Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.
View / Open Files
Authors
Sweeting, Mike
White, Ian
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
Emerging Risk Factors Collaboration
Publication Date
2019-02-14Journal Title
Eur Heart J
ISSN
0195-668X
Publisher
Oxford University Press (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.. Eur Heart J, 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 '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.
Keywords
Emerging Risk Factors Collaboration, Humans, Cardiovascular Diseases, Calibration, Risk Assessment, Prospective Studies, Algorithms, Aged, Middle Aged, Female, Male
Sponsorship
British Heart Foundation (None)
British Heart Foundation (CH/12/2/29428)
Wellcome Trust (204623/Z/16/Z)
Medical Research Council (G0701619)
Medical Research Council (MR/K014811/1)
Medical Research Council (G0401527)
Medical Research Council (G1000143)
Medical Research Council (MR/L003120/1)
Medical Research Council (G0800270)
Medical Research Council (MR/N003284/1)
European Research Council (268834)
Medical Research Council (MC_UU_00002/7)
TCC (None)
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/
Statistics
Total file downloads (since January 2020). For more information on metrics see the
IRUS guide.
Recommended or similar items
The current recommendation prototype on the Apollo Repository will be turned off on 03 February 2023. Although the pilot has been fruitful for both parties, the service provider IKVA is focusing on horizon scanning products and so the recommender service can no longer be supported. We recognise the importance of recommender services in supporting research discovery and are evaluating offerings from other service providers. If you would like to offer feedback on this decision please contact us on: support@repository.cam.ac.uk