Resources

These tools may be used for doctor-patient communication or educational or research purposes.

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Clinician resources

U-Prevent is an online platform that aims to provide tools for personalizing cardiovascular disease prevention. These tools may be used for educational or research purposes or to support doctor-patient communication. Naturally, we recommend only using U-Prevent within the scope of the locally applicable guidelines. Please read the terms and conditions before using U-Prevent.

Guidelines

You may use the following links to access international guidelines

European guidelines:
American guidelines:
British guidelines:

Risk scores

Individual risk estimations for (recurrent) major cardiovascular events can be used for patient education. These tools may allow patients to gain more insight into their personal prognosis, thereby increasing their health-motivation and positively impacting adherence to prescribed therapy.

Individual risk estimations can also guide medical decision-making about preventive treatment. High-risk individuals are more likely to benefit from preventive treatment, such as cholesterol-lowering, blood pressure-lowering (BMJ 2011). High-risk patients experience a larger absolute risk reduction (ARR) and subsequently have a lower number needed to treat (NNT) from any type of preventive treatment (Eur Heart J 2014).

U-Prevent provides online calculation tools of the following risk scores:
SMART risk score
The SMART risk score ( Heart 2013) can be used for all individual patients with clinical manifest atherosclerotic vascular disease (ASCVD). These include coronary artery disease, cerebrovascular disease, peripheral artery disease, abdominal aortic aneurysm and polyvascular disease. The SMART risk score estimates individual risk for (recurrent) myocardial infarction, stroke or vascular death in the next 10 years if standard care is provided. It is based on common, easy-to-measure, clinical patient characteristics. The SMART risk score was developed in data from the SMART study cohort and externally validated in 18,436 patients from the TNT (Treating to New Targets), IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering), SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels), and CAPRIE (Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events) trials ( >Circulation 2016).

Treatment effect assumptions

Lifestyle optimization (i.e. healthy diet, physical exercise and optimal body weight) is indicated for all patients with an ASCVD-history. The SMART risk score calculator estimates the effect of additional treatment options based on the following assumptions:
  • Smoking cessation: this option is only applicable to current smokers. Smoking cessation is assumed to reduce the hazard ratio for cardiovascular events of current smokers versus never smokers (i.e. 1.98; BMJ 2015) to that of ex-smokers versus never smokers (i.e. 1.18; BMJ 2015). Thus, the resulting hazard ratio for cardiovascular events of current to ex-smoking is 0.60.
  • Cholesterol lowering: A hazard ratio of 0.78 was assumed per 1.0 mmol/L (39 mg/dL) lowering of LDL-cholesterol ( Lancet 2012) to a target of 1.7 mmol/L (70 mg/dL).
  • Blood pressure lowering: The hazard ratio for lowering of systolic blood pressure is assumed to be 0.77 per 10 mmHg decrease ( Lancet 2016) to an optional target of 130, 140, 150 or 160 mmHg.
  • Antithrombotic treatment: estimated risk is based on the assumption that standard care is provided. Such standard care (HR =1) for cardiovascular patients includes the use of aspirin or equivalent type of antithrombotic treatment. We assume that aspirin cessation is associated with the inverse effect of starting aspirin (i.e. HR 1/0.81 = 1.23; Lancet 2009). Other types of antithrombotic treatment that result in equivalent cardiovascular risk reduction include monotherapy with other platelet aggregation inhibitors, vitamin K antagonists or DOAC’s.
ADVANCE risk score
The ADVANCE risk score (Eur J Cardiovasc Prev Rehabil 2011) can be used for patients with type 2 diabetes mellitus without clinical manifest atherosclerotic vascular disease (ASCVD). The risk score is based on 10 clinical parameters and estimates individual risk for myocardial infarction, stroke or vascular death in the next 4 years. The ADVANCE risk score was developed in data from 7,168 participants of the ADVANCE trial cohort without a history of cardiovascular disease and externally validated in 1,836 patients with type 2 diabetes mellitus and without cardiovascular disease from the DIABHYCAR cohort (Eur J Cardiovasc Prev Rehabil 2011). To facilitate clinical interpretation, the U-Prevent tool extrapolates the 4-year risk as estimated by the ADVANCE risk score to 10-years using the following formula: risk10 years = 1-(1-risk4 years)^10/4.

