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Derivation and validation of a 10-year risk score for symptomatic abdominal aortic aneurysm

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Show simple item record Welsh, Paul Welsh, Claire E. Jhund, Pardeep S. Woodward, Mark Brown, Rosemary Lewsey, Jim Celis-Morales, Carlos A. Ho, Frederick K. Mackay, Daniel F. Gill, Jason M.R. Gray, Stuart R. Katikireddi, Srinivasa Vittal Pell, Jill P. Forbes, John F. Sattar, Naveed 2022-01-07T12:18:15Z 2022-01-07T12:18:15Z 2021
dc.description peer-reviewed en_US
dc.description.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 with current guidelines used for ultrasound screening of AAA. METHODS: United Kingdom Biobank participants without previous AAA were split into a derivation cohort (n=401820, 54.6% women, mean age 56.4 years, 95.5% White race) and validation cohort (n=83816). 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 modeled. Discrimination of the risk score was compared with a model of US Preventive Services Task Force (USPSTF) AAA screening guidelines. RESULTS: In the derivation cohort, there were 1570 (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 10 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 compared with 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 with USPSTF alone (net reclassification index +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 are needed. en_US
dc.language.iso eng en_US
dc.publisher American Heart Association en_US
dc.relation.ispartofseries Circulation;144, pp. 604–614.
dc.subject aneurysm en_US
dc.subject prediction en_US
dc.subject risk score en_US
dc.title Derivation and validation of a 10-year risk score for symptomatic abdominal aortic aneurysm en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.1161/CIRCULATIONAHA.120.053022
dc.contributor.sponsor Chest, Heart, and Stroke Association Scotland en_US
dc.contributor.sponsor NHS Research Scotland Senior Clinical Fellowship en_US
dc.contributor.sponsor Medical Research Council en_US
dc.contributor.sponsor Scottish Government Chief Scientist Office en_US
dc.relation.projectid Res16/A165 en_US
dc.relation.projectid SCAF/15/02 en_US
dc.relation.projectid MC_ UU_00022/2 en_US
dc.relation.projectid SPHSU17 en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US

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