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Prediction of individualized lifetime benefit from cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation in apparently healthy people
Open accessAbstract
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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“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]
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“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]
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“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]
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Metadata
- 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
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-05-18
- Volume
- 41
- Issue
- 11
- Pages
- 1190-1199
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC7229871
- OpenAlex
- W2946535940
- Semantic Scholar
- 368b09086d76ea5df90cd8c033f6fe36aba73100
- 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
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- 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 › Cardiology and Cardiovascular Medicine › 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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