medwireNews: The chances that someone with chronic obstructive pulmonary disease (COPD) will experience a first cardiovascular event is significantly underestimated by the widely established QRISK3 risk calculator, research suggests.
Considering data on more than 13,000 individuals with COPD, the 10-year risk for having cardiovascular disease (CVD) was 22.1% when calculated using QRISK3. The 10-year CVD risk calculated using Kaplan-Meier statistics, however, was 33.5%, meaning that the observed risk was 52.0% higher than the predicted risk.
Notably, the “underestimation of risk is especially pronounced in younger COPD patients,” Mohsen Sadatsafavi (The University of British Columbia, Vancouver, Canada) and fellow researchers report in Thorax.
Indeed, the observed 10-year CVD risk was found to be 82% higher than the predicted 10-year CVD risk among individuals with COPD who were aged 65 years or younger (25.7 vs 14.1%, respectively). The difference was less marked among those who were older than 65 years, but still 38% higher (42.6 vs 30.8%).
“[O]ur assessment of QRISK3 provides novel insight into the discrepancy between the predicted and observed CVD risk in COPD, with important clinical and research implications,” say the researchers.
Sadatsafavi and team performed a retrospective cohort study using data from the UK Clinical Practice Research Datalink GOLD primary care database. Their aim was to estimate the risk for a first cardiovascular event, defined as a composite of fatal or nonfatal coronary heart disease, ischemic stroke, or transient ischemic attack, among people with COPD and compare it to the predicted risk.
They used QRISK3 to determine the predicted risk as it is “an exemplary CVD risk scoring tool,” they say. It considers up to 21 predictive factors to calculate an overall risk score, has been widely validated, and is recommended for use by the UK’s National Institute for Health and Clinical Excellence.
The study population consisted of 13,208 individuals with COPD and no prior CVD who were aged a mean of 65 years; just under half (45%) were women.
The incidence of CVD in the entire population was estimated to be 3.53 events per 100 person–years. This was significantly higher than that estimated for the general population of patients who had been used to develop the QRISK3 score (1.20 events per 100 person–years).
The standardized incidence ratio (SIR) for CVD comparing people with COPD versus the general primary care population used to develop QRISK3 was calculated as 1.62 for men and 1.71 for women. Among younger men (≤65 years), the SIR was 1.86, decreasing to 1.38 among older men; the corresponding values in women were 2.13 and 1.46.
“CVD risk assessment is often neglected in COPD patients,” say the researchers. “However, our results show that even when CVD risk is assessed, it underestimates the true risk, leading to potential missed opportunities for CVD risk modification through lifestyle interventions and therapeutics.”
The researchers call for current CVD risk assessment tools to be “validated and recalibrated” specifically for use in patients with COPD.
Moreover, they say that “COPD should be considered as a distinct predictor in future CVD risk scoring tools.”
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