Spiros Denaxas: The Risk Factor Paradox in Recurrent Heart Disease
Spiros Denaxas, Professor of Biomedical Informatics, shared a post on LinkedIn about a recent article by Laura Pasea et al., published in European Heart Journal, adding:
“Delighted to see our work led by Laura Pasea and Riyaz Suleman Patel at the UCL Institute of Health Informatics and UCL Institute of Cardiovascular Science out now in the European Heart Journal.
Why do risk factors like obesity, family history, even LDL cholesterol often look weak when studying recurrent heart disease?
Using electronic health records from approximately 3.3 million adults and approximately 57,000 CHD survivors, the study shows:
- The ‘weakening’ is systemic: it affects every risk factor, and scales with how strong the factor was for a first event.
- A standard 10-year risk model discriminated well for first events (AUC approximately 0.84) but barely beat chance for recurrent ones (AUC approximately 0.55).
- The cause is collider bias, not biology; these paradoxes shouldn’t be read as evidence against causality or a reason to deprioritise proven therapies like LDL-C lowering.
Great example of why causal thinking matters in secondary prevention.
Congratulations Laura and Riyaz Suleman Patel, and the whole team.”
Title: Risk factors and coronary events: attenuation of the association in secondary prevention
Authors: Laura Pasea, Spiros Denaxas, Kate Tilling, Frank Dudbridge, Aroon D Hingorani, Harry Hemingway, Folkert W Asselbergs, Riyaz S Patel
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