Treatment effect assumptions

Lifestyle optimization (i.e. healthy diet, physical exercise and optimal body weight) is indicated for all patients with type 2 diabetes mellitus. The ADVANCE risk score calculator estimates the effect of additional treatment options based on the following assumptions:
  • Smoking cessation: this option is only applicable to current smokers. Smoking cessation is assumed to reduce the hazard ratio for cardiovascular events of current smokers versus never smokers (i.e. 1.98; BMJ 2015) to that of ex-smokers versus never smokers (i.e. 1.18; BMJ 2015). Thus, the resulting hazard ratio for cardiovascular events of current to ex-smoking is 0.60.
  • Cholesterol lowering: A hazard ratio of 0.78 was assumed per 1.0 mmol/L (39 mg/dl) lowering of LDL-cholesterol (Lancet 2012) to a target of 2.5 mmol/L (100 mg/dl).
  • Blood pressure lowering: The hazard ratio for lowering of systolic blood pressure is assumed to be 0.74 per 10 mmHg decrease (JAMA 2015) to an optional target of 130, 140, 150 or 160 mmHg.
  • Antithrombotic treatment: We assume that the use of aspirin or equivalent type of antithrombotic treatment is associated with a hazard ratio of 0.88 (Lancet 2009). Other types of antithrombotic treatment that result in equivalent cardiovascular risk reduction include monotherapy with other platelet aggregation inhibitors, vitamin K antagonists or DOAC’s.
SCORE chart
The different versions of the HEART SCORE are based on the 2016 European Guidelines on cardiovascular disease prevention in clinical practice (Eur Heart J 2016) and the 2018 Dutch Cardiovascular Risk Management Guidelines. The European version of the HEART SCORE risk estimator can be used to estimate 10-year risk for cardiovascular death in apparently healthy individuals. The low-risk version is recommended for use in Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, The Netherlands, Norway, Portugal, San Marino, Slovenia, Spain, Sweden, Switzerland and the United Kingdom. The high-risk version is recommended for use in Bosnia and Herzegovina, Croatia, Czech Republic, Estonia, Hungary, Lithuania, Montenegro, Morocco, Poland, Romania, Serbia, Slovakia, Tunisia and Turkey. The Dutch version of the HEART SCORE estimator can be used to estimate 10-year risk for both fatal and non-fatal cardiovascular outcomes in Dutch patients only. Age, cholesterol and blood pressure are rounded to the nearest category of the appropriate HEART SCORE table.

Treatment effect assumptions

Lifestyle optimization (i.e. healthy diet, physical exercise and optimal body weight) is indicated for all people with cardiovascular risk factors. The HEART SCORE calculator estimates the effect of additional treatment options based on the following assumptions:
  • Smoking cessation: this option is only applicable to current smokers. Smoking cessation is assumed to reduce the hazard ratio for cardiovascular events of current smokers versus never smokers (i.e. 1.98; BMJ 2015) to that of ex-smokers versus never smokers (i.e. 1.18; BMJ 2015). Thus, the resulting hazard ratio for cardiovascular events of current to ex-smoking is 0.60.
  • Cholesterol lowering: A hazard ratio of 0.78 was assumed per 1.0 mmol/L (39 mg/dl) lowering of LDL-cholesterol (Lancet 2012) to a target of 2.5 mmol/L (100 mg/dl).
  • Blood pressure lowering: The hazard ratio for lowering of systolic blood pressure is assumed to be 0.74 per 10 mmHg decrease (JAMA 2015) to an optional target of 130, 140, 150 or 160 mmHg.
  • Antithrombotic treatment: We assume that the use of aspirin or equivalent type of antithrombotic treatment is associated with a hazard ratio of 0.88 (Lancet 2009). Other types of antithrombotic treatment that result in equivalent cardiovascular risk reduction include monotherapy with other platelet aggregation inhibitors, vitamin K antagonists or DOAC’s.
Pooled cohort ASCVD risk equation
The race- and sex-specific Pooled Cohort ASCVD risk equation is based on the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk ( Circulation 2014). It can be used to predict 10-year risk for coronary heart disease death, nonfatal myocardial infarction, and fatal or nonfatal stroke in apparently healthy patients from the United States. The Pooled Cohort ASCVD risk equation was developed in pooled data of NHLBI-sponsored cohort studies, including the ARIC (Atherosclerosis Risk in Communities) study, the Cardiovascular Health Study, and the CARDIA (Coronary Artery Risk Development in Young Adults) study, combined with applicable data from the Framingham Original and Offspring Study cohorts.

