Should noncardiovascular mortality be considered

Authors: Biniyam G Demissei Douwe Postmus Mattia A Valente Pim van der Harst Wijk H van Gilst Edwin R Van den Heuvel Hans L Hillege

Publish Date: 2014/11/07

Volume: 30, Issue: 1, Pages: 47-56

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Abstract

Competing noncardiovascular related deaths were not accounted for in the Systematic COronary Risk Evaluation SCORE model In this study we assessed the impact of noncardiovascular related deaths on the prognostic performance and yield of the SCORE model 5752 participants from the Prevention of Renal and Vascular End stage Disease cohort aged 40 years and older who were free of atherosclerotic cardiovascular disease CVD at baseline were included A causespecific hazards CSH CVDrelated mortality prediction model that accounted for nonCVDrelated deaths was developed The prognostic performance of this model was then compared with a refitted SCORE model During a median followup period of 125 years 139 CVD and 495 nonCVDrelated deaths were reported Discriminatory performance was comparable between the models Cindex = 064 The models showed good calibration although the CSH model underestimated risk in the highest decile while the refitted SCORE model showed overestimation The CSH model classified more nonevents into the low risk group compared to the refitted SCORE model n = 51 yet it was accompanied by a misclassification of six events into the low risk group The refitted SCORE model classified more individuals as high risk However the potential overtreatment that may result from utilizing the refitted SCORE model when compared with the CSH model still falls within acceptable limits Our findings do not support the incorporation of noncardiovascular mortality into the estimation of total cardiovascular risk in the SCORE modelStep 1 The same causespecific proportional hazards Weibull models for CHD and atherosclerotic nonCHDrelated mortality were used In addition a causespecific hazards model which takes the form of equation in step 1 was fit for nonCVDrelated mortality The regression coefficients β k and the parameters of the baseline hazard function for this causespecific hazards function are presented in Table 2

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