Abstract
BackgroundOnly few countries have cohorts enabling specific and up-to-date cardiovascular disease (CVD) risk estimation. Individual risk assessment based on study samples that differ too much from the target population could jeopardize the benefit of risk charts in general practice. Our aim was to provide up-to-date and valid CVD risk estimation for a Swiss population using a novel record linkage approach.MethodsAnonymous record linkage was used to follow-up (for mortality, until 2008) 9,853 men and women aged 25–74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CVD) study of 1983–92. The linkage success was 97.8%, loss to follow-up 1990–2000 was 4.7%. Based on the ESC SCORE methodology (Weibull regression), we used age, sex, blood pressure, smoking, and cholesterol to generate three models. We compared the 1) original SCORE model with a 2) recalibrated and a 3) new model using the Brier score (BS) and cross-validation.ResultsBased on the cross-validated BS, the new model (BS = 14107×10−6) was somewhat more appropriate for risk estimation than the original (BS = 14190×10−6) and the recalibrated (BS = 14172×10−6) model. Particularly at younger age, derived absolute risks were consistently lower than those from the original and the recalibrated model which was mainly due to a smaller impact of total cholesterol.ConclusionUsing record linkage of observational and routine data is an efficient procedure to obtain valid and up-to-date CVD risk estimates for a specific population.
Highlights
The SCORE (Systematic COronary Risk Evaluation) project from the European Society of Cardiology (ESC) pooled a dozen of prospective cohorts from European countries. [1] The aim was to provide a method to estimate absolute risk for fatal cardiovascular disease (CVD) based on major CVD risk factors. [1] The result is a clinically useful and evidence-based tool for risk prediction widely used in clinical practice. [2] for several reasons, CVD risk estimation may be misleading
There has been a dramatic decrease in CVD mortality in most countries with a concomitant increase in life expectancy. [3,7] These demographic changes should be reflected in the risk scores, e.g. by shifting the prediction age classes towards older ages
The proportion of coronary heart disease (CHD) based on all CVD was lower in the MONICA sample, in women
Summary
The SCORE (Systematic COronary Risk Evaluation) project from the European Society of Cardiology (ESC) pooled a dozen of prospective cohorts from European countries. [1] The aim was to provide a method to estimate absolute risk for fatal cardiovascular disease (CVD) based on major CVD risk factors. [1] The result is a clinically useful and evidence-based tool for risk prediction widely used in clinical practice. [2] for several reasons, CVD risk estimation may be misleading. [1] The aim was to provide a method to estimate absolute risk for fatal cardiovascular disease (CVD) based on major CVD risk factors. [1] The result is a clinically useful and evidence-based tool for risk prediction widely used in clinical practice. There is substantial variation in the prevalence of CVD risk factors, mortality and trends of CVD across populations and with respect to the relationship between CVD risk factors and risk of death.[1,3,4,5] Such differences are not fully taken into account by pooled data originating from different countries, even if separate models for high and low risk countries are provided for SCORE. Few countries have cohorts enabling specific and up-to-date cardiovascular disease (CVD) risk estimation. Our aim was to provide up-to-date and valid CVD risk estimation for a Swiss population using a novel record linkage approach
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