Treatment effect assumptions

Lifestyle optimization (i.e. healthy diet, physical exercise and optimal body weight) is indicated for all people with cardiovascular risk factors. The ASCVD calculator estimates the effect of additional treatment options based on the following assumptions:
  • Smoking cessation: this option is only applicable to current smokers. Smoking cessation is assumed to reduce the hazard ratio for cardiovascular events of current smokers versus never smokers (i.e. 1.98; BMJ 2015) to that of ex-smokers versus never smokers (i.e. 1.18; BMJ 2015). Thus, the resulting hazard ratio for cardiovascular events of current to ex-smoking is 0.60.
  • Cholesterol lowering: A hazard ratio of 0.78 was assumed per 1.0 mmol/L (39 mg/dl) lowering of LDL-cholesterol ( Lancet 2012) to a target of 2.5 mmol/L (100 mg/dl).
  • Blood pressure lowering: The hazard ratio for lowering of systolic blood pressure is assumed to be 0.74 per 10 mmHg decrease ( JAMA 2015) to an optional target of 130, 140, 150 or 160 mmHg.
  • Antithrombotic treatment: We assume that the use of aspirin or equivalent type of antithrombotic treatment is associated with a hazard ratio of 0.88 ( Lancet 2009). Other types of antithrombotic treatment that result in equivalent cardiovascular risk reduction include monotherapy with other platelet aggregation inhibitors, vitamin K antagonists or DOAC’s.
Elderly risk score
The elderly risk score can be used for patients aged >70 years with or without cardiovascular disease ( Clin Res Cardiol 2017). It estimates individual risk for myocardial infarction, stroke or vascular death in the next 10 years. The elderly risk score was developed in data from the “PROspective Study of Pravastatin in Elderly at Risk" (PROSPER) trial and externally validated in data from elderly patients enrolled in the "Secondary Manifestations of ARTerial disease" (SMART) cohort study (n = 1442) and the "Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm" (ASCOT-LLA) trial (n = 1893). Risk estimates are adjusted for the competing risk of non-vascular mortality. If the option 'other' geographical regions is selected, Northern/Western-European risk estimates are reported as a default.

Treatment effect assumptions

Lifestyle optimization (i.e. healthy diet, physical exercise and optimal body weight) is indicated for all elderly people with cardiovascular risk factors. The elderly risk score calculator estimates the effect of additional treatment options based on the following assumptions:
  • Smoking cessation: this option is only applicable to current smokers. Smoking cessation is assumed to reduce the hazard ratio for cardiovascular events of current smokers versus never smokers (i.e. 1.98; BMJ 2015) to that of ex-smokers versus never smokers (i.e. 1.18; BMJ 2015). Thus, the resulting hazard ratio for cardiovascular events of current to ex-smoking is 0.60.
  • Cholesterol lowering: A hazard ratio of 0.78 was assumed per 1.0 mmol/L (39 mg/dl) lowering of LDL-cholesterol ( Lancet 2012) to a target of 2.5 mmol/L (100 mg/dl).
  • Blood pressure lowering: The hazard ratio for lowering of systolic blood pressure is assumed to be 0.74 per 10 mmHg decrease ( JAMA 2015) to an optional target of 130, 140, 150 or 160 mmHg.
  • Antithrombotic treatment: We assume that the use of aspirin or equivalent type of antithrombotic treatment coagulation is associated with a hazard ratio of 0.88 ( Lancet 2009). Other types of antithrombotic treatment that result in equivalent cardiovascular risk reduction include monotherapy with other platelet aggregation inhibitors, vitamin K antagonists or DOAC’s.

