risk score, and may help refine clinical management. To broaden generalizability across regions, we updated the existing tool (SMART2 risk score) and recalibrated it with regional incidence rates and assessed its performance in external populations. Methods and results: Individuals with coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysms were included from the Utrecht Cardiovascular Cohort-SMART cohort [n = 8355; 1706 ASCVD events during a median follow-up of 8.2 years (interquartile range 4.2-12.5)] to derive a 10-year risk prediction model for recurrent ASCVD events (non-fatal myocardial infarction, non-fatal stroke, or cardiovascular mortality) using a Fine and Gray competing risk-adjusted model. The model was recalibrated to four regions across Europe, and to Asia (excluding Japan), Japan, Australia, North America, and Latin America using contemporary cohort data from each target region. External validation used data from seven cohorts [Clinical Practice Research Datalink, SWEDEHEART, the international REduction of Atherothrombosis for Continued Health (REACH) Registry, Estonian Biobank, Spanish Biomarkers in Acute Coronary Syndrome and Biomarkers in Acute Myocardial Infarction (BACS/BAMI), the Norwegian COgnitive Impairment After STroke, and Bialystok PLUS/Polaspire] and included 369 044 individuals with established ASCVD of whom 62 807 experienced an ASCVD event. C-statistics ranged from 0.605 [95% confidence interval (CI) 0.547-0.664] in BACS/BAMI to 0.772 (95% CI 0.659-0.886) in REACH Europe high-risk region. The clinical utility of the model was demonstrated across a range of clinically relevant treatment thresholds for intensified treatment options. Conclusion: The SMART2 risk score provides an updated, validated tool for the prediction of recurrent ASCVD events in patients with established ASCVD across European and non-European populations. The use of this tool could allow for a more personalized approach to secondary prevention based upon quantitative rather than qualitative estimates of residual risk.
AB - Aims: The 10-year risk of recurrent atherosclerotic cardiovascular disease (ASCVD) events in patients with established ASCVD can be estimated with the Secondary Manifestations of ARTerial disease (SMART) risk score, and may help refine clinical management. To broaden generalizability across regions, we updated the existing tool (SMART2 risk score) and recalibrated it with regional incidence rates and assessed its performance in external populations. Methods and results: Individuals with coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysms were included from the Utrecht Cardiovascular Cohort-SMART cohort [n = 8355; 1706 ASCVD events during a median follow-up of 8.2 years (interquartile range 4.2-12.5)] to derive a 10-year risk prediction model for recurrent ASCVD events (non-fatal myocardial infarction, non-fatal stroke, or cardiovascular mortality) using a Fine and Gray competing risk-adjusted model. The model was recalibrated to four regions across Europe, and to Asia (excluding Japan), Japan, Australia, North America, and Latin America using contemporary cohort data from each target region. External validation used data from seven cohorts [Clinical Practice Research Datalink, SWEDEHEART, the international REduction of Atherothrombosis for Continued Health (REACH) Registry, Estonian Biobank, Spanish Biomarkers in Acute Coronary Syndrome and Biomarkers in Acute Myocardial Infarction (BACS/BAMI), the Norwegian COgnitive Impairment After STroke, and Bialystok PLUS/Polaspire] and included 369 044 individuals with established ASCVD of whom 62 807 experienced an ASCVD event. C-statistics ranged from 0.605 [95% confidence interval (CI) 0.547-0.664] in BACS/BAMI to 0.772 (95% CI 0.659-0.886) in REACH Europe high-risk region. The clinical utility of the model was demonstrated across a range of clinically relevant treatment thresholds for intensified treatment options. Conclusion: The SMART2 risk score provides an updated, validated tool for the prediction of recurrent ASCVD events in patients with established ASCVD across European and non-European populations. The use of this tool could allow for a more personalized approach to secondary prevention based upon quantitative rather than qualitative estimates of residual risk.
KW - Established ASCVD
KW - Personalized treatment
KW - Recurrent risk
KW - Residual risk
KW - Risk prediction
KW - Secondary prevention
UR - https://www.scopus.com/pages/publications/85129505005
U2 - 10.1093/eurheartj/ehac056
DO - 10.1093/eurheartj/ehac056
M3 - Article
AN - SCOPUS:85129505005
SN - 0195-668X
VL - 43
SP - 1715
EP - 1727
JO - European Heart Journal
JF - European Heart Journal
IS - 18
ER -
SDG 3 Good Health and Well-being