The Pooled Cohort Equation (PCE) predicts 10-year risk of first-time atherosclerotic
cardiovascular disease (ASCVD) events and was incorporated in analyses of a primary
and secondary prevention population in the Systolic Blood Pressure Intervention Trial
(SPRINT). Whether PCE enhances risk prediction among secondary prevention populations
is unknown. We sought to compare ASCVD events by level of PCE-predicted risk among
primary and secondary prevention SPRINT populations. SPRINT randomized adults with
hypertension and ≥1 CVD risk factor or previous CVD events to systolic blood pressure
control targeting <120 mm Hg or 135 to 139 mm Hg. We calculated the hazard ratio (HR)
of ASCVD events among secondary versus primary (reference) prevention subgroups overall
and by predicted 10-year ASCVD risk categories (<10%, 10% to <20%, 20% to <30%, and
≥30%) and within risk subgroups, comparing to the lowest risk category. Among 8,151
participants, 16% with previous CVD, mean age was 66 years and 35% were women. The
HR for ASCVD events overall was 2.51 (1.96, 3.20). HR was 2.97 (1.47, 5.99) among
<10% 10-year risk and 2.23 (1.38, 3.59) among ≥30% risk. Within subgroups comparing
≥30% to <10% risk (reference) categories, the HR was 2.85 (1.76, 4.63) for primary
and 2.14 (1.07, 4.30) for the secondary prevention. In conclusion, history of previous
events was a potent risk factor for subsequent ASCVD events. The PCE does not enhance
risk prediction among secondary prevention populations and may differentially underestimate
risk in secondary prevention populations with lowest predicted risk.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 63: 2935-2959
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Hypertension. 2017; (HYP.0000000000000066)
- 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 63: 2889-2934
- 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol. 2019; 73: 3168-3209
- Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension.J Am Coll Cardiol. 2018; 71: 1601-1610
- Comparison of frequency of atherosclerotic cardiovascular and safety events with systolic blood pressure <120 mm hg versus 135-139 mm hg in a Systolic Blood Pressure Intervention Trial primary prevention subgroup.Am J Cardiol. 2018; 122: 1185-1190
- Systolic Blood Pressure Intervention Trial (SPRINT): Protocol Version 4.0.2012 (Available at:) (Accessed June 14, 2018)
- A randomized trial of intensive versus standard blood-pressure control.N Engl J Med. 2015; 373: 2103-2116
- Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis.Springer, Switzerland2015
- Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score.JAMA. 2007; 297: 611-619
- C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men.Circulation. 2008; 118 (4p following 2251): 2243-2251
- Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study.BMJ. 2017; 357: j2099
- Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC).Heart Br Card Soc. 2007; 93: 172-176
- Validation of the atherosclerotic cardiovascular disease Pooled Cohort risk equations.JAMA. 2014; 311: 1406-1415
- A general cardiovascular risk profile: the Framingham Study.Am J Cardiol. 1976; 38: 46-51
- An updated coronary risk profile. A statement for health professionals.Circulation. 1991; 83: 356-362
- Utility of the Framingham Risk score in predicting secondary events in patients following percutaneous coronary intervention: a time-trend analysis.Am Heart J. 2016; 172: 115-128
- Development and validation of a prediction rule for recurrent vascular events based on a cohort study of patients with arterial disease: the SMART risk score.Heart Br Card Soc. 2013; 99: 866-872
- Distribution of estimated 10-year risk of recurrent vascular events and residual risk in a secondary prevention population.Circulation. 2016; 134: 1419-1429
Article info
Publication history
Published online: September 06, 2019
Received in revised form:
August 23,
2019
Received:
July 31,
2019
Footnotes
Registration Number
ClinicalTrials.gov: NCT01206062.
Suggested Tweet: Prior CVD is a major risk for subsequent events in SPRINT, even when accounting for baseline Pooled Cohort Equation-predicted risk.
Funding: This work was sponsored by the Department of Medicine at the Larner College of Medicine. SPJ is sponsored by an NHLBI career development award (K23HL135273), Boston, MA.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
