Journal Article

DKFZ-2019-00675

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.

Pennells, L. ; Kaptoge, S. ; Wood, A. ; Sweeting, M. ; Zhao, X. ; White, I. ; Burgess, S. ; Willeit, P. ; Bolton, T. ; Moons, K. G. M. ; van der Schouw, Y. T. ; Selmer, R. ; Khaw, K.-T. ; Gudnason, V. ; Assmann, G. ; Amouyel, P. ; Salomaa, V. ; Kivimaki, M. ; Nordestgaard, B. G. ; Blaha, M. J. ; Kuller, L. H. ; Brenner, H.DKFZ* ; Gillum, R. F. ; Meisinger, C. ; Ford, I. ; Knuiman, M. W. ; Rosengren, A. ; Lawlor, D. A. ; Völzke, H. ; Cooper, C. ; Marín Ibañez, A. ; Casiglia, E. ; Kauhanen, J. ; Cooper, J. A. ; Rodriguez, B. ; Sundström, J. ; Barrett-Connor, E. ; Dankner, R. ; Nietert, P. J. ; Davidson, K. W. ; Wallace, R. B. ; Blazer, D. G. ; Björkelund, C. ; Donfrancesco, C. ; Krumholz, H. M. ; Nissinen, A. ; Davis, B. R. ; Coady, S. ; Whincup, P. H. ; Jørgensen, T. ; Ducimetiere, P. ; Trevisan, M. ; Engström, G. ; Crespo, C. J. ; Meade, T. W. ; Visser, M. ; Kromhout, D. ; Kiechl, S. ; Daimon, M. ; Price, J. F. ; Gómez de la Cámara, A. ; Wouter Jukema, J. ; Lamarche, B. ; Onat, A. ; Simons, L. A. ; Kavousi, M. ; Ben-Shlomo, Y. ; Gallacher, J. ; Dekker, J. M. ; Arima, H. ; Shara, N. ; Tipping, R. W. ; Roussel, R. ; Brunner, E. J. ; Koenig, W. ; Sakurai, M. ; Pavlovic, J. ; Gansevoort, R. T. ; Nagel, D. ; Goldbourt, U. ; Barr, E. L. M. ; Palmieri, L. ; Njølstad, I. ; Sato, S. ; Monique Verschuren, W. M. ; Varghese, C. V. ; Graham, I. ; Onuma, O. ; Greenland, P. ; Woodward, M. ; Ezzati, M. ; Psaty, B. M. ; Sattar, N. ; Jackson, R. ; Ridker, P. M. ; Cook, N. R. ; D'Agostino, R. B. ; Thompson, S. G. ; Danesh, J. ; Di Angelantonio, E. ; Emerging Risk Factors Collaboration (Collaboration Author)

2019
Oxford University Press Oxford

This record in other databases:  

Please use a persistent id in citations: doi:10.1093/eurheartj/ehy653

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.

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Contributing Institute(s):

1. C070 Klinische Epidemiologie und Alternf. (C070)

Research Program(s):

1. 323 - Metabolic Dysfunction as Risk Factor (POF3-323) (POF3-323)

Appears in the scientific report 2019

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Database coverage:
; BIOSIS Previews ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; IF >= 20 ; JCR ; NCBI Molecular Biology Database ; Nationallizenz ; PubMed Central ; SCOPUS ; Science Citation Index ; Science Citation Index Expanded ; Web of Science Core Collection

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