Lifetime treatment effect estimators

For shared decision-making on the initiation or withdrawal of cardiovascular preventive therapies, personalized estimates of the effect of treatment may be useful in addition to risk. For this purpose, U-Prevent provides tools to estimate both 10-year and lifetime effects of the most frequently applied preventive interventions, including blood pressure lowering, lipid lowering and platelet aggregation inhibition. The 2016 European Guidelines on cardiovascular disease prevention (Eur Heart J 2016) recommend that lifetime calculators may be used as an educational tool in individuals <50 years of age. We expect, however, that these calculators may also help to improve your patients’ insight in their cardiovascular prognosis and motivation for therapy in patients >50 years of age and, especially, elderly. Notably, lifetime estimations of cardiovascular prognosis and the effect of therapy may be especially useful in certain groups of patients. For example, younger patients often have an inherently low 10-year risk due to their age, even in the presence of important risk-factors such as hypertension. But this low 10-year risk masks a high lifetime risk. Conversely, older patients inherently have a high 10-year risk, but the benefit of preventive treatment may be limited by short life-expectancy.
In BMJ 2016 we explained the methodological principles that the lifetime treatment effect estimators are based on. A video-abstract of this article can be viewed below.
The U-Prevent lifetime scores are described below. All scores were derived from multiple, large, observational population-based cohorts and can be used for estimating risk and cardiovascular event-free life-expectancy. For estimation of individual treatment effect, the lifetime score estimates are combined with hazard ratios from trials or meta-analyses. Below, we also summarize which hazard ratios were applied to each of the scores. The effects of these treatments are assumed to be independent and multiplicative. Estimates of (gain) in cardiovascular-free life-expectancy are based on (differences in) median predicted survival for an individual patient.
SMART-REACH score
The SMART-REACH model ( JAHA 2018 ) can be used for all individual patients with clinical manifest atherosclerotic vascular disease (ASCVD). These include coronary artery disease, cerebrovascular disease, peripheral artery disease, abdominal aortic aneurysm and polyvascular disease. The SMART-REACH model estimates individual 10-year risk and lifetime risk (i.e. risk until age 90 years) for (recurrent) myocardial infarction, stroke or vascular death and (recurrent) event free life-expectancy if standard care is provided. It is based on common, easy-to-measure, clinical patient characteristics. The SMART-REACH model was developed in data from 14,259 cardiovascular patients from Western-Europe enrolled in the REACH registry and externally validated in 19,170 cardiovascular patients from Northern-America enrolled in the REACH registry and 6,959 patients from The Netherlands, enrolled in the SMART study cohort. For all 'other' geographical regions, the Western-European version is used as a default.

