Estimating the incidence and key risk factors of cardiovascular disease in patients at high risk of imminent fracture using routinely collected real-world data from the UK
Estimating the incidence and key risk factors of cardiovascular disease in patients at high risk of imminent fracture using routinely collected real-world data from the UK
The objective of this work was to estimate the incidence rate of cardiovascular disease (CVD) events (myocardial infarction, stroke or CVD-death) at 1 year among 3 cohorts of patients at high risk of fracture (osteoporosis; previous fracture; and anti-osteoporosis medication), and to identify the key risk factors of CVD events in these three cohorts. To do so, this prospective cohort study used data from the Clinical Practice Research Datalink, a primary care database from United Kingdom. Major Adverse Cardiovascular Events (MACE: a composite outcome for the occurrence of either myocardial infarction (MI), stroke or CVD death) were identified in patients aged fifty or over at high or imminent fracture risk identified in three different cohorts (not mutually exclusive): recently diagnosed with osteoporosis (OST, n=65,295), incident fragility fracture (IFX, n=67,065), and starting oral bisphosphonates (OBP, n=145,959). About 1.90%, 4.39% and 2.38% of the participants in OST, IFX and OBP cohorts, respectively, experienced MACE events. IFX was the cohort with the higher risk: MACE incidence rates (cases/1000 person-years) were 19.63 (18.54;20.73) in OST, 52.64 (50.7,54.5) in IFX, and 26.26 (25.41;27.12) in OBP cohorts. Risk of MACE events at 1-year was predicted in the 3 cohorts. Models using a set of general, CVD, and fracture candidates selected by lasso regression had a good discrimination (≥70%) and internal validity, and generally outperformed the models using only the CVD risk factors of general population listed in QRISK tool. Main risk factors common in all MACE models were sex, age, smoking, alcohol, atrial fibrillation, anti-hypertensive medication, prior MI/stroke, established CVD, glomerular filtration rate, systolic blood pressure, cholesterol levels, and number of concomitant medicines. Identified key risk factors highlight the differences of patients at high risk of fracture versus general population. Proposed models could improve prediction of CVD events in patients with osteoporosis in primary care settings.
CARDIOVASCULAR RISK ASSESSMENT, INCIDENCE RATES, ORAL BISPHONATES, OSTEOPOROSIS, PROGNOSTIC MODEL
1986-1996
Moncusi, Marta Pineda
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El-Hussain, Leena
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Delmestri, Antonella
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Cooper, Cyrus
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Moayyeri, Alireza
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Libanati, Cesar
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Toth, Emese
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Prieto-Alhambra, Daniel
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Khalid, Sara
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1 October 2022
Moncusi, Marta Pineda
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El-Hussain, Leena
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Delmestri, Antonella
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Cooper, Cyrus
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Moayyeri, Alireza
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Libanati, Cesar
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Toth, Emese
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Prieto-Alhambra, Daniel
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Khalid, Sara
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Moncusi, Marta Pineda, El-Hussain, Leena, Delmestri, Antonella, Cooper, Cyrus and Prieto-Alhambra, Daniel
,
et al.
(2022)
Estimating the incidence and key risk factors of cardiovascular disease in patients at high risk of imminent fracture using routinely collected real-world data from the UK.
Journal of Bone and Mineral Research, 37 (10), .
(doi:10.1002/jbmr.4648).
Abstract
The objective of this work was to estimate the incidence rate of cardiovascular disease (CVD) events (myocardial infarction, stroke or CVD-death) at 1 year among 3 cohorts of patients at high risk of fracture (osteoporosis; previous fracture; and anti-osteoporosis medication), and to identify the key risk factors of CVD events in these three cohorts. To do so, this prospective cohort study used data from the Clinical Practice Research Datalink, a primary care database from United Kingdom. Major Adverse Cardiovascular Events (MACE: a composite outcome for the occurrence of either myocardial infarction (MI), stroke or CVD death) were identified in patients aged fifty or over at high or imminent fracture risk identified in three different cohorts (not mutually exclusive): recently diagnosed with osteoporosis (OST, n=65,295), incident fragility fracture (IFX, n=67,065), and starting oral bisphosphonates (OBP, n=145,959). About 1.90%, 4.39% and 2.38% of the participants in OST, IFX and OBP cohorts, respectively, experienced MACE events. IFX was the cohort with the higher risk: MACE incidence rates (cases/1000 person-years) were 19.63 (18.54;20.73) in OST, 52.64 (50.7,54.5) in IFX, and 26.26 (25.41;27.12) in OBP cohorts. Risk of MACE events at 1-year was predicted in the 3 cohorts. Models using a set of general, CVD, and fracture candidates selected by lasso regression had a good discrimination (≥70%) and internal validity, and generally outperformed the models using only the CVD risk factors of general population listed in QRISK tool. Main risk factors common in all MACE models were sex, age, smoking, alcohol, atrial fibrillation, anti-hypertensive medication, prior MI/stroke, established CVD, glomerular filtration rate, systolic blood pressure, cholesterol levels, and number of concomitant medicines. Identified key risk factors highlight the differences of patients at high risk of fracture versus general population. Proposed models could improve prediction of CVD events in patients with osteoporosis in primary care settings.
Text
J of Bone Mineral Res - 2022 - Pineda‐Moncus - Estimating the incidence and key risk factors of cardiovascular disease in (1)
- Accepted Manuscript
More information
Accepted/In Press date: 1 July 2022
e-pub ahead of print date: 11 July 2022
Published date: 1 October 2022
Additional Information:
Funding Information:
The authors acknowledge Mahkameh Mafi for project management; CPRD for their support; and Amgen and UCB Pharma for funding this study. A subsection of an earlier version of information reported in this article was presented as a poster abstract (ID: P1129) by LE‐H, SK, MA, ET, CL and, DP‐A at the WCO‐IOF‐ESCEO 2020 congress (available at https://doi.org/10.1007/s00198-020-05696-3 ).
Funding Information:
All authors have completed the ICMJE disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare the following interests: MP‐M, LE‐H, AD, CC, and SK have no conflicts to declare. DP‐A reports an institutional grant from NIHR, grants from Chesi‐Taylor and Novartis, grants and other support from Amgen and UCB Biopharma, and other support from Astellas, AstraZeneca, Johnson and Johnson, Janssen—on behalf of IMI‐funded EHDEN and EMIF consortiums—and Synapse Management Partners. MA, CL, and ET are current employees of UCB Biopharma and hold stock shares of the company.
Funding Information:
The study was sponsored by Amgen and UCB Pharma. The study funders play a role in the conceptualization, study design, and preparation of the manuscript.
Publisher Copyright:
© 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Keywords:
CARDIOVASCULAR RISK ASSESSMENT, INCIDENCE RATES, ORAL BISPHONATES, OSTEOPOROSIS, PROGNOSTIC MODEL
Identifiers
Local EPrints ID: 468472
URI: http://eprints.soton.ac.uk/id/eprint/468472
ISSN: 0884-0431
PURE UUID: 39a0a074-131f-45f6-9413-adb2a6b6c3bf
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Date deposited: 16 Aug 2022 16:37
Last modified: 18 Mar 2024 05:11
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Contributors
Author:
Marta Pineda Moncusi
Author:
Leena El-Hussain
Author:
Antonella Delmestri
Author:
Alireza Moayyeri
Author:
Cesar Libanati
Author:
Emese Toth
Author:
Daniel Prieto-Alhambra
Author:
Sara Khalid
Corporate Author: et al.
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