Development and validation of a cardiovascular disease risk-prediction model using population health surveys: the Cardiovascular Disease Population Risk Tool (CVDPoRT)

Abstract

Background: Routinely collected data from large population health surveys linked to chronic disease outcomes create an opportunity to develop more complex risk-prediction algorithms. We developed a predictive algorithm to estimate 5-year risk of incident cardiovascular disease in the community setting.

Methods: We derived the Cardiovascular Disease Population Risk Tool (CVDPoRT) using prospectively collected data from Ontario respondents of the Canadian Community Health Surveys, representing 98% of the Ontario population (survey years 2001 to 2007; follow-up from 2001 to 2012) linked to hospital admission and vital statistics databases. Predictors included body mass index, hypertension, diabetes, and multiple behavioural, demographic and general health risk factors. The primary outcome was the first major cardiovascular event resulting in hospital admission or death. Death from a noncardiovascular cause was considered a competing risk.

Results: We included 104 219 respondents aged 20 to 105 years. There were 3709 cardiovascular events and 818 478 person-years follow-up in the combined derivation and validation cohorts (5-year cumulative incidence function, men: 0.026, 95% confidence interval [CI] 0.025-0.028; women: 0.018, 95% 0.017-0.019). The final CVDPoRT algorithm contained 12 variables, was discriminating (men: C statistic 0.82, 95% CI 0.81-0.83; women: 0.86, 95% CI 0.85-0.87) and was well-calibrated in the overall population (5-year observed cumulative incidence function v. predicted risk, men: 0.28%; women: 0.38%) and in nearly all predefined policy-relevant subgroups (206 of 208 groups).

Interpretation: The CVDPoRT algorithm can accurately discriminate cardiovascular disease risk for a wide range of health profiles without the aid of clinical measures. Such algorithms hold potential to support precision medicine for individual or population uses. Study registration: ClinicalTrials.gov, no. NCT02267447.

Conflict of interest statement

Competing interests: None declared.

© 2018 Joule Inc. or its licensors.

Figures

Figure 1:

Study flow diagram showing Canadian Community Health Survey (CCHS) cohorts linked for the Cardiovascular Disease Population Risk Tool. CVD = cardiovascular disease, MI = myocardial infarction, OHIP = Ontario Health Insurance Plan.

Figure 2:

Relative risk by median risk exposure for 40-year-old women. A) The sliders reflect age (range 20–80 yr), exposure level for each risk (range 10th–90th percentile, reflecting percentile exposure level in the total population) and sex-specific algorithm (male, female). B) Point estimate (red dot) and 95% confidence interval (blue line) of 5-year relative risk of cardiovascular event by exposure variable. Reference group for continuous variables = lower number from the exposure slider (10th percentile in this example), with the exception of smoking, where reference group = nonsmoker. Reference group for categorical variables = pink dot. C) Visualization for impact of age interaction and exposure level on relative risk for selected exposure: y-axis = relative risk, x-axis = age or percentile exposure. In this example, selected exposure = current smoker, age = 40, percentile exposure for pack-years = 50th. Blue line represents range of relative risk by age or percentile of exposure. See www.projectbiglife.ca for an interactive version of this figure. BMI = body mass index, MET = metabolic equivalent of task.

Figure 3:

Relative risk by median risk exposure for 40-year-old men. A) The sliders reflect age (range 20–80 yr), exposure level for each risk (range 10th–90th percentile, reflecting percentile exposure level in the total population) and sex-specific algorithm (male, female). B) Point estimate (red dot) and 95% confidence interval (blue line) of 5-year relative risk of cardiovascular event by exposure variable. Reference group for continuous variables = lower number from exposure slider (10th percentile in this example), with the exception of smoking, where reference group = nonsmoker. Reference group for categorical variables = pink dot. C) Visualization for impact of age interaction and exposure level on relative risk for selected exposure: y-axis = relative risk, x-axis = age or percentile exposure. In this example, selected exposure = current smoker, age = 40, percentile exposure for pack-years = 50th. Blue line represents range of relative risk by age or percentile of exposure. See www.projectbiglife.ca for an interactive version of this figure. BMI = body mass index.