{"id":1731,"date":"2018-06-08T07:24:52","date_gmt":"2018-06-08T07:24:52","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=1731"},"modified":"2018-06-08T07:31:14","modified_gmt":"2018-06-08T07:31:14","slug":"overestimation-of-cardiovascular-risk-and-what-to-do-about-it","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/06\/08\/overestimation-of-cardiovascular-risk-and-what-to-do-about-it\/","title":{"rendered":"Overestimation of cardiovascular risk and what to do about it"},"content":{"rendered":"<p>&nbsp;<\/p>\n<p><em>A New Zealand study\u00a0sets new standards for predicting\u00a0cardiovascular\u00a0risk and questions the validity of pre-existing\u00a0risk equations\u00a0<\/em><\/p>\n<p style=\"text-align: right\">Carl Heneghan<\/p>\n<hr \/>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-thumbnail wp-image-1324 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2017\/06\/Carl-Heneghan-150x150.png\" alt=\"\" width=\"150\" height=\"150\" \/><\/p>\n<p>Prevention of cardiovascular disease relies on identifying those most at risk. Most cohorts of patients were established many years ago with patients at higher risk. A recent prospective <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29735391\">cohort study done in New Zealand<\/a> representing primary care patients found that most individuals seen in primary care were at low risk of cardiovascular disease, and that pre-existing risk scores substantially overestimated risk.<\/p>\n<p>The PREDICT study automatically recruited participants in primary care at the point of risk assessment and linked them to ICD-hospital codes and mortality data. 401 752 people aged 30-74 years were assessed between 2002, and 2015. \u00a0Mean follow-up was 4\u00b72 years, and 15 386 (4%) people had cardiovascular events: 1507 (10%) of these were fatal.<\/p>\n<p>The median 5-year CVD risk was 2\u00b73% in women and 3\u00b72% in men, and the adjusted risk increased with socioeconomic deprivation, and in certain ethnic groups (M\u0101ori, Pacific, and Indian patients).<\/p>\n<p>The results of this study show that primary care equations, based on historical data, require calibration by some margin. \u00a0Currently recommended American risk equations overestimated cardiovascular disease in the New Zealand population by about 40% in men and by 60% in women.<\/p>\n<p>Overestimation of cardiovascular risk is not new; previous studies have shown that the <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27436865\">American equations<\/a> overestimate CVD risk, particularly in <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25686167\">modern multi-ethnic cohorts<\/a>.<\/p>\n<p>Given the comprehensive, prospective nature of this cohort, it would be wise for other countries to assess calibration in primary care populations with the PREDICT data, which sets new standards for how to assess CVD risk. We need linked prospective cohort studies to inform practice when it comes to assessing risk.<\/p>\n<hr \/>\n<p>References<\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29735391\">Cardiovascular disease risk prediction equations in 400 000 primary care patients in New Zealand: a derivation and validation study.<\/a> Lancet. 2018 May 12;391(10133):1897-1907. doi: 10.1016\/S0140-6736(18)30664-0. Epub 2018 May 4.<\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27436865\">Risk score overestimation: the impact of individual cardiovascular risk factors and preventive therapies on the performance of the American Heart Association-American College of Cardiology-Atherosclerotic Cardiovascular Disease risk score in a modern multi-ethnic cohort.<\/a> Eur Heart J. 2017 Feb 21;38(8):598-608. doi: 10.1093\/eurheartj\/ehw301.<\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25686167\">An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort.\u00a0<\/a>Ann Intern Med. 2015 Feb 17;162(4):266-75. doi: 10.7326\/M14-1281.<\/p>\n<hr \/>\n<p><strong>More from BMJ EBM\u00a0<\/strong><\/p>\n<p><a class=\"highwire-cite-linked-title\" href=\"http:\/\/ebm.bmj.com\/content\/early\/2018\/05\/04\/bmjebm-2017-110832\"><span class=\"highwire-cite-title\">Appropriately testing patients with intermediate risk for coronary artery disease: how well are we doing?