Revealing the limitations of 10-year MACE observations: 20-year observed total cardiovascular burden in the EPIC-Norfolk study
Background Primary prevention strategies for cardiovascular disease (CVD) conventionally rely on 10-year risk estimates of major adverse cardiovascular events (MACE). However, communicating longer-term total CVD risk may better facilitate informed preventive decisions. Therefore, we aimed to quantif...
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BMJ Publishing Group
2025-02-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e002981.full |
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| author | Frank LJ Visseren Harald T Jorstad Marjolein Snaterse S Matthijs Boekholdt Tinka J van Trier Jannick AN Dorresteijn Manon van den Bogaart Wilma JM Scholte op Reimer Ron JG Peters |
| author_facet | Frank LJ Visseren Harald T Jorstad Marjolein Snaterse S Matthijs Boekholdt Tinka J van Trier Jannick AN Dorresteijn Manon van den Bogaart Wilma JM Scholte op Reimer Ron JG Peters |
| author_sort | Frank LJ Visseren |
| collection | DOAJ |
| description | Background Primary prevention strategies for cardiovascular disease (CVD) conventionally rely on 10-year risk estimates of major adverse cardiovascular events (MACE). However, communicating longer-term total CVD risk may better facilitate informed preventive decisions. Therefore, we aimed to quantify how well 10-year observed incidence reflects 20-year observed incidence and how MACE reflects total CVD events across demographic groups, using observations in long-term prospective data.Methods In individuals aged 40–79 without CVD or diabetes from the population-based EPIC-Norfolk cohort, we compared the first occurrence of 10 and 20 years (1) 3-point MACE events (non-fatal myocardial infarction+non-fatal stroke+fatal CVD) and (2) total CVD events (all non-fatal and fatal CVD events leading to hospitalisation), stratified by sex and age.Results Among 22 569 participants (57% women), incident 10-year and 20-year 3-point MACE was 5.3% and 15.5%, respectively, yielding 20/10 year ratios from 2.2 (in older men) to 4.5 (in younger women). Total CVD increased from 10.5% at 10 years to 26.9% at 20 years, with ratios ranging from 1.9 (older men) to 3.9 (younger women). Ratios between 10-year MACE and 20-year total CVD varied substantially, ranging from 3-fold in (older men) to 10-fold (younger women).Conclusions The observed incidence of CVD roughly triples from 10 to 20 years of follow-up, with 10-year MACE observations underestimating 20-year total CVD burden by a factor ranging from 3 (older men) to 10 (younger women). These findings highlight the limitations of communicating 10-year MACE risk assessments to facilitate informed decisions in longer-term CVD prevention—particularly in younger women. |
| format | Article |
| id | doaj-art-90445666a0db44fa9bedbe37e9290d1f |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-90445666a0db44fa9bedbe37e9290d1f2025-02-05T04:45:10ZengBMJ Publishing GroupOpen Heart2053-36242025-02-0112110.1136/openhrt-2024-002981Revealing the limitations of 10-year MACE observations: 20-year observed total cardiovascular burden in the EPIC-Norfolk studyFrank LJ Visseren0Harald T Jorstad1Marjolein Snaterse2S Matthijs Boekholdt3Tinka J van Trier4Jannick AN Dorresteijn5Manon van den Bogaart6Wilma JM Scholte op Reimer7Ron JG Peters82 Department of Vascular Medicine, Utrecht University, Utrecht, The Netherlands1 Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands1 Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands1 Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands1 Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands2 Department of Vascular Medicine, Utrecht University, Utrecht, The Netherlands1 Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands1 Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands1 Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The NetherlandsBackground Primary prevention strategies for cardiovascular disease (CVD) conventionally rely on 10-year risk estimates of major adverse cardiovascular events (MACE). However, communicating longer-term total CVD risk may better facilitate informed preventive decisions. Therefore, we aimed to quantify how well 10-year observed incidence reflects 20-year observed incidence and how MACE reflects total CVD events across demographic groups, using observations in long-term prospective data.Methods In individuals aged 40–79 without CVD or diabetes from the population-based EPIC-Norfolk cohort, we compared the first occurrence of 10 and 20 years (1) 3-point MACE events (non-fatal myocardial infarction+non-fatal stroke+fatal CVD) and (2) total CVD events (all non-fatal and fatal CVD events leading to hospitalisation), stratified by sex and age.Results Among 22 569 participants (57% women), incident 10-year and 20-year 3-point MACE was 5.3% and 15.5%, respectively, yielding 20/10 year ratios from 2.2 (in older men) to 4.5 (in younger women). Total CVD increased from 10.5% at 10 years to 26.9% at 20 years, with ratios ranging from 1.9 (older men) to 3.9 (younger women). Ratios between 10-year MACE and 20-year total CVD varied substantially, ranging from 3-fold in (older men) to 10-fold (younger women).Conclusions The observed incidence of CVD roughly triples from 10 to 20 years of follow-up, with 10-year MACE observations underestimating 20-year total CVD burden by a factor ranging from 3 (older men) to 10 (younger women). These findings highlight the limitations of communicating 10-year MACE risk assessments to facilitate informed decisions in longer-term CVD prevention—particularly in younger women.https://openheart.bmj.com/content/12/1/e002981.full |
| spellingShingle | Frank LJ Visseren Harald T Jorstad Marjolein Snaterse S Matthijs Boekholdt Tinka J van Trier Jannick AN Dorresteijn Manon van den Bogaart Wilma JM Scholte op Reimer Ron JG Peters Revealing the limitations of 10-year MACE observations: 20-year observed total cardiovascular burden in the EPIC-Norfolk study Open Heart |
| title | Revealing the limitations of 10-year MACE observations: 20-year observed total cardiovascular burden in the EPIC-Norfolk study |
| title_full | Revealing the limitations of 10-year MACE observations: 20-year observed total cardiovascular burden in the EPIC-Norfolk study |
| title_fullStr | Revealing the limitations of 10-year MACE observations: 20-year observed total cardiovascular burden in the EPIC-Norfolk study |
| title_full_unstemmed | Revealing the limitations of 10-year MACE observations: 20-year observed total cardiovascular burden in the EPIC-Norfolk study |
| title_short | Revealing the limitations of 10-year MACE observations: 20-year observed total cardiovascular burden in the EPIC-Norfolk study |
| title_sort | revealing the limitations of 10 year mace observations 20 year observed total cardiovascular burden in the epic norfolk study |
| url | https://openheart.bmj.com/content/12/1/e002981.full |
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