A competing risk approach for the European Heart SCORE model based on cause-specific and all-cause mortality

作者：Stovring Henrik^*; Harmsen Charlotte G; Wisloff Torbjorn; Jarbol Dorte E; Nexoe Jorgen; Nielsen Jesper B; Kristiansen Ivar S

来源：European Journal of Preventive Cardiology, 2013, 20(5): 827-836.

DOI：10.1177/2047487312445425

• Absolute risk reduction
• cardiovascular mortality
• competing risk model
• prolongation of life
• risk prediction

Background: %26lt;br%26gt;The European Heart SCORE model constitutes the basis for national guidelines for primary prevention and treatment of cardiovascular disease (CVD) in several European countries. The model estimates individuals%26apos; 10-year CVD mortality risks from age, sex, smoking status, systolic blood pressure, and total cholesterol level. The SCORE model, however, is not mathematically consistent and does not estimate all-cause mortality. Our aim is to modify the SCORE model to allow consistent estimation of both CVD-specific and all-cause mortality. %26lt;br%26gt;Methods: %26lt;br%26gt;Using a competing risk approach, we first re-estimated the cause-specific risk of dying from cardiovascular disease, and secondly we incorporated non-CVD mortality. Finally, non-CVD mortality was allowed to also depend on smoking status, and not only age and sex. From the models, we estimated CVD-specific and all-cause 10-year mortality risk, and the expected residual lifetime together with corresponding expected effects of statin treatment. %26lt;br%26gt;Results: %26lt;br%26gt;The modified model provided CVD-specific 10-year mortality risks similar to those of the European Heart SCORE model. Incorporation of non-CVD mortality increased 10-year mortality risks, in particular for older individuals. When non-CVD mortality was assumed unaffected by smoking status, the absolute risk reduction due to statin treatment ranged from 0.0% to 3.5%, whereas the gain in expected residual lifetime ranged from 3 to 11 months. Statin effectiveness increased for non-smokers and declined for smokers, when smoking was allowed to influence non-CVD mortality. %26lt;br%26gt;Conclusion: %26lt;br%26gt;The modified model provides mathematically consistent estimates of mortality risk and expected residual lifetime together with expected benefits from statin treatment.

• 出版日期2013-10