Treatment drop-in in a contemporary cohort used to derive cardiovascular risk prediction equations.

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dc.contributor.authorLiang J
dc.contributor.authorJackson RT
dc.contributor.authorPylypchuk R
dc.contributor.authorChoi Y
dc.contributor.authorChung, Claris Yee Seung
dc.contributor.authorCrengle S
dc.contributor.authorGao P
dc.contributor.authorGrey C
dc.contributor.authorHarwood M
dc.contributor.authorHolt A
dc.contributor.authorKerr A
dc.contributor.authorMehta S
dc.contributor.authorWells S
dc.contributor.authorPoppe K
dc.date.accessioned2024-11-04T02:44:02Z
dc.date.available2024-11-04T02:44:02Z
dc.date.issued2024
dc.description.abstractBACKGROUND: No routinely recommended cardiovascular disease (CVD) risk prediction equations have adjusted for CVD preventive medications initiated during follow-up (treatment drop-in) in their derivation cohorts. This will lead to underestimation of risk when equations are applied in clinical practice if treatment drop-in is common. We aimed to quantify the treatment drop-in in a large contemporary national cohort to determine whether equations are likely to require adjustment. METHODS: Eight de-identified individual-level national health administrative datasets in Aotearoa New Zealand were linked to establish a cohort of almost all New Zealanders without CVD and aged 30-74 years in 2006. Individuals dispensing blood-pressure-lowering and/or lipid-lowering medications between 1 July 2006 and 31 December 2006 (baseline dispensing), and in each 6-month period during 12 years' follow-up to 31 December 2018 (follow-up dispensing), were identified. Person-years of treatment drop-in were determined. RESULTS: A total of 1 399 348 (80%) out of the 1 746 695 individuals in the cohort were not dispensed CVD medications at baseline. Blood-pressure-lowering and/or lipid-lowering treatment drop-in accounted for 14% of follow-up time in the group untreated at baseline and increased significantly with increasing predicted baseline 5-year CVD risk (12%, 31%, 34% and 37% in <5%, 5-9%, 10-14% and ≥15% risk groups, respectively) and with increasing age (8% in 30-44 year-olds to 30% in 60-74 year-olds). CONCLUSIONS: CVD preventive treatment drop-in accounted for approximately one-third of follow-up time among participants typically eligible for preventive treatment (≥5% 5-year predicted risk). Equations derived from cohorts with long-term follow-up that do not adjust for treatment drop-in effect will underestimate CVD risk in higher risk individuals and lead to undertreatment. Future CVD risk prediction studies need to address this potential flaw.
dc.identifier.citationLiang J, Jackson RT, Pylypchuk R, Choi Y, Chung C, Crengle S, Gao P, Grey C, Harwood M, Holt A, Kerr A, Mehta S, Wells S, Poppe K (2024). Treatment drop-in in a contemporary cohort used to derive cardiovascular risk prediction equations.. Heart.
dc.identifier.doihttp://doi.org/10.1136/heartjnl-2024-324179
dc.identifier.issn1355-6037
dc.identifier.issn1468-201X
dc.identifier.urihttps://hdl.handle.net/10092/107312
dc.languageeng
dc.publisherBMJ
dc.rightsAll rights reserved unless otherwise stated
dc.rights.urihttp://hdl.handle.net/10092/17651
dc.subjectCardiovascular Diseases
dc.subjectCohort Studies
dc.subjectElectronic Health Records
dc.subjectRisk Assessment
dc.subjectTreatment Outcome
dc.subjectHealth Services
dc.subject.anzsrc32 - Biomedical and clinical sciences::3201 - Cardiovascular medicine and haematology::320101 - Cardiology (incl. cardiovascular diseases)
dc.subject.anzsrc42 - Health sciences::4202 - Epidemiology::420205 - Epidemiological modelling
dc.subject.anzsrc42 - Health sciences::4206 - Public health::420605 - Preventative health care
dc.subject.anzsrc32 - Biomedical and clinical sciences::3214 - Pharmacology and pharmaceutical sciences::321402 - Clinical pharmacology and therapeutics
dc.titleTreatment drop-in in a contemporary cohort used to derive cardiovascular risk prediction equations.
dc.typeJournal Article
uc.collegeUC Business School
uc.departmentDepartment of Accounting and Information Systems
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