{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T20:46:55Z","timestamp":1771274815834,"version":"3.50.1"},"reference-count":35,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University Medical Centre Utrecht"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Guidelines recommend using cardiovascular (CV) risk prediction models to support treatment decisions. Psychological factors such as depression, anxiety, and insomnia may affect CV risk. The aim is to evaluate the added value of these psychological factors on top of the SMART2 model for estimating 10-year risk of recurrent CV events in patients with atherosclerotic CV disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Patients aged 40\u201380 with atherosclerotic CV disease were included from the UCC-SMART, HUNT3, HUNT4, NORCOR, and Nor-COAST cohorts. Potential added value of (self-reported) symptoms, diagnoses, and treatment for depression, anxiety, and insomnia on top of the SMART2 was investigated using Fine and Gray models, with SMART2 coefficients as an offset. Added value was assessed by change (\u0394) in C-statistic and calibration. A total of 20 050 patients were eligible, with 2987 experiencing recurrent CV events. Psychological factors were present in 3\u20139%, 3\u201345%, and 10\u201314% of patients for diagnosis, self-reported symptoms, and prescribed treatment, respectively. No psychological factors were significantly associated with recurrent CV events on top of SMART2 and performance in patients with psychological factors was adequate (C-statistics 0.61\u20130.70). Added value of psychological factors was minimal, with the \u0394C-statistic ranging from \u22120.0003 [95% confidence interval: \u22120.0005\u20130.0001] for symptoms of depression, to 0.0011 [0.0011\u20130.0011] for prescribed treatment with anxiolytics. There was no relevant difference in calibration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>SMART2 model reliably estimates recurrent CV event risk in patients with psychological factors. Psychological factors have no added value to CV risk prediction when integrated on top of the SMART2 risk score.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf526","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T17:21:17Z","timestamp":1756228877000},"source":"Crossref","is-referenced-by-count":1,"title":["Psychological factors beyond the SMART2 model for predicting recurrent events in atherosclerotic cardiovascular disease patients"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7616-3839","authenticated-orcid":false,"given":"Joris","family":"Holtrop","sequence":"first","affiliation":[{"name":"Department of Vascular Medicine, University Medical Centre Utrecht , PO Box 85500, Utrecht 3508 GA ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8623-7911","authenticated-orcid":false,"given":"Mari Nordb\u00f8","family":"Gynnild","sequence":"additional","affiliation":[{"name":"Department of Stroke, Clinic of Medicine, St. Olav University Hospital , Trondheim ,","place":["Norway"]},{"name":"Department of Cardiology, St. Olav University Hospital , Trondheim ,","place":["Norway"]},{"name":"Department of Circulation and Medical Imaging, Norwegian University of Science and Technology , Trondheim ,","place":["Norway"]},{"name":"K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9383-2161","authenticated-orcid":false,"given":"Toril","family":"Dammen","sequence":"additional","affiliation":[{"name":"Division of Mental Health and Addiction, Department of Research and Innovation, Section of Psychiatric Treatment Research, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4000-6298","authenticated-orcid":false,"given":"H\u00e5vard","family":"Dalen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St. Olav University Hospital , Trondheim ,","place":["Norway"]},{"name":"Department of Circulation and Medical Imaging, Norwegian University of Science and Technology , Trondheim ,","place":["Norway"]},{"name":"Department of Medicine, Levanger Hospital, Nord-Tr\u00f8ndelag Hospital Trust , Levanger ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7897-9808","authenticated-orcid":false,"given":"Ingvild","family":"Saltvedt","sequence":"additional","affiliation":[{"name":"Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU\u2014Norwegian University of Science and Technology , Trondheim ,","place":["Norway"]},{"name":"Department of Geriatric Medicine, St. Olavs Hospital, Trondheim University Hospital , Trondheim ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2887-3722","authenticated-orcid":false,"given":"Hanne","family":"Ellekj\u00e6r","sequence":"additional","affiliation":[{"name":"Department of Stroke, Clinic of Medicine, St. Olav University Hospital , Trondheim ,","place":["Norway"]},{"name":"Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU\u2014Norwegian University of Science and Technology , Trondheim ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2299-6745","authenticated-orcid":false,"given":"Steven H J","family":"Hageman","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, University Medical Centre Utrecht , PO Box 85500, Utrecht 3508 GA ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3951-5223","authenticated-orcid":false,"given":"Frank L J","family":"Visseren","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, University Medical Centre Utrecht , PO Box 85500, Utrecht 3508 GA ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6530-5479","authenticated-orcid":false,"given":"John William","family":"McEvoy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Galway , Galway ,","place":["Ireland"]},{"name":"Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0190-8526","authenticated-orcid":false,"given":"Jannick A N","family":"Dorresteijn","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, University Medical Centre Utrecht , PO Box 85500, Utrecht 3508 GA ,","place":["The 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