Journal article
Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies
European heart journal, Vol.40(7), pp.621-+
02/14/2019
DOI: 10.1093/eurheartj/ehy653
PMCID: PMC6374687
PMID: 30476079
Abstract
There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.
Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at 'high' 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22-24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44-51 such individuals using original algorithms, in contrast to 37-39 individuals with recalibrated algorithms.
Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need.
Details
- Title: Subtitle
- Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies
- Creators
- Lisa Pennells - University of CambridgeStephen Kaptoge - University of CambridgeAngela Wood - University of CambridgeMike Sweeting - University of CambridgeXiaohui Zhao - University of CambridgeIan White - University College LondonStephen Burgess - University of CambridgePeter Willeit - University of CambridgeThomas Bolton - University of CambridgeKarel G M Moons - Utrecht UniversityYvonne T van der Schouw - Utrecht UniversityRandi Selmer - Norwegian Institute of Public HealthKay-Tee Khaw - University of CambridgeVilmundur Gudnason - University of IcelandGerd Assmann - Assmann-Foundation for Prevention, Gronowskistraße 33, Münster, GermanyPhilippe Amouyel - Institut PasteurVeikko Salomaa - Finnish Institute for Health and WelfareMika Kivimaki - University College LondonBørge G Nordestgaard - University of CopenhagenMichael J Blaha - Johns Hopkins UniversityLewis H Kuller - University of PittsburghHermann Brenner - German Cancer Research CenterRichard F Gillum - Howard UniversityChrista Meisinger - German Research Center for Environmental Health, Ingolstädter Landstraße 1, Neuherberg, GermanyIan Ford - University of GlasgowMatthew W Knuiman - The University of Western AustraliaAnnika Rosengren - University of GothenburgDebbie A Lawlor - University of BristolHenry Völzke - Universität GreifswaldCyrus Cooper - University of SouthamptonAlejandro Marín Ibañez - San Jose Norte Health Centre, 16 Lugar De Santuario Cabañas, Zaragoza, SpainEdoardo Casiglia - University of PaduaJussi Kauhanen - University of Eastern FinlandJackie A Cooper - University College LondonBeatriz Rodriguez - University of Hawaiʻi at MānoaJohan Sundström - Uppsala UniversityElizabeth Barrett-Connor - University of California San DiegoRachel Dankner - Tel Aviv UniversityPaul J Nietert - Medical University of South CarolinaKarina W Davidson - Columbia UniversityRobert B Wallace - University of IowaDan G Blazer - Duke UniversityCecilia Björkelund - University of GothenburgChiara Donfrancesco - Istituto Superiore di SanitàHarlan M Krumholz - Yale UniversityAulikki Nissinen - Finnish Institute for Health and WelfareBarry R Davis - The University of Texas Health Science Center at HoustonSean Coady - National Institutes of HealthPeter H Whincup - St George's, University of LondonTorben Jørgensen - University of CopenhagenPierre Ducimetiere - Université Paris CitéMaurizio Trevisan - City University of New YorkGunnar Engström - Lund UniversityCarlos J Crespo - Portland State UniversityTom W Meade - University of LondonMarjolein Visser - Vrije Universiteit AmsterdamDaan Kromhout - University of GroningenStefan Kiechl - Innsbruck Medical UniversityMakoto Daimon - Yamagata UniversityJackie F Price - University of EdinburghAgustin Gómez de la Cámara - Department of Clinical Research, Hospital 12 de Octubre, Av. Cordoba, Madrid, SpainJ Wouter Jukema - Leiden University Medical CenterBenoît Lamarche - Université LavalAltan Onat - Istanbul UniversityLeon A Simons - UNSW SydneyMaryam Kavousi - Erasmus University RotterdamYoav Ben-Shlomo - University of BristolJohn Gallacher - University of OxfordJacqueline M Dekker - Vrije Universiteit AmsterdamHisatomi Arima - Kyushu UniversityNawar Shara - Memorial Hospital of South BendRobert W Tipping - Merck & Co., Inc., Rahway, NJ, USARonan Roussel - Centre de Recherche des CordeliersEric J Brunner - University College LondonWolfgang Koenig - Technical University of MunichMasaru Sakurai - Kanazawa Medical UniversityJelena Pavlovic - Erasmus University RotterdamRon T Gansevoort - University of GroningenDorothea Nagel - Ludwig-Maximilians-Universität MünchenUri Goldbourt - Tel Aviv UniversityElizabeth L M Barr - The Heart Research InstituteLuigi Palmieri - Istituto Superiore di SanitàInger Njølstad - Department of Public Health, University of Tromsø, Hansine Hansens veg 18, Tromsø, NorwayShinichi Sato - Chiba Prefectural Institute of Public HealthW M Monique Verschuren - Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, The NetherlandsCherian V Varghese - World Health Organization - PakistanIan Graham - Trinity College DublinOyere Onuma - World Health Organization - PakistanPhilip Greenland - Northwestern UniversityMark Woodward - UNSW SydneyMajid Ezzati - Imperial College LondonBruce M Psaty - University of WashingtonNaveed Sattar - University of GlasgowRod Jackson - University of AucklandPaul M Ridker - Harvard UniversityNancy R Cook - Harvard UniversityRalph B D'Agostino - Boston UniversitySimon G Thompson - University of CambridgeJohn Danesh - University of CambridgeEmanuele Di Angelantonio - University of CambridgeEmerging Risk Factors Collaboration
- Resource Type
- Journal article
- Publication Details
- European heart journal, Vol.40(7), pp.621-+
- DOI
- 10.1093/eurheartj/ehy653
- PMID
- 30476079
- PMCID
- PMC6374687
- NLM abbreviation
- Eur Heart J
- ISSN
- 0195-668X
- eISSN
- 1522-9645
- Grant note
- G0401527 / Medical Research Council MR/N003284/1 / Medical Research Council MC_U147585819 / Medical Research Council 10/33/04 / Department of Health RG/19/4/34452 / British Heart Foundation MC_U147585827 / Medical Research Council RG/16/11/32334 / British Heart Foundation G0800270 / Medical Research Council G0400491 / Medical Research Council MC_UU_12011/1 / Medical Research Council 14136 / Cancer Research UK 19583 / Versus Arthritis SP/09/002 / British Heart Foundation MC_UP_A620_1015 / Medical Research Council RG/13/16/30528 / British Heart Foundation G0701619 / Medical Research Council MC_UP_A620_1014 / Medical Research Council MC_UU_12011/2 / Medical Research Council P30 ES005605 / NIEHS NIH HHS MC_UU_12013/5 / Medical Research Council MR/R024227/1 / Medical Research Council MC_U147585824 / Medical Research Council 204623/Z/16/Z / Wellcome Trust RG/13/13/30194 / British Heart Foundation R01 HL109284 / NHLBI NIH HHS MR/L003120/1 / Medical Research Council MR/K013351/1 / Medical Research Council 001 / World Health Organization MR/K014811/1 / Medical Research Council RG/13/2/30098 / British Heart Foundation MC_UU_12023/21 / Medical Research Council G1000143 / Medical Research Council MC_UU_00002/7 / Medical Research Council 268834 / European Research Council
- Language
- English
- Date published
- 02/14/2019
- Academic Unit
- Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984363624002771
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