The following is a summary of “Universal Risk Prediction for Individuals With and Without Atherosclerotic Cardiovascular Disease,” published in the February 2024 issue of Cardiology by Mok et al.

The American College of Cardiology/American Heart Association guidelines propose separate risk classification systems for the prevention of primary and secondary cardiovascular disease. Yet, both share common predictors, suggesting the potential for a universal approach to predict major adverse cardiovascular events (MACEs).

Researchers conducted a retrospective study to assess predictor performance in individuals with and without atherosclerotic cardiovascular disease (ASCVD) and to develop and validate a universal risk prediction model.

They analyzed 9,138 participants from the Atherosclerosis Risk In Communities (ARIC) study, comprising (n = 609) and without (n = 8,529) ASCVD at baseline (1996-1998), assessing traditional predictors alongside additional factors like body mass index and cardiac biomarkers (troponin and natriuretic peptide) using Cox models for MACEs, including myocardial infarction, stroke, and heart failure. Model performance was also evaluated.

The results showed that over a follow-up period of roughly 20 years, there were 3,209 MACEs (2,797 for no prior ASCVD). Most predictors exhibited similar associations with MACE regardless of baseline ASCVD status. A universal risk prediction model incorporating predictors selected by least absolute shrinkage, selection operator regression, and bootstrapping demonstrated good discrimination for both groups (c-statistics of 0.747 and 0.691). The risk classification also exhibited excellent calibration, regardless of ASCVD status. This universal prediction approach identified individuals without ASCVD with a risk higher than some individuals with ASCVD. External validation of 5,322 participants in the MESA (Multi-Ethnic Study of Atherosclerosis) confirmed these findings.

Investigators concluded that a universal risk prediction model accurately identifies future ASCVD risk regardless of prior disease, potentially aiding preventive care transitions.

Source: jacc.org/doi/abs/10.1016/j.jacc.2023.11.028