1. Including measures of chronic kidney disease to improve cardiovascular risk prediction by SCORE2 and SCORE2-OP.
- Author
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Matsushita, Kunihiro, Kaptoge, Stephen, Hageman, Steven, Sang, Yingying, Ballew, Shoshana, Grams, Morgan, Surapaneni, Aditya, Sun, Luanluan, Arnlov, Johan, Bozic, Milica, Brenner, Hermann, Brunskill, Nigel, Chang, Alex, Chinnadurai, Rajkumar, Cirillo, Massimo, Correa, Adolfo, Ebert, Natalie, Eckardt, Kai-Uwe, Gansevoort, Ron, Gutierrez, Orlando, Hadaegh, Farzad, He, Jiang, Hwang, Shih-Jen, Jafar, Tazeen, Jassal, Simerjot, Kayama, Takamasa, Kovesdy, Csaba, Landman, Gijs, Levey, Andrew, Lloyd-Jones, Donald, Major, Rupert, Miura, Katsuyuki, Muntner, Paul, Nadkarni, Girish, Nowak, Christoph, Ohkubo, Takayoshi, Pena, Michelle, Polkinghorne, Kevan, Sairenchi, Toshimi, Schaeffner, Elke, Schneider, Markus, Shalev, Varda, Shlipak, Michael, Solbu, Marit, Stempniewicz, Nikita, Tollitt, James, Valdivielso, José, van der Leeuw, Joep, Wang, Angela, Wen, Chi-Pang, Woodward, Mark, Yamagishi, Kazumasa, Yatsuya, Hiroshi, Zhang, Luxia, Dorresteijn, Jannick, Di Angelantonio, Emanuele, Visseren, Frank, Pennells, Lisa, and Coresh, Josef
- Subjects
Cardiovascular disease ,Chronic kidney disease ,Meta-analysis ,Risk prediction ,Humans ,Aged ,Aged ,80 and over ,Cardiovascular Diseases ,Risk Factors ,Creatinine ,Renal Insufficiency ,Chronic ,Albuminuria ,Glomerular Filtration Rate ,Heart Disease Risk Factors - Abstract
AIMS: The 2021 European Society of Cardiology (ESC) guideline on cardiovascular disease (CVD) prevention categorizes moderate and severe chronic kidney disease (CKD) as high and very-high CVD risk status regardless of other factors like age and does not include estimated glomerular filtration rate (eGFR) and albuminuria in its algorithms, systemic coronary risk estimation 2 (SCORE2) and systemic coronary risk estimation 2 in older persons (SCORE2-OP), to predict CVD risk. We developed and validated an Add-on to incorporate CKD measures into these algorithms, using a validated approach. METHODS: In 3,054 840 participants from 34 datasets, we developed three Add-ons [eGFR only, eGFR + urinary albumin-to-creatinine ratio (ACR) (the primary Add-on), and eGFR + dipstick proteinuria] for SCORE2 and SCORE2-OP. We validated C-statistics and net reclassification improvement (NRI), accounting for competing risk of non-CVD death, in 5,997 719 participants from 34 different datasets. RESULTS: In the target population of SCORE2 and SCORE2-OP without diabetes, the CKD Add-on (eGFR only) and CKD Add-on (eGFR + ACR) improved C-statistic by 0.006 (95%CI 0.004-0.008) and 0.016 (0.010-0.023), respectively, for SCORE2 and 0.012 (0.009-0.015) and 0.024 (0.014-0.035), respectively, for SCORE2-OP. Similar results were seen when we included individuals with diabetes and tested the CKD Add-on (eGFR + dipstick). In 57 485 European participants with CKD, SCORE2 or SCORE2-OP with a CKD Add-on showed a significant NRI [e.g. 0.100 (0.062-0.138) for SCORE2] compared to the qualitative approach in the ESC guideline. CONCLUSION: Our Add-ons with CKD measures improved CVD risk prediction beyond SCORE2 and SCORE2-OP. This approach will help clinicians and patients with CKD refine risk prediction and further personalize preventive therapies for CVD.
- Published
- 2023