Treatment effect assumptions

Lifestyle optimization (i.e. healthy diet, physical exercise and optimal body weight) is indicated for all patients with an ASCVD-history. The SMART-REACH calculator estimates the effect of medications changes compared to current treatment. Treatment estimates are based on the following assumptions:
  • Smoking cessation: this option is only applicable to current smokers. Smoking cessation is assumed to reduce the hazard ratio for cardiovascular events of current smokers versus never smokers (i.e. 1.98; BMJ 2015) to that of ex-smokers versus never smokers (i.e. 1.18; BMJ 2015). The resulting hazard ratio for cardiovascular events of current to ex-smoking, thus, is 0.60. Also, smoking cessation is assumed to reduce the hazard ratio for non-vascular mortality of current smokers versus never smokers (i.e. 1.83; Arch Intern Med 2012) to that of ex-smokers versus never smokers (i.e. 1.34; Arch Intern Med 2012). The resulting hazard ratio for non-vascular mortality of current to ex-smoking, thus, is 0.73.
  • Cholesterol lowering: A hazard ratio of 0.78 was assumed per 1.0 mmol/L (39 mg/dl) lowering of LDL-cholesterol (Lancet 2012) without a bottom limit. The anticipated change in LDL-cholesterol is based on the patients’ baseline cholesterol level. The percentage change in LDL-cholesterol was derived from BMJ 2003 for different types and doses of statins. Ezetimibe is assumed to result in an additional 24% decrease in LDL-cholesterol (N Engl J Med 2015) and PCSK9-inhibition therapy is assumed to result in an additional 59% decrease in LDL-cholesterol (N Eng J Med 2017).
  • Blood pressure lowering: The hazard ratio for lowering of systolic blood pressure is assumed to be 0.77 per 10 mmHg decrease (Lancet 2016). Treatment effect is truncated at 130 mmHg, since this is currently the lowest recommended treatment target in guidelines. The calculation tool estimates the effect of reaching this target regardless whether this is achieved by lifestyle or medication.
  • Anticoagulation therapy: estimated risk and (recurrent) event-free life-expectancy are based on the assumption that standard care is provided. Such standard care (HR =1) for cardiovascular patients includes the use of aspirin or equivalent type of anticoagulation therapy, including monotherapy with vitamin K antagonists or DOACs. We assume that aspirin cessation is associated with the inverse effect of starting aspirin (i.e. HR 1/0.81 = 1.23; Lancet 2009). Dual antiplatelet therapy (DAPT) compared to aspirin alone is associated with a HR 0.78 (Eur Heart J 2016). Combined use of aspirin with a low dose DOAC is associated with a HR 0.76 (N Eng J Med 2017).

Patient resources

Antihypertensives, anticoagulants and cholesterol lowering drugs are used by many for the prevention of cardiovascular diseases. However, not everybody benefits equally. Some benefit more than average, while others do not. U-Prevent intends to help you and your doctor to make the right decisions on the use of these types of medication. With U-Prevent, you are in control! We recommend that you use U-Prevent together with your doctor. Your doctor can provide your personal health details that are needed to use the calculation tools and help you interpret the calculator’s output. A comprehensive overview of your personal details and results can be printed for you to keep and discuss with your family or friends. Watch the videos below to learn more.
U-Prevent: you are in control
What is cardiovascular disease?
What is cholesterol?
What does a statin do?
Do statins have side-effects?

