Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.
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Authors
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
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
Wallace, Robert B
Blazer, Dan G
Björkelund, Cecilia
Donfrancesco, Chiara
Krumholz, Harlan M
Nissinen, Aulikki
Davis, Barry R
Coady, Sean
Whincup, Peter H
Ducimetiere, Pierre
Trevisan, Maurizio
Engström, Gunnar
Crespo, Carlos J
Meade, Tom W
Visser, Marjolein
Kromhout, Daan
Kiechl, Stefan
Daimon, Makoto
Price, Jackie F
Wouter Jukema, J
Onat, Altan
Simons, Leon A
Ben-Shlomo, Yoav
Gallacher, John
Dekker, Jacqueline M
Arima, Hisatomi
Shara, Nawar
Tipping, Robert W
Roussel, Ronan
Brunner, Eric J
Koenig, Wolfgang
Sakurai, Masaru
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
Emerging Risk Factors Collaboration,
Publication Date
2019-02Journal Title
European heart journal
ISSN
0195-668X
Publisher
OUP
Volume
40
Issue
7
Pages
621-631
Language
eng
Type
Article
This Version
VoR
Physical Medium
Print
Metadata
Show full item recordCitation
Pennells, L., Kaptoge, S., Wood, A., Sweeting, M., Zhao, X., White, I., Burgess, S., et al. (2019). Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.. European heart journal, 40 (7), 621-631. https://doi.org/10.1093/eurheartj/ehy653
Abstract
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 “re-calibration”, 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 re-calibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before re-calibration, FRS, SCORE and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, while RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high-risk. By contrast, re-calibration 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 re-calibrated algorithms.
Conclusion Before re-calibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple re-calibration nearly equalised their performance and improved modelled targeting of preventive action to clinical need.
Keywords
Emerging Risk Factors Collaboration, Humans, Cardiovascular Diseases, Calibration, Risk Assessment, Prospective Studies, Algorithms, Aged, Middle Aged, Female, Male
Sponsorship
British Heart Foundation (RG/13/13/30194)
British Heart Foundation (CH/12/2/29428)
Wellcome Trust (204623/Z/16/Z)
MRC (G0701619)
MRC (MR/K014811/1)
MRC (G0401527)
MRC (G1000143)
MRC (MR/L003120/1)
MRC (G0800270)
MEDICAL RESEARCH COUNCIL (MR/N003284/1)
European Research Council (268834)
Medical Research Council (MC_UU_00002/7)
Identifiers
External DOI: https://doi.org/10.1093/eurheartj/ehy653
This record's URL: https://www.repository.cam.ac.uk/handle/1810/286673
Rights
Attribution-NonCommercial 4.0 International
Licence URL: https://creativecommons.org/licenses/by-nc/4.0/