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Cardiovascular risk prediction models for people with severe mental illness: results from the prediction and management of cardiovascular risk in people with severe mental illnesses (PRIMROSE) research program

Cardiovascular risk prediction models for people with severe mental illness: results from the prediction and management of cardiovascular risk in people with severe mental illnesses (PRIMROSE) research program
Cardiovascular risk prediction models for people with severe mental illness: results from the prediction and management of cardiovascular risk in people with severe mental illnesses (PRIMROSE) research program
Importance: people with severe mental illness (SMI), including schizophrenia and bipolar disorder, have excess rates of cardiovascular disease (CVD). Risk prediction models validated for the general population may not accurately estimate cardiovascular risk in this group.

Objective: to develop and validate a risk model exclusive to predicting CVD events in people with SMI incorporating established cardiovascular risk factors and additional variables.

Design, Setting, and Participants: we used anonymous/deidentified data collected between January 1, 1995, and December 31, 2010, from the Health Improvement Network (THIN) to conduct a primary care, prospective cohort and risk score development study in the United Kingdom. Participants included 38?824 people with a diagnosis of SMI (schizophrenia, bipolar disorder, or other nonorganic psychosis) aged 30 to 90 years. During a median follow-up of 5.6 years, 2324 CVD events (6.0%) occurred.

Main Outcomes and Measures: ten-year risk of the first cardiovascular event (myocardial infarction, angina pectoris, cerebrovascular accidents, or major coronary surgery). Predictors included age, sex, height, weight, systolic blood pressure, diabetes mellitus, smoking, body mass index (BMI), lipid profile, social deprivation, SMI diagnosis, prescriptions for antidepressants and antipsychotics, and reports of heavy alcohol use.

Results: we developed 2 CVD risk prediction models for people with SMI: the PRIMROSE BMI model and the PRIMROSE lipid model. These models mutually excluded lipids and BMI. In terms of discrimination, from cross-validations for men, the PRIMROSE lipid model D statistic was 1.92 (95% CI, 1.80-2.03) and C statistic was 0.80 (95% CI, 0.76-0.83) compared with 1.74 (95% CI, 1.63-1.86) and 0.78 (95% CI, 0.75-0.82) for published Cox Framingham risk scores. The corresponding results in women were 1.87 (95% CI, 1.76-1.98) and 0.79 (95% CI, 0.76-0.82) for the PRIMROSE lipid model and 1.58 (95% CI, 1.48-1.68) and 0.77 (95% CI, 0.73-0.81) for the Cox Framingham model. Discrimination statistics for the PRIMROSE BMI model were comparable to those for the PRIMROSE lipid model. Calibration plots suggested that both PRIMROSE models were superior to the Cox Framingham models.

Conclusions and relevance: the PRIMROSE BMI and lipid CVD risk prediction models performed better in SMI compared with models that include only established CVD risk factors. Further work on the clinical effectiveness and cost-effectiveness of the PRIMROSE models is needed to ascertain the best thresholds for offering CVD interventions
2168-6238
143-151
Osborn, D.P.
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Hardoon, S.
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Omar, R.Z.
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Holt, R.I.G.
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King, M.
aba8e88c-72f5-402a-9c29-0212b60351b4
Larsen, J.
ecdde8c4-d879-4db5-9332-32eea91e7433
Marston, L.
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Morris, R.W.
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Nazareth, I.
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Walters, K.
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Petersen, I.
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Osborn, D.P.
cf77e532-e40d-4848-908f-4641c1f60221
Hardoon, S.
8c086257-7c16-4925-8cb6-2a334c3cac23
Omar, R.Z.
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Holt, R.I.G.
d54202e1-fcf6-4a17-a320-9f32d7024393
King, M.
aba8e88c-72f5-402a-9c29-0212b60351b4
Larsen, J.
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Marston, L.
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Morris, R.W.
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Nazareth, I.
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Walters, K.
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Petersen, I.
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Osborn, D.P., Hardoon, S., Omar, R.Z., Holt, R.I.G., King, M., Larsen, J., Marston, L., Morris, R.W., Nazareth, I., Walters, K. and Petersen, I. (2015) Cardiovascular risk prediction models for people with severe mental illness: results from the prediction and management of cardiovascular risk in people with severe mental illnesses (PRIMROSE) research program. JAMA Psychiatry, 72 (2), 143-151. (doi:10.1001/jamapsychiatry.2014.2133). (PMID:25536289)

