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

Lisa Pennells, Stephen Kaptoge, Angela Wood, Mike Sweeting, Xiaohui Zhao, Ian White, Stephen Burgess, Peter Willeit, Thomas Bolton, Karel G.M. Moons, Yvonne T. Van Der Schouw, Randi Selmer, Kay Tee Khaw, Vilmundur Gudnason, Gerd Assmann, Philippe Amouyel, Veikko Salomaa, Mika Kivimaki, Børge G. Nordestgaard, Michael J. BlahaLewis H. Kuller, Hermann Brenner, Richard F. Gillum, Christa Meisinger, Ian Ford, Matthew W. Knuiman, Annika Rosengren, Debbie A. Lawlor, Henry Völzke, Cyrus Cooper, Alejandro Marín Ibañez, Edoardo Casiglia, Jussi Kauhanen, Jackie A. Cooper, Beatriz Rodriguez, Johan Sundström, Elizabeth Barrett-Connor, Rachel Dankner, Paul J. Nietert, Karina W. Davidson, Robert B. Wallace, Dan G. Blazer, Cecilia Björkelund, Chiara Donfrancesco, Harlan M. Krumholz, Aulikki Nissinen, Barry R. Davis, Sean Coady, Peter H. Whincup, Torben Jørgensen, Pierre Ducimetiere, Maurizio Trevisan, Gunnar Engström, Carlos J. Crespo, Tom W. Meade, Marjolein Visser, Daan Kromhout, Stefan Kiechl, Makoto Daimon, Jackie F. Price, Agustin Gómez De La Cámara, J.W. Jukema, Benoît Lamarche, Altan Onat, Leon A. Simons, Maryam Kavousi, Yoav Ben-Shlomo, John Gallacher, Jacqueline M. Dekker, Hisatomi Arima, Nawar Shara, Robert W. Tipping, Ronan Roussel, Eric J. Brunner, Wolfgang Koenig, Masaru Sakurai, Jelena Pavlovic, Ron T. Gansevoort, Dorothea Nagel, Uri Goldbourt, Elizabeth L.M. Barr, Luigi Palmieri, Inger Njølstad, Shinichi Sato, W.M. Monique Verschuren, Cherian V. Varghese, Ian Graham, Oyere Onuma, Philip Greenland, Mark Woodward, Majid Ezzati, Bruce M. Psaty, Naveed Sattar, Rod Jackson, Paul M. Ridker, Nancy R. Cook, Ralph B. D'Agostino, Simon G. Thompson, John Danesh, Emanuele Di Angelantonio*, Lara M. Simpson, Sara L. Pressel, David J. Couper, Vijay Nambi, Kunihiro Matsushita, Aaron R. Folsom, Jonathan E. Shaw, Dianna J. Magliano, Paul Z. Zimmet, S.G. Wannamethee, Johann Willeit, Peter Santer, Georg Egger, Juan Pablo Casas, Antointtte Amuzu, Valérie Tikhonoff, Susan E. Sutherland, Mary Cushman, Anne Johanne Søgaard, Lise Lund Håheim, Inger Ariansen, Anne Tybjærg-Hansen, Gorm B. Jensen, Peter Schnohr, Simona Giampaoli, Diego Vanuzzo, Salvatore Panico, Beverley Balkau, Fabrice Bonnet, Michel Marre, Agustin Gómez De La Cámara, Miguel Angel Rubio Herrera, Yechiel Friedlander, John McCallum, Stela McLachlan, Jack Guralnik, Caroline L. Phillips, Nick Wareham, Ben Schöttker, Kai Uwe Saum, Bernd Holleczek, Hanna Tolonen, Erkki Vartiainen, Pekka Jousilahti, Kennet Harald, Joseph M. Massaro, Michael Pencina, Ramachandran Vasan, Takamasa Kayama, Takeo Kato, Toshihide Oizumi, Jørgen Jespersen, Lars Møller, Else Marie Bladbjerg, A. Chetrit, Lars Wilhelmsen, Lauren Lissner, Elaine Dennison, Yutaka Kiyohara, Toshiharu Ninomiya, Yasufumi Doi, Giel Nijpels, Coen D.A. Stehouwer, Yamagishi Kazumasa, Hiroyasu Iso, Sudhir Kurl, Tomi Pekka Tuomainen, Jukka T. Salonen, Dorly J.H. Deeg, Peter M. Nilsson, Hedblad Bo, Olle Melander, Ian H. De Boer, Andrew Paul DeFilippis, Graham Watt, Aage Tverdal, Susan Kirkland, Daichi Shimbo, Jonathan Shaffer, Stephan J.L. Bakker, Pim Van Der Harst, Hans L. Hillege, Jean Dallongeville, Helmut Schulte, Stella Trompet, Roelof A.J. Smit, David J. Stott, Jean Pierre Després, Bernard Cantin, Gilles R. Dagenais, Gail Laughlin, Deborah Wingard, Thor Aspelund, Gudny Eiriksdottir, Elias Freyr Gudmundsson, Arfan Ikram, Frank J.A. Van Rooij, Oscar H. Franco, Oscar L. Rueda-Ochoa, Taulant Muka, Marija Glisic, Hugh Tunstall-Pedoe, Barbara V. Howard, Zhang Ying, Stacey Jolly, George Davey-Smith, Günay Can, Hüsniye Yüksel, Hideaki Nakagawa, Yuko Morikawa, Katsuyuki Miura, Martin Ingelsson, Vilmantas Giedraitis, J.M. Gaziano, Martin Shipley, Volker Arndt, Alejandro Marín Ibañez, Johanna M. Geleijnse

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

26 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)621-631
Number of pages11
JournalEuropean Heart Journal
Volume40
Issue number7
DOIs
Publication statusPublished - 14 Feb 2019

Keywords

  • Calibration
  • Cardiovascular disease
  • Discrimination
  • Risk algorithms
  • Risk prediction

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