Cholesterol and Hypertension Treatment Improve Coronary Risk Prediction but Not Time-Dependent Covariates or Competing Risks

Figures & data

Table 1 Baseline Demographic Characteristics and Cardiovascular Risk Factors of the Included Participants by Groups Depending on the Event That Occurred in the Follow-Up

	No Event N=7367	CAD Event N=386	Stroke Event N=239	Other CV Death N=79	Cancer Death N=399	p-value
Women	4132 (56.1%)	129 (33.4%)	102 (42.7%)	37 (46.8%)	149 (37.3%)	<0.001
Age, years	52.0 [44.0;61.0]	62.0 [55.0;69.0]	64.0 [56.0;70.0]	69.0 [66.0;72.0]	64.0 [56.0;70.0]	<0.001
University education	3367 (45.7%)	102 (26.4%)	48 (20.1%)	16 (20.3%)	103 (25.8%)	<0.001
Total cholesterol, mg/dL	213 [187;241]	226 [201;259]	216 [195;244]	212 [190;242]	211 [183;243]	<0.001
HDL cholesterol, mg/dL	50.8 [43.0;60.6]	45.0 [37.6;56.0]	47.7 [41.0;56.7]	49.5 [40.7;62.5]	48.5 [40.2;59.0]	<0.001
LDL cholesterol, mg/dL	140 [116;165]	155 [124;184]	144 [126;170]	139 [120;170]	139 [115;167]	<0.001
Triglycerides, mg/dL	90.0 [68.0;125]	115 [86.2;155]	100 [75.0;132]	111 [76.0;148]	97.0 [75.0;134]	<0.001
Systolic blood pressure, mmHg	124 [113;138]	139 [126;154]	140 [125;155]	144 [134;154]	136 [123;150]	<0.001
Diastolic blood pressure, mmHg	78.0 [72.0;85.0]	82.0 [74.0;89.0]	82.0 [75.0;90.0]	80.0 [72.5;87.0]	79.0 [72.0;86.0]	<0.001
Diabetes	837 (11.4%)	100 (25.9%)	57 (23.8%)	24 (30.4%)	91 (22.8%)	<0.001
Smoking	1687 (22.9%)	103 (26.7%)	51 (21.3%)	11 (13.9%)	105 (26.3%)	0.051
BMI, km/m^2	26.7 [23.9;29.7]	28.2 [25.7;31.0]	27.6 [25.2;31.2]	29.3 [25.7;32.8]	27.3 [24.8;30.4]	<0.001
Cholesterol treatment	584 (7.93%)	88 (22.8%)	35 (14.6%)	16 (20.3%)	31 (7.77%)	<0.001
Blood pressure treatment	1089 (14.8%)	127 (32.9%)	69 (28.9%)	29 (36.7%)	105 (26.3%)	<0.001
Diabetes treatment	241 (3.27%)	54 (14.0%)	32 (13.4%)	16 (20.3%)	33 (8.27%)	<0.001

Notes: Categorical variables are summarized with absolute (N) and relative frequencies (%), continuous variables with the median and interquartile range.

Abbreviations: BMI, body mass index; CAD, coronary artery disease; CV, cardiovascular; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol.

Figure 1 Cumulative incidence of coronary events, stroke, other cardiovascular mortality, and cancer mortality during the follow-up. Incidence units are 1/100 inhabitants.

Abbreviation: CV, cardiovascular.

Table 2 Variable Estimates in the Models with Best Discrimination

	Model With Competing Risks		Model Without Competing Risks
	REGICOR + Treatments		REGICOR Model
	HR (95% CI)	p-value	HR (95% CI)	p-value
Women	0.53 (0.42, 0.66)	<0.001	0.53 (0.42, 0.66)	<0.001
Age (x10years)	1.67 (1.48, 1.88)	<0.001	1.90 (1.68, 2.15)	<0.001
Total cholesterol (x10mg/dL)	1.07 (1.05, 1.09)	<0.001	1.06 (1.04, 1.09)	<0.001
HDL cholesterol (x10mg/dL)	0.80 (0.72, 0.89)	<0.001	0.80 (0.73, 0.87)	<0.001
Systolic blood pressure (x10mmHg)	1.13 (1.06, 1.21)	<0.001	1.15 (1.08, 1.23)	<0.001
Diastolic blood pressure (x10mmHg)	0.99 (0.87, 1.13)	0.940	0.99 (0.88, 1.12)	0.872
Diabetes	1.33 (1.05, 1.70)	0.019	1.50 (1.19, 1.89)	0.001
Current smoker	1.63 (1.28, 2.07)	<0.001	1.65 (1.29, 2.09)	<0.001
Cholesterol treatment	2.02 (1.56, 2.61)	<0.001	–	–
Blood pressure treatment	1.29 (1.02, 1.65)	0.036	–	–

Abbreviations: CI, confidence interval; HDL, high-density lipoprotein cholesterol; HR, hazard ratio.

Figure 2 Discrimination of the models.

Abbreviations: AUC, area under the receiver operating characteristic curve; CI, confidence interval; Ref, reference; REGICOR, Girona Heart Registry.

Table 3 Reclassification by the Categorical Net Reclassification Index Between the Basic Model with the Variables from the Framingham-REGICOR Function and the Models with and without Treatments, Time-Dependent Covariates and Competing Risks

	NRI (95% CI)	p-value
Models including competing risks
REGICOR + time-dependent covariates	0.66 (−3.49, 4.81)	0.755
REGICOR + treatments	0.073 (0.017, 0.130)	0.011
REGICOR + time-dependent covariates + treatments	0.049 (−0.007, 0.104)	0.086
Models not including competing risks
REGICOR + time-dependent covariates	2.04 (−3.71, 7.79)	0.487
REGICOR + treatments	0.089 (0.036, 0.142)	0.001
REGICOR + time-dependent covariates + treatments	−0.002 (−0.097, 0.094)	0.970

Abbreviations: CI, confidence interval; cNRI, categorical net reclassification index.