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dc.contributor.authorPennells, Lisa
dc.contributor.authorKaptoge, Stephen
dc.contributor.authorWood, Angela
dc.contributor.authorSweeting, Michael
dc.contributor.authorZhao, Xiaohui
dc.contributor.authorWhite, Ian
dc.contributor.authorBurgess, Stephen
dc.contributor.authorWilleit, Peter
dc.contributor.authorBolton, Thomas
dc.contributor.authorMoons, Karel GM
dc.contributor.authorvan der Schouw, Yvonne T
dc.contributor.authorSelmer, Randi
dc.contributor.authorKhaw, Kay-Tee
dc.contributor.authorGudnason, Vilmundur
dc.contributor.authorAssmann, Gerd
dc.contributor.authorAmouyel, Philippe
dc.contributor.authorSalomaa, Veikko
dc.contributor.authorKivimaki, Mika
dc.contributor.authorNordestgaard, Børge G
dc.contributor.authorBlaha, Michael J
dc.contributor.authorKuller, Lewis H
dc.contributor.authorBrenner, Hermann
dc.contributor.authorGillum, Richard F
dc.contributor.authorMeisinger, Christa
dc.contributor.authorFord, Ian
dc.contributor.authorKnuiman, Matthew W
dc.contributor.authorRosengren, Annika
dc.contributor.authorLawlor, Debbie A
dc.contributor.authorVölzke, Henry
dc.contributor.authorCooper, Cyrus
dc.contributor.authorMarín Ibañez, Alejandro
dc.contributor.authorCasiglia, Edoardo
dc.contributor.authorKauhanen, Jussi
dc.contributor.authorCooper, Jackie A
dc.contributor.authorRodriguez, Beatriz
dc.contributor.authorSundström, Johan
dc.contributor.authorBarrett-Connor, Elizabeth
dc.contributor.authorDankner, Rachel
dc.contributor.authorNietert, Paul J
dc.contributor.authorDavidson, Karina W
dc.contributor.authorWallace, Robert B
dc.contributor.authorBlazer, Dan G
dc.contributor.authorBjörkelund, Cecilia
dc.contributor.authorDonfrancesco, Chiara
dc.contributor.authorKrumholz, Harlan M
dc.contributor.authorNissinen, Aulikki
dc.contributor.authorDavis, Barry R
dc.contributor.authorCoady, Sean
dc.contributor.authorWhincup, Peter H
dc.contributor.authorJørgensen, Torben
dc.contributor.authorDucimetiere, Pierre
dc.contributor.authorTrevisan, Maurizio
dc.contributor.authorEngström, Gunnar
dc.contributor.authorCrespo, Carlos J
dc.contributor.authorMeade, Tom W
dc.contributor.authorVisser, Marjolein
dc.contributor.authorKromhout, Daan
dc.contributor.authorKiechl, Stefan
dc.contributor.authorDaimon, Makoto
dc.contributor.authorPrice, Jackie F
dc.contributor.authorGómez de la Cámara, Agustin
dc.contributor.authorWouter Jukema, J
dc.contributor.authorLamarche, Benoît
dc.contributor.authorOnat, Altan
dc.contributor.authorSimons, Leon A
dc.contributor.authorKavousi, Maryam
dc.contributor.authorBen-Shlomo, Yoav
dc.contributor.authorGallacher, John
dc.contributor.authorDekker, Jacqueline M
dc.contributor.authorArima, Hisatomi
dc.contributor.authorShara, Nawar
dc.contributor.authorTipping, Robert W
dc.contributor.authorRoussel, Ronan
dc.contributor.authorBrunner, Eric J
dc.contributor.authorKoenig, Wolfgang
dc.contributor.authorSakurai, Masaru
dc.contributor.authorPavlovic, Jelena
dc.contributor.authorGansevoort, Ron T
dc.contributor.authorNagel, Dorothea
dc.contributor.authorGoldbourt, Uri
dc.contributor.authorBarr, Elizabeth LM
dc.contributor.authorPalmieri, Luigi
dc.contributor.authorNjølstad, Inger
dc.contributor.authorSato, Shinichi
dc.contributor.authorMonique Verschuren, WM
dc.contributor.authorVarghese, Cherian V
dc.contributor.authorGraham, Ian
dc.contributor.authorOnuma, Oyere
dc.contributor.authorGreenland, Philip
dc.contributor.authorWoodward, Mark
dc.contributor.authorEzzati, Majid
dc.contributor.authorPsaty, Bruce M
dc.contributor.authorSattar, Naveed
dc.contributor.authorJackson, Rod
dc.contributor.authorRidker, Paul M
dc.contributor.authorCook, Nancy R
dc.contributor.authorD'Agostino, Ralph B
dc.contributor.authorThompson, Simon G
dc.contributor.authorDanesh, John
dc.contributor.authorDi Angelantonio, Emanuele
dc.contributor.authorEmerging Risk Factors Collaboration
dc.date.accessioned2018-12-12T00:30:08Z
dc.date.available2018-12-12T00:30:08Z
dc.date.issued2019-02-14
dc.identifier.issn0195-668X
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/286673
dc.description.abstractAIMS: 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.
dc.format.mediumPrint
dc.languageeng
dc.publisherOxford University Press (OUP)
dc.rightsAttribution-NonCommercial 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.subjectEmerging Risk Factors Collaboration
dc.subjectHumans
dc.subjectCardiovascular Diseases
dc.subjectCalibration
dc.subjectRisk Assessment
dc.subjectProspective Studies
dc.subjectAlgorithms
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.titleEqualization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.
dc.typeArticle
prism.endingPage631
prism.issueIdentifier7
prism.publicationDate2019
prism.publicationNameEur Heart J
prism.startingPage621
prism.volume40
dc.identifier.doi10.17863/CAM.26008
dcterms.dateAccepted2018-10-04
rioxxterms.versionofrecord10.1093/eurheartj/ehy653
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2019-02
dc.contributor.orcidPennells, Lisa [0000-0002-8594-3061]
dc.contributor.orcidKaptoge, Stephen [0000-0002-1155-4872]
dc.contributor.orcidWood, Angela [0000-0002-7937-304X]
dc.contributor.orcidSweeting, Michael [0000-0003-0980-8965]
dc.contributor.orcidZhao, Xiaohui [0000-0001-9922-2815]
dc.contributor.orcidBurgess, Stephen [0000-0001-5365-8760]
dc.contributor.orcidDanesh, John [0000-0003-1158-6791]
dc.contributor.orcidDi Angelantonio, Emanuele [0000-0001-8776-6719]
dc.identifier.eissn1522-9645
rioxxterms.typeJournal Article/Review
pubs.funder-project-idBritish Heart Foundation (None)
pubs.funder-project-idBritish Heart Foundation (CH/12/2/29428)
pubs.funder-project-idWellcome Trust (204623/Z/16/Z)
pubs.funder-project-idMedical Research Council (G0701619)
pubs.funder-project-idMedical Research Council (MR/K014811/1)
pubs.funder-project-idMedical Research Council (G0401527)
pubs.funder-project-idMedical Research Council (G1000143)
pubs.funder-project-idMedical Research Council (MR/L003120/1)
pubs.funder-project-idMedical Research Council (G0800270)
pubs.funder-project-idMedical Research Council (MR/N003284/1)
pubs.funder-project-idEuropean Research Council (268834)
pubs.funder-project-idMedical Research Council (MC_UU_00002/7)
cam.issuedOnline2018-11-22


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Attribution-NonCommercial 4.0 International
Except where otherwise noted, this item's licence is described as Attribution-NonCommercial 4.0 International