Record type: Article

Abstract

Importance: people with severe mental illness (SMI), including schizophrenia and bipolar disorder, have excess rates of cardiovascular disease (CVD). Risk prediction models validated for the general population may not accurately estimate cardiovascular risk in this group.

Objective: to develop and validate a risk model exclusive to predicting CVD events in people with SMI incorporating established cardiovascular risk factors and additional variables.

Design, Setting, and Participants: we used anonymous/deidentified data collected between January 1, 1995, and December 31, 2010, from the Health Improvement Network (THIN) to conduct a primary care, prospective cohort and risk score development study in the United Kingdom. Participants included 38?824 people with a diagnosis of SMI (schizophrenia, bipolar disorder, or other nonorganic psychosis) aged 30 to 90 years. During a median follow-up of 5.6 years, 2324 CVD events (6.0%) occurred.

Main Outcomes and Measures: ten-year risk of the first cardiovascular event (myocardial infarction, angina pectoris, cerebrovascular accidents, or major coronary surgery). Predictors included age, sex, height, weight, systolic blood pressure, diabetes mellitus, smoking, body mass index (BMI), lipid profile, social deprivation, SMI diagnosis, prescriptions for antidepressants and antipsychotics, and reports of heavy alcohol use.

Results: we developed 2 CVD risk prediction models for people with SMI: the PRIMROSE BMI model and the PRIMROSE lipid model. These models mutually excluded lipids and BMI. In terms of discrimination, from cross-validations for men, the PRIMROSE lipid model D statistic was 1.92 (95% CI, 1.80-2.03) and C statistic was 0.80 (95% CI, 0.76-0.83) compared with 1.74 (95% CI, 1.63-1.86) and 0.78 (95% CI, 0.75-0.82) for published Cox Framingham risk scores. The corresponding results in women were 1.87 (95% CI, 1.76-1.98) and 0.79 (95% CI, 0.76-0.82) for the PRIMROSE lipid model and 1.58 (95% CI, 1.48-1.68) and 0.77 (95% CI, 0.73-0.81) for the Cox Framingham model. Discrimination statistics for the PRIMROSE BMI model were comparable to those for the PRIMROSE lipid model. Calibration plots suggested that both PRIMROSE models were superior to the Cox Framingham models.

Conclusions and relevance: the PRIMROSE BMI and lipid CVD risk prediction models performed better in SMI compared with models that include only established CVD risk factors. Further work on the clinical effectiveness and cost-effectiveness of the PRIMROSE models is needed to ascertain the best thresholds for offering CVD interventions

Full text not available from this repository.

More information

Accepted/In Press date: 29 July 2014
e-pub ahead of print date: 23 December 2014
Published date: February 2015
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 380212
URI: http://eprints.soton.ac.uk/id/eprint/380212
ISSN: 2168-6238
PURE UUID: ac2a6b10-955a-474c-aa52-2160eed8d3e8
ORCID for R.I.G. Holt: ORCID iD orcid.org/0000-0001-8911-6744

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Date deposited: 07 Sep 2015 10:35
Last modified: 23 Feb 2021 02:36

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Contributors

Author: D.P. Osborn
Author: S. Hardoon
Author: R.Z. Omar
Author: R.I.G. Holt ORCID iD
Author: M. King
Author: J. Larsen
Author: L. Marston
Author: R.W. Morris
Author: I. Nazareth
Author: K. Walters
Author: I. Petersen

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