Researcher resources

Scientific publications on personalized medicine and prediction by the Vascular Medicine research group of the University Medical Center Utrecht, The Netherlands (update 22-06-2018):
1. Berkelmans GF, Gudbjörnsdottir S, Franzen S, Svensson AM, van der Graaf Y, Eliasson B, Visseren FL, Dorresteijn JA. Development and validation of a decision support tool for individualizing lifelong lipid, blood pressure, and aspirin treatment in adults with type 2 diabetes mellitus. Submitted
2. Kaasenbrood L, Bhatt DL, Dorresteijn JA, Wilson PW, D’Agostino RB, Massaro JM, van der Graaf Y, Cramer MJ, Kappelle LJ, de Borst GJ, Steg PhG, Visseren FL. Estimated life-expectancy without recurrent cardiovascular events in patients with vascular disease: the REACH-SMART model. Submitted
3. Berkelmans GF, Visseren FL, Jaspers NE, Spiering W, van der Graaf Y, Dorresteijn JA. SPRINT trial: it is not the blood pressure! Eur J Prev Cardiol. 2017 Sep;24(14):1482-1484
4. Stam-Slob MC, van der Graaf Y, Greving JP, Dorresteijn JA, Visseren FL. Cost-Effectiveness of Intensifying Lipid-Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients. J Am Heart Assoc. 2017 Feb 18;6(2).
5. Kaasenbrood L, Boekholdt SM, van der Graaf Y, Ray KK, Peters RJ, Kastelein JJ, Amarenco P, LaRosa JC, Cramer MJ, Westerink J, Kappelle LJ, de Borst GJ, Visseren FL. Distribution of Estimated 10-Year Risk of Recurrent Vascular Events and Residual Risk in a Secondary Prevention Population. Circulation. 2016 Nov 8;134(19):1419-1429.
6. van der Leeuw J, Visseren FL, Woodward M, van der Graaf Y, Grobbee DE, Harrap S, Heller S, Mancia G, Marre M, Poulter N, Zoungas S, Chalmers J. Estimation of individual beneficial and adverse effects of intensive glucose control for patients with type 2 diabetes. Diabetologia. 2016 Dec;59(12):2603-2612.
7. Stam-Slob MC, Visseren FL, Wouter Jukema J, van der Graaf Y, Poulter NR, Gupta A, Sattar N, Macfarlane PW, Kearney PM, de Craen AJ, Trompet S. Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patients. Clin Res Cardiol. 2017 Jan;106(1):58-68.
8. van der Sande NG, Dorresteijn JA, Visseren FL, Dwyer JP, Blankestijn PJ, van der Graaf Y, Heerspink HL. Individualized prediction of the effect of angiotensin receptor blockade on renal and cardiovascular outcomes in patients with diabetic nephropathy. Diabetes Obes Metab. 2016 Nov;18(11):1120-1127.
9. van Kruijsdijk RC, Visseren FL, Boni L, Groen HJ, Dingemans AM, Aerts JG, van der Graaf Y, Ardizzoni A, Smit EF. Pemetrexed plus carboplatin versus pemetrexed in pretreated patients with advanced non-squamous non-small-cell lung cancer: treating the right patients based on individualized treatment effect prediction. Ann Oncol. 2016 Jul;27(7):1280-6.
10. Kaasenbrood L, Poulter NR, Sever PS, Colhoun HM, Livingstone SJ, Boekholdt SM, Pressel SL, Davis BR, van der Graaf Y, Visseren FL; CARDS, ALLHAT, and ASCOT Investigators. Development and Validation of a Model to Predict Absolute Vascular Risk Reduction by Moderate-Intensity Statin Therapy in Individual Patients With Type 2 Diabetes Mellitus: The Anglo Scandinavian Cardiac Outcomes Trial, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, and Collaborative Atorvastatin Diabetes Study. Circ Cardiovasc Qual Outcomes. 2016 May;9(3):213-21.
11. Dorresteijn JA, Kaasenbrood L, Cook NR, van Kruijsdijk RC, van der Graaf Y, Visseren FL, Ridker PM. How to translate clinical trial results into gain in healthy life expectancy for individual patients. BMJ. 2016 Mar 30;352:i1548.
12. Krikke M, Hoogeveen RC, Hoepelman AI, Visseren FL, Arends JE. Cardiovascular risk prediction in HIV-infected patients: comparing the Framingham, atherosclerotic cardiovascular disease risk score (ASCVD), Systematic Coronary Risk Evaluation for the Netherlands (SCORE-NL) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk prediction models. HIV Med. 2016 Apr;17(4):289-97.
13. van Kruijsdijk RC, Visseren FL, Ridker PM, Dorresteijn JA, Buring JE, van der Graaf Y, Cook NR. Individualised prediction of alternate-day aspirin treatment effects on the combined risk of cancer, cardiovascular disease and gastrointestinal bleeding in healthy women. Heart. 2015 Mar;101(5):369-76.
