Cited by 120Health Promotion and Cardiovascular PreventionLipoproteins and Cardiovascular HealthCardiovascular Health and Risk Factors

Prediction of individualized lifetime benefit from cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation in apparently healthy people

Open access
Jaspers, Nicole E M, Blaha, Michael J, Matsushita, Kunihiro, van der Schouw, Yvonne T, Wareham, Nicholas J, Khaw, Kay-Tee, Geisel, Marie H, Lehmann, Nils +8 more·2020·European Heart Journal

Abstract

Aims: The benefit an individual can expect from preventive therapy varies based on risk-factor burden, competing risks, and treatment duration. We developed and validated the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model for the estimation of individual-level 10 years and lifetime treatment-effects of cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation in apparently healthy people. Methods and results: Model development was conducted in the Multi-Ethnic Study of Atherosclerosis (n = 6715) using clinical predictors. The model consists of two complementary Fine and Gray competing-risk adjusted left-truncated subdistribution hazard functions: one for hard cardiovascular disease (CVD)-events, and one for non-CVD mortality. Therapy-effects were estimated by combining the functions with hazard ratios from preventive therapy trials. External validation was performed in the Atherosclerosis Risk in Communities (n = 9250), Heinz Nixdorf Recall (n = 4177), and the European Prospective Investigation into Cancer and Nutrition-Netherlands (n = 25 833), and Norfolk (n = 23 548) studies. Calibration of the LIFE-CVD model was good and c-statistics were 0.67–0.76. The output enables the comparison of short-term vs. long-term therapy-benefit. In two people aged 45 and 70 with otherwise identical risk-factors, the older patient has a greater 10-year absolute risk reduction (11.3% vs. 1.0%) but a smaller gain in life-years free of CVD (3.4 vs. 4.5 years) from the same therapy. The model was developed into an interactive online calculator available via www.U-Prevent.com. Conclusion: The model can accurately estimate individual-level prognosis and treatment-effects in terms of improved 10-year risk, lifetime risk, and life-expectancy free of CVD. The model is easily accessible and can be used to facilitate personalized-medicine and doctor–patient communication.

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Crossref · 10.1093/eurheartj/ehz239

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  • Earlier onset of metabolic risk factors is associated with increased risk for CVD and mortality, motivating the timely identification and treatment of risk factors.

    “Earlier onset of metabolic risk factors is associated with increased risk for CVD and mortality, motivating the timely identification and treatment of risk factors.47–49”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [47]

    The Introduction links greater risk-factor burden with CVD prevention decisions, and the Discussion says earlier risk-reducing treatment can yield greater lifetime benefit. Neither section establishes that earlier onset of metabolic risk factors increases CVD risk or mortality; the paper models risk factors and treatment timing rather than comparing ages of risk-factor onset. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • Several studies found that GLP-1-based therapies would not be cost-effective compared with usual care, especially when used as first-line therapy.

    “In general, these studies found that GLP-1–based therapies would not be cost-effective compared with usual care, especially when used as first-line therapy.”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [47]

    The Discussion (page unavailable) mentions cost-effectiveness only as a consideration for early cardiovascular-prevention treatment; it reports no cost-effectiveness findings. Searches for GLP-1 therapies, usual care, and first-line diabetes treatment found no passage addressing the claim. (LLM, conf=0.77)

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  • GLP-1 RAs appear to primarily reduce the risk of atherosclerotic events, such as MI and stroke.

    “In contrast, GLP-1 RAs appear to primarily reduce the risk of atherosclerotic events, such as MI and stroke.45–48”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [47]

    The Outcomes section defines cardiovascular events to include MI and stroke, but does not assess whether GLP-1 receptor agonists reduce them. Searches for “GLP-1” and “glucagon-like peptide-1 receptor agonist” found no passage addressing that therapy; the paper’s Additional information section instead discusses other risk-reducing strategies. No page numbers were provided in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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2 of the 34 references couldn’t be matched to a known paper.

Research works printed but not linked: 8

  1. [17]17. Ganesh SK, Tragante V, Guo W, et al. Loci influencing blood pressure identified using a cardiovascular gene- centric array. Hum Mol Genet 2013;22(8):1663-78.
  2. [27]27. Cholesterol Treatment Trialists C, Baigent C, Blackwell L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376(9753):1670-81.
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  5. [30]30. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016;387(10022):957-67.
  6. [31]31. Antithrombotic Trialists C, Baigent C, Blackwell L, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373(9678):1849-60.
  7. [32]32. Mons U, Muezzinler A, Gellert C, et al. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ 2015;350:h1551.
  8. [33]33. Gellert C, Schottker B, Brenner H. Smoking and all-cause mortality in older people: systematic review and meta- analysis. Arch Intern Med 2012;172(11):837-44. p=0.04, current smoking (chi-squared 1.3, p=2.5 x10 -4 ), and type 2 diabetes (chi-squared 1.5, p=1.4x10 - 4 ).

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Authors
Jaspers, N. E. M., Blaha, M. J., Matsushita, K., van der Schouw, Y. T., Wareham, N. J., Khaw, K.-T., Geisel, M. H., Lehmann, N., Erbel, R., Jöckel, K.-H., van der Graaf, Y., Verschuren, W. M. M., Boer, J. M. A., Nambi, V., Visseren, F. L. J., & Dorresteijn, J. A. N.
Affiliations
  • University Medical Center Utrecht (NL)
  • Johns Hopkins University (US)
  • Julius Center for Health Sciences, University Medical Center Utrecht , Heidelberglaan 100, 3584 CX Utrecht, Netherlands
  • University of Cambridge (GB)
  • Essen University Hospital (DE)
  • National Institute for Public Health and the Environment (NL)
  • Michael E. DeBakey VA Medical Center (US)
Corresponding author
Visseren, Frank L J
Venue
European Heart Journal
Published
2019-05-18
Volume
41
Issue
11
Pages
1190-1199
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
OpenAlex
W2946535940
Cited by
120
References
34
Citations by year
2026: 11 · 2025: 13 · 2024: 18 · 2023: 15 · 2022: 20 · 2021: 24 · 2020: 14 · 2019: 5
FWCI
14.50
Type
journal article
Language
en
Open access
Locations
  • European Heart Journal (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Rivm Repository (Netherlands National Institute for Public Health and the Environment) (submittedVersion)
  • Rivm (National Institute for Public Health and the Environment) (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion)
  • Apollo
Funders
  • Netherlands Heart Foundation (2016T026, HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169)
  • National Heart, Lung, and Blood Institute (UL1-TR-000040, UL1-TR-001420)
  • NCATS
  • National Institutes of Health (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I)
  • ‘Europe Against Cancer’ programme of the European commission
  • Dutch ministry of health, Welfare and Sports
  • Netherlands Organization for Research and Development
  • World Cancer Research Fund
  • Medical Research Council
  • Heinz Nixdorf Foundation
  • German Ministry of Education and Science
  • BMBF
  • Deutsches Zentrum für Luft- und Raumfahrt
  • German Research Council Assessment (SI 236/8-1, SI 236/9-1)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
cardiovascular risk prediction, cholesterol lowering, blood pressure reduction, antithrombotic therapy, smoking cessation, prophylaxis, competing risks, absolute risk reduction, personalized medicine, physician-patient communication, online risk calculator
MeSH terms
Aged, Blood Pressure, Cardiovascular Diseases, Cholesterol, Fibrinolytic Agents, Humans, Middle Aged, Netherlands, Prospective Studies, Risk Factors, Smoking Cessation

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