Derivation and validation of a 10-year risk score for symptomatic abdominal aortic aneurysm: cohort study of nearly 500 000 individuals (original) (raw)

Welsh, P. et al. (2021) Derivation and validation of a 10-year risk score for symptomatic abdominal aortic aneurysm: cohort study of nearly 500 000 individuals.Circulation, 144(8), pp. 604-614. (doi: 10.1161/CIRCULATIONAHA.120.053022) (PMID:34167317) (PMCID:PMC8378547)

Abstract

Background: Abdominal aortic aneurysm (AAA) can occur in patients who are ineligible for routine ultrasound screening. A simple AAA risk score was derived and compared to current guidelines used for ultrasound screening of AAA. Methods: UK Biobank participants without previous AAA were split into a derivation cohort (n=401,820, 54.6% women, mean age 56.4 years, 95.5% white race) and validation cohort (n=83,816). Incident AAA was defined as first hospital inpatient diagnosis of AAA, death from AAA, or an AAA-related surgical procedure. A multivariable Cox model was developed in the derivation cohort into an AAA risk score that did not require blood biomarkers. To illustrate the sensitivity and specificity of the risk score for AAA, a theoretical threshold to refer patients for ultrasound at 0.25% 10-year risk was modelled. Discrimination of the risk score was compared to a model of US Preventive Services Task Force (USPSTF) AAA screening guidelines. Results: In the derivation cohort there were 1,570 (0.40%) cases of AAA over a median 11.3 years of follow-up. Components of the AAA risk score were age (stratified by smoking status), weight (stratified by smoking status), antihypertensive and cholesterol lowering medication use, height, diastolic blood pressure, baseline cardiovascular disease, and diabetes. In the validation cohort, over ten years of follow-up, the C-index for the model of the USPSTF guidelines was 0.705 (95% CI 0.678, 0.733). The C-index of the risk score as a continuous variable was 0.856 (95%CI 0.837-0.878). In the validation cohort, the USPSTF model yielded sensitivity 63.9% and specificity 71.3%. At the 0.25% 10-year risk threshold, the risk score yielded sensitivity 82.1% and specificity 70.7%, while also improving the net reclassification index (NRI) compared to the USPSTF model +0.176 (95%CI 0.120, 0.232). A combined model, whereby risk scoring was combined with the USPSTF model, also improved prediction compared to USPSTF alone (NRI +0.101, 95%CI 0.055, 0.147). Conclusions: In an asymptomatic general population, a risk score based on patient age, height, weight and medical history may improve identification of asymptomatic patients at risk for clinical events from AAA. Further development and validation of risk scores to detect asymptomatic AAA is needed.

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Funder and Project Information

Associations of blood biomarkers with cardiovascular disease and related cardiometabolic outcomes and risk prediction in the clinical setting: UK biobank

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MC_UU_12017/13

HW - MRC/CSO Social and Public Health Sciences Unit

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Measuring and Analysing Socioeconomic Inequalities in Health

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SPHSU13

HW - MRC/CSO Social and Public Health Sciences Unit

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