Routinely collected female-specific risk factors to improve prediction of cardiovascular disease in women

Background

Heart disease is the leading cause of death in women. Yet women with heart disease remain understudied, underrecognised, underdiagnosed and undertreated, with no improvement in cardiovascular disease burden for women in the last decade (1).

It is important that our approach to prevent cardiovascular disease is equitable for women and men. Current cardiovascular risk scores could be improved for women. The digitalization of electronical health records has created new opportunities to develop and validate cardiovascular risk models using routinely collected healthcare data that better reflects clinical practice. To date cardiovascular risk scores only include traditional risk factors (e.g. cholesterol or blood pressure) but there is evidence that female-specific risk factors (e.g. adverse pregnancy outcomes, premature menopause, breast cancer treatment) are associated with increased risk of developing cardiovascular disease in women (2-4).

Incorporation of female-specific risk factors in cardiovascular risk scores may refine cardiovascular risk estimates in women. Using contemporary routinely collected healthcare data, the PhD student will identify female-specific cardiovascular risk factors that are routinely collected and should be incorporated into a female-specific cardiovascular risk score. The PhD student will develop a cardiovascular risk score for women that includes female-specific risk factors and compare model performance with clinically applied risk scores (e.g. SCORE2). Accordingly, the PhD student will externally validate the performance in important subgroups (age, ethnicity and social deprivation groups) to ensure equality in the provision of preventative medicine.

We anticipate that this research project will inform the development of a female-specific cardiovascular risk score that incorporates routinely collected female-specific risk factors to facilitate implementation of preventative strategies to reduce morbidity and mortality and increase equity in cardiovascular care.

Aims

To identify female-specific cardiovascular risk factors that are routinely collected in primary and secondary care and develop and validate a female-specific cardiovascular risk score to potentially improve the prediction of cardiovascular disease in women.

Training Outcomes

This is an important area of clinical research with both a high feasibility and translational potential into clinical practice. The work conducted will be of interest to scientific and lay audiences, providing opportunities to present the data to a wide range of people and media and develop public engagement skills.

The project will provide the student with an excellent opportunity to develop data analysis skills using electronic health records, providing training in data protection, governance, handling sensitive data and statistics.

The student will benefit from expert clinical advice from a world class team including an internationally recognised clinical academic gynaecologist and cardiologist, alongside epidemiology and data analysis support and training from four experienced academic supervisors.

There will be opportunities to interact with a wider team of data scientist researchers that will provide a platform for future career development and networking opportunities.

The student will develop scientific writing and presentation skills and are expected to present their results at local, national and international meetings and publish their findings in peer reviewed journals.

References

1. Vogel B, Acevedo M, Appelman Y, Noel Bairey Merz C, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, et al. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021;397(10292):2385-2438.
2. Cho L, Davis M, Elgendy I, Epps K, Lindley KJ, Mehta PK, Michos ED, Minissian M, Pepine C, Vaccarino V, et al; ACC CVD Womens Committee Members. Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review. J Am Coll Cardiol 2020;75(20):2602-2618.
3. Garcia M, Mulvagh SL, Noel Bairey Merz C, Buring JE, Manson JE. Cardiovascular Disease in Women: Clinical Perspectives. Circ Res 2016;118(8):1273-93.
4. Zhu F, Qi H, Bos M, Boersma E, Kavousi M. Female Reproductive Factors and Risk of New-Onset Heart Failure: Findings From UK Biobank. JACC Heart Fail 2023 Sep;11(9):1203-1212.