“What is the effect for me personally if I stop smoking, or start taking blood pressure medication?” UMC Utrecht has developed a new mathematical model that can answer these kinds of questions for healthy people. The LIFE-CVD model predicts what the individual effect of medication will be and how many healthy years this will yield.
Take, for example, a 63-year-old healthy, fit man who has reached a neat 130 mmHg thanks to blood pressure medication. He has never smoked. But he does appear to have a “bad” cholesterol of 3.5 mmol/L. Since his father suffered a heart attack around his 60th birthday, this man would like to know what he can do to prevent cardiovascular disease as much as possible. The model calculates that with a high dose of cholesterol drugs, he could extend his healthy life expectancy by about 1.5 years, to about 87 years. He is happy to discuss this with his family doctor.
This is how the model that physician-researcher Nicole Jaspers developed could work. The model is included in www.U-Prevent.nl. She obtained her doctorate on it on April 4.
“Ideally, for each person, the benefits of blood pressure-lowering or cholesterol-lowering therapy outweigh the drawbacks. But the balance between the advantages and disadvantages is determined by an interplay of several factors and is slightly different for each person,” Nicole explains. The LIFE-CVD (LIFEtime-perspective CardioVascular Disease) model was developed to predict the effects of therapies for healthy people without cardiovascular disease. “A physician enters some easily determined characteristics into the calculator on U-Prevent, and the model does the math behind the scenes. For each individual, the model calculates healthy life expectancy and the effect of smoking cessation, cholesterol and blood pressure reduction expressed in how many additional healthy years.”
This is a big advantage over what was possible before, according to Jaspers. “Previous models primarily predicted the 10-year risk, or the risk of having a heart attack or stroke in the next 10 years. As a result, people with a higher 10-year risk were more likely to be prescribed treatment. However, not everyone at high risk benefits equally from therapy. The 10-year risk is largely determined by age, which can lead to overtreatment of some people (such as the elderly) and missed treatment opportunities in others (such as the young).”
For this thesis, data from more than a hundred thousand patients was brought together by Utrecht researchers thanks in part to international collaboration with research groups in Cambridge and Johns Hopkins, and with financial support from the Heart Foundation and others. The LIFE-CVD model has been made freely available for use in the consulting room via an online calculator on the website U-Prevent and via the ‘vascular risk app’ that can be downloaded for free in App stores.
