Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.

Pennells, Lisa

Kaptoge, Stephen

Wood, Angela

Sweeting, Mike

Zhao, Xiaohui

White, Ian

Burgess, Stephen

Willeit, Peter

Bolton, Thomas

Moons, Karel GM

van der Schouw, Yvonne T

Selmer, Randi

Khaw, Kay-Tee

Gudnason, Vilmundur

Assmann, Gerd

Amouyel, Philippe

Salomaa, Veikko

Kivimaki, Mika

Nordestgaard, Børge G

Blaha, Michael J

Kuller, Lewis H

Brenner, Hermann

Gillum, Richard F

Meisinger, Christa

Ford, Ian

Knuiman, Matthew W

Rosengren, Annika

Lawlor, Debbie A

Völzke, Henry

Cooper, Cyrus

Marín Ibañez, Alejandro

Casiglia, Edoardo

Kauhanen, Jussi

Cooper, Jackie A

Rodriguez, Beatriz

Sundström, Johan

Barrett-Connor, Elizabeth

Dankner, Rachel

Nietert, Paul J

Davidson, Karina W

Wallace, Robert B

Blazer, Dan G

Björkelund, Cecilia

Donfrancesco, Chiara

Krumholz, Harlan M

Nissinen, Aulikki

Davis, Barry R

Coady, Sean

Whincup, Peter H

Jørgensen, Torben

Ducimetiere, Pierre

Trevisan, Maurizio

Engström, Gunnar

Crespo, Carlos J

Meade, Tom W

Visser, Marjolein

Kromhout, Daan

Kiechl, Stefan

Daimon, Makoto

Price, Jackie F

Gómez de la Cámara, Agustin

Wouter Jukema, J

Lamarche, Benoît

Onat, Altan

Simons, Leon A

Kavousi, Maryam

Ben-Shlomo, Yoav

Gallacher, John

Dekker, Jacqueline M

Arima, Hisatomi

Shara, Nawar

Tipping, Robert W

Roussel, Ronan

Brunner, Eric J

Koenig, Wolfgang

Sakurai, Masaru

Pavlovic, Jelena

Gansevoort, Ron T

Nagel, Dorothea

Goldbourt, Uri

Barr, Elizabeth LM

Palmieri, Luigi

Njølstad, Inger

Sato, Shinichi

Monique Verschuren, WM

Varghese, Cherian V

Graham, Ian

Onuma, Oyere

Greenland, Philip

Woodward, Mark

Ezzati, Majid

Psaty, Bruce M

Sattar, Naveed

Jackson, Rod

Ridker, Paul M

Cook, Nancy R

D'Agostino, Ralph B

Thompson, Simon G

Danesh, John

Di Angelantonio, Emanuele

Emerging Risk Factors Collaboration

2019-06-18T13:57:38Z

2019-06-18T13:57:38Z

2019-02

2019-06-18T13:57:38Z

AIMS: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. METHODS AND RESULTS: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. CONCLUSION: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.

5198769

0195-668X

1522-9645

https://hdl.handle.net/10161/18955

eng

Oxford University Press (OUP)

European heart journal

10.1093/eurheartj/ehy653

Emerging Risk Factors Collaboration

Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.

Journal article

621

631

7

School of Medicine

Duke

Center for the Study of Aging and Human Development

Institutes and Centers

Family Medicine and Community Health

Clinical Science Departments

Psychiatry & Behavioral Sciences, Geriatric Behavioral Health

Psychiatry & Behavioral Sciences

Duke Clinical Research Institute

Biostatistics & Bioinformatics

Basic Science Departments

Published

40