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

MedStar author(s):
Citation: European Heart Journal. 40(7):621-631, 2019 02 14.PMID: 30476079Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Algorithms | *Cardiovascular Diseases/et [Etiology] | Aged | Calibration | Female | Humans | Male | Middle Aged | Prospective Studies | Risk AssessmentYear: 2019Local holdings: Available online from MWHC library: 1996 - present (after 1 year), Available in print through MWHC library: 1999 - 2006ISSN:
  • 0195-668X
Name of journal: European heart journalAbstract: 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.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.Copyright (c) The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology.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.All authors: Amouyel P, Arima H, Assmann G, Barr ELM, Barrett-Connor E, Ben-Shlomo Y, Bjorkelund C, Blaha MJ, Blazer DG, Bolton T, Brenner H, Brunner EJ, Burgess S, Casiglia E, Coady S, Cook NR, Cooper C, Cooper JA, Crespo CJ, D'Agostino RB, Daimon M, Danesh J, Dankner R, Davidson KW, Davis BR, Dekker JM, Di Angelantonio E, Donfrancesco C, Ducimetiere P, Emerging Risk Factors Collaboration, Engstrom G, Ezzati M, Ford I, Gallacher J, Gansevoort RT, Gillum RF, Goldbourt U, Gomez de la Camara A, Graham I, Greenland P, Gudnason V, Jackson R, Jorgensen T, Kaptoge S, Kauhanen J, Kavousi M, Khaw KT, Kiechl S, Kivimaki M, Knuiman MW, Koenig W, Kromhout D, Krumholz HM, Kuller LH, Lamarche B, Lawlor DA, Marin Ibanez A, Meade TW, Meisinger C, Monique Verschuren WM, Moons KGM, Nagel D, Nietert PJ, Nissinen A, Njolstad I, Nordestgaard BG, Onat A, Onuma O, Palmieri L, Pavlovic J, Pennells L, Price JF, Psaty BM, Ridker PM, Rodriguez B, Rosengren A, Roussel R, Sakurai M, Salomaa V, Sato S, Sattar N, Selmer R, Shara N, Simons LA, Sundstrom J, Sweeting M, Thompson SG, Tipping RW, Trevisan M, van der Schouw YT, Varghese CV, Visser M, Volzke H, Wallace RB, Whincup PH, White I, Willeit P, Wood A, Woodward M, Wouter Jukema J, Zhao XOriginally published: European Heart Journal. 40(7):621-631, 2019 02 14.Fiscal year: FY2019Digital Object Identifier: Date added to catalog: 2018-12-14
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30476079 Available 30476079

Available online from MWHC library: 1996 - present (after 1 year), Available in print through MWHC library: 1999 - 2006

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.

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.

Copyright (c) The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology.

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.

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