\u00a0<\/span><\/a><span class=\"highwire-cite-metadata-journal highwire-cite-metadata\">BMJ Evidence-Based Medicine\u00a0<\/span><span class=\"highwire-cite-metadata-date highwire-cite-metadata\">May 2018,\u00a0<\/span><span class=\"highwire-cite-metadata-pages highwire-cite-metadata\">ebmed-2017-110832;\u00a0<\/span><span class=\"highwire-cite-metadata-doi highwire-cite-metadata\"><span class=\"label\">DOI:<\/span>\u00a010.1136\/bmjebm-2017-110832<\/span><\/p>\n<p><a class=\"highwire-cite-linked-title\" href=\"http:\/\/ebm.bmj.com\/content\/15\/4\/112\"><span class=\"highwire-cite-title\">An \u2018e-Nudge\u2019 electronic reminder system that highlights individuals at raised cardiovascular risk encourages GPs to improve the collection of patient cardiovascular risk factor data.\u00a0<\/span><\/a><span class=\"highwire-cite-metadata-journal highwire-cite-metadata\">Evidence-Based Medicine\u00a0<\/span><span class=\"highwire-cite-metadata-date highwire-cite-metadata\">Aug<\/span><span class=\"highwire-cite-metadata-date highwire-cite-metadata\">2010,\u00a0<\/span><span class=\"highwire-cite-metadata-volume highwire-cite-metadata\">15\u00a0<\/span><span class=\"highwire-cite-metadata-issue highwire-cite-metadata\">(4)\u00a0<\/span><span class=\"highwire-cite-metadata-pages highwire-cite-metadata\">112;\u00a0<\/span><span class=\"highwire-cite-metadata-doi highwire-cite-metadata\"><span class=\"label\">DOI:<\/span>\u00a010.1136\/ebm1097<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1618 alignright\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2-1.png\" alt=\"\" width=\"380\" height=\"203\" srcset=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2-1.png 380w, https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2-1-300x160.png 300w\" sizes=\"auto, (max-width: 380px) 100vw, 380px\" \/><\/p>\n<p>BMJ\u00a0<a href=\"http:\/\/ebm.bmj.com\/\">Evidence-Based Medicine<\/a>\u00a0\u2013\u00a0original evidence-based research, insights and opinion<\/p>\n<p>Read more about BMJ EBM content in the <a href=\"http:\/\/ebm.bmj.com\/content\/early\/2018\/01\/24\/bmjebm-2018-110906\">Welcome to BMJ Evidence-Based Medicine Editorial<\/a>.<\/p>\n<hr \/>\n<p><b>Competing interests<\/b><\/p>\n<p>Carl has received expenses and fees for his media work including BBC Inside Health. He holds grant funding from the NIHR, the NIHR School of Primary Care Research, The NIHR Oxford BRC\u00a0 and the WHO. He has also received income from the publication of a series of toolkit books. CEBM jointly runs the\u00a0<a title=\"\" href=\"http:\/\/evidencelive.org\/\">EvidenceLive<\/a>\u00a0Conference with the BMJ and the\u00a0<a title=\"\" href=\"http:\/\/www.preventingoverdiagnosis.net\/\">Overdiagnosis Conference<\/a>\u00a0with some international partners which are based on a\u00a0 non-profit model.<strong>\u00a0<\/strong><\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; A New Zealand study\u00a0sets new standards for predicting\u00a0cardiovascular\u00a0risk and questions the validity of pre-existing\u00a0risk equations\u00a0 Carl Heneghan Prevention of cardiovascular disease relies on identifying those most at risk. Most cohorts of patients were established many years ago with patients at higher risk. A recent prospective cohort study done in New Zealand representing primary care [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/06\/08\/overestimation-of-cardiovascular-risk-and-what-to-do-about-it\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":1711,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14374,14388],"tags":[],"class_list":["post-1731","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-carl-heneghan","category-evidence-watch"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Overestimation of cardiovascular risk and what to do about it - BMJ EBM Spotlight<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/06\/08\/overestimation-of-cardiovascular-risk-and-what-to-do-about-it\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Overestimation of cardiovascular risk and what to do about it - BMJ EBM Spotlight\" \/>\n<meta property=\"og:description\" content=\"&nbsp; A New Zealand study\u00a0sets new standards for predicting\u00a0cardiovascular\u00a0risk and questions the validity of pre-existing\u00a0risk equations\u00a0 Carl Heneghan Prevention of cardiovascular disease relies on identifying those most at risk. Most cohorts of patients were established many years ago with patients at higher risk. 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Most cohorts of patients were established many years ago with patients at higher risk. 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