External validation of the SMART2 model for recurrent cardiovascular risk: performance in socioeconomic, ethnic and psychiatric subgroups
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Le résumé fourni par la source
BACKGROUND: Secondary prevention is critical for patients with established atherosclerotic cardiovascular diseases (ASCVD). The SMART2 model predicts recurrent ASCVD risk but does not account for psychiatric disorders, socioeconomic deprivation or ethnicity. We aimed to evaluate SMART2 model performance overall and in subgroups defined by these factors. METHODS: SMART2 was externally validated using electronic health records of patients aged 40-80 in the Leiden-The Hague region. Patients hospitalised for cardiovascular disease or coronary interventions between 1 January 2010 and 31 December 2021 were included. Model performance was assessed using discrimination (10-year area under ROC curve (AUC)) and calibration (observed/expected (OE) ratios and plots, adjusted for competing risks), both overall and in subgroups defined by three factors: psychiatric history, socioeconomic status (SES) and ethnicity. RESULTS: Among 15 528 patients (66% male, mean age 65) with established ASCVD, median follow-up was 6.0 years. Recurrent cardiovascular events occurred in 2220 patients, and 1820 had competing events. Overall AUC was 0.63 (95% CI 0.61 to 0.65). OE ratio was 0.96 (95% CI 0.92 to 1.00). The model underestimated risk in patients with low SES (OE 1.09, 95% CI 1.02 to 1.17) and in non-Western patients (OE 1.16, 95% CI 1.02 to 1.31). Calibration was adequate in patients with psychiatric history, but the model was substantially underestimating for patients with multiple vulnerabilities-combinations of low SES, non-Western ethnicity and psychiatric history-with OE ranging from 1.19 to 1.29, depending on the combination. CONCLUSION: The SMART2 model is well-calibrated in the general population but underestimates risk, especially in subgroups with multiple vulnerabilities. Patients in these vulnerable subgroups may require intensified monitoring. Clinicians should consider social, ethnic and psychiatric factors when interpreting risk estimates.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- External validation of the SMART2 model for recurrent cardiovascular risk: performance in socioeconomic, ethnic and psychiatric subgroups
- Date Crossref
- 01/01/2026
- Éditeur
- BMJ
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Leiden University Medical Center Public Health and Primary Care pays non établi dans la noticeOrganisme public
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University Medical Center Utrecht pays non établi dans la noticeÉtablissement de santé
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Altrecht GGZ pays non établi dans la noticeÉtablissement de santé
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Haga Hospital pays non établi dans la noticeÉtablissement de santé
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Juliana Kinderziekenhuis pays non établi dans la noticeÉtablissement de santé
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University Medical Centre Utrecht Department of Vascular Medicine pays non établi dans la noticeUniversité ou école supérieure
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Altrecht Mental Health Institute pays non établi dans la noticeStructure de recherche
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HagaZiekenhuis pays non établi dans la noticeInstitution
Public Health and Primary Care — Leiden University Medical Center, University Medical Center Utrecht et Altrecht GGZ, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.