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.

中文翻译：

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预测表面健康人群从降低胆固醇、降低血压、抗血栓治疗和戒烟中获得的个体化终生获益


目的 个人可以从预防性治疗中获得的益处因危险因素负担、竞争风险和治疗持续时间而异。我们开发并验证了生命周期视角的心血管疾病 (LIFE-CVD) 模型，用于评估表面健康人群的个体水平 10 年和终生治疗效果，包括降低胆固醇、降低血压、抗血栓治疗和戒烟。方法和结果 模型开发是在动脉粥样硬化多种族研究 (n = 6715) 中使用临床预测因子进行的。该模型由两个互补的 Fine 和 Gray 竞争风险调整左截断亚分布危险函数组成：一种用于硬心血管疾病 (CVD) 事件，另一种用于非 CVD 死亡率。通过将功能与预防性治疗试验的风险比相结合来估计治疗效果。外部验证在社区动脉粥样硬化风险 (n = 9250)、Heinz Nixdorf Recall (n = 4177)、欧洲癌症和营养前瞻性调查 - 荷兰 (n = 25 833) 和诺福克 (n = 23 548) 中进行）研究。 LIFE-CVD 模型的校准良好，c 统计量为 0.67-0.76。输出可以比较短期与长期治疗效果。在危险因素相同的 45 岁和 70 岁的两个人中，老年患者的 10 年绝对风险降低幅度更大（11.3% 比 1.0%），但无 CVD 生命年的增益较小（3.4 比 4.5）年）来自相同的治疗。该模型被开发为交互式在线计算器，可通过 www.U-Prevent.com 获取。 结论 该模型可以准确估计个体水平的预后和治疗效果，包括改善的 10 年风险、终生风险和无 CVD 预期寿命。该模型易于访问，可用于促进个性化医疗和医患沟通。