14. van der Leeuw J, Visseren FL, Woodward M, Zoungas S, Kengne AP, van der Graaf Y, Glasziou P, Hamet P, MacMahon S, Poulter N, Grobbee DE, Chalmers J. Predicting the effects of blood pressure-lowering treatment on major cardiovascular events for individual patients with type 2 diabetes mellitus: results from Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation. Hypertension. 2015 Jan;65(1):115-21.
15. van der Leeuw J, van Dieren S, Beulens JW, Boeing H, Spijkerman AM, van der Graaf Y, van der A DL, Nöthlings U, Visseren FL, Rutten GE, Moons KG, van der Schouw YT, Peelen LM. The validation of cardiovascular risk scores for patients with type 2 diabetes mellitus. Heart. 2015 Feb;101(3):222-9.
16. van der Leeuw J, Ridker PM, van der Graaf Y, Visseren FL. Personalized cardiovascular disease prevention by applying individualized prediction of treatment effects. Eur Heart J. 2014 Apr;35(13):837-43.
17. van der Leeuw J, Oemrawsingh RM, van der Graaf Y, Brugts JJ, Deckers JW, Bertrand M, Fox K, Ferrari R, Remme WJ, Simoons ML, Boersma E, Visseren FL. Prediction of absolute risk reduction of cardiovascular events with perindopril for individual patients with stable coronary artery disease - results from EUROPA. Int J Cardiol. 2015 Mar 1;182:194-9.
18. Dorresteijn JA, Boekholdt SM, van der Graaf Y, Kastelein JJ, LaRosa JC, Pedersen TR, DeMicco DA, Ridker PM, Cook NR, Visseren FL. High-dose statin therapy in patients with stable coronary artery disease: treating the right patients based on individualized prediction of treatment effect. Circulation. 2013 Jun 25;127(25):2485-93.
19. Dorresteijn JA, Visseren FL, Wassink AM, Gondrie MJ, Steyerberg EW, Ridker PM, Cook NR, van der Graaf Y; SMART Study Group. Development and validation of a prediction rule for recurrent vascular events based on a cohort study of patients with arterial disease: the SMART risk score. Heart. 2013 Jun;99(12):866-72.
20. Dorresteijn JA, Visseren FL, Ridker PM, Paynter NP, Wassink AM, Buring JE, van der Graaf Y, Cook NR. Aspirin for primary prevention of vascular events in women: individualized prediction of treatment effects. Eur Heart J. 2011 Dec;32(23):2962-9.
21. Wassink AM, van der Graaf Y, Janssen KJ, Cook NR, Visseren FL; SMART Study Group. Prediction model with metabolic syndrome to predict recurrent vascular events in patients with clinically manifest vascular diseases. Eur J Prev Cardiol. 2012 Dec;19(6):1486-95.
22. Dorresteijn JA, Visseren FL, Ridker PM, Wassink AM, Paynter NP, Steyerberg EW, van der Graaf Y, Cook NR. Estimating treatment effects for individual patients based on the results of randomised clinical trials. BMJ. 2011 Oct 3;343:d5888.
23. Jaspers NE, Blaha MJ, Matsushita K, Lehmann N, Erbel RA, van eer Graaf Y, van der Schouw YT, Nambi V, Verschuren WM, Boer JM, Visseren FL, Dorresteijn JA. Prediction of individualized lifetime benefit from cholesterol lowering, blood pressure lowering, antithrombotic therapy, and smoking cessation, in apparently healthy people. Submitted.
24. Koopal C, Visseren FL, Westerink J, van der Graaf Y, Ginsberg HN, Keech AC. Predicting the Effect of Fenofibrate on Cardiovascular Risk for Individual Patients With Type 2 Diabetes. Diabetes Care. 2018 Jun;41(6):1244-1250.
25. Jaspers NE, Visseren FL, Numans ME, Smulders YM, van Loenen Martinet FA, van der Graaf Y, Dorresteijn JA. Variation in minimum desired cardiovascular disease-free longevity benefit from statin and antihypertensive medications: a cross-sectional study of patient and primary care physician perspectives. BMJ Open. 2018 May 26;8(5):e021309.
26. Kaasenbrood L, Ray KK, Boekholdt SM, Smulders YM, LaRosa JC, Kastelein JJ, van der Graaf Y, Dorresteijn JA, Visseren FL. Estimated individual lifetime benefit from PCSK9 inhibition in statin-treated patients with coronary artery disease. Heart. 2018 Apr 5. pii: heartjnl-2017-312510.

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