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

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)

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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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Ho, Dr Frederick and Woodward, Professor Mark and Katikireddi, Professor Vittal and Mackay, Professor Daniel and Brown, Miss Rosemary and Welsh, Professor Paul and Celis, Dr Carlos and Gray, Professor Stuart and Pell, Professor Jill and Sattar, Professor Naveed and Gill, Professor Jason and Jhund, Professor Pardeep and Welsh, Dr Claire and Lewsey, Professor Jim
Authors: Welsh, P., Welsh, C. E., Jhund, P. S., Woodward, M., Brown, R., Lewsey, J., Celis-Morales, C. A., Ho, F. K., MacKay, D. F., Gill, J. M.R., Gray, S. R., Katikireddi, S. V., Pell, J. P., Forbes, J., and Sattar, N.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:Circulation
Publisher:American Heart Association
ISSN (Online):1524-4539
Published Online:25 June 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Circulation 144(8): 604-614
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
172776Associations of blood biomarkers with cardiovascular disease and related cardiometabolic outcomes and risk prediction in the clinical setting: UK biobankNaveed SattarChest Heart and Stroke Scotland (CHSS)Res16/A165Institute of Cardiovascular & Medical Sciences
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02HW - Public Health
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU13