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. Blaha & 200 others Lewis 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. Wouter 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. Goya 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, W. M.Monique Verschuren, Graham Watt, W. M.Monique Verschuren, 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. Michael Gaziano, Martin Shipley, Volker Arndt, Alejandro Marín Ibañez, Johanna M. Geleijnse

Research output: Contribution to JournalArticleAcademicpeer-review

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

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Meta-Analysis
Prospective Studies
Cardiovascular Diseases
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Health Services Needs and Demand
Population Characteristics
Primary Prevention
Calibration
Guidelines

Keywords

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

Cite this

Pennells, Lisa ; Kaptoge, Stephen ; Wood, Angela ; Sweeting, Mike ; Zhao, Xiaohui ; White, Ian ; Burgess, Stephen ; Willeit, Peter ; Bolton, Thomas ; Moons, Karel G.M. ; 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 L.M. ; Palmieri, Luigi ; Njølstad, Inger ; Sato, Shinichi ; Monique Verschuren, W. M. ; 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. ; Danesh, John ; Di Angelantonio, Emanuele ; Simpson, Lara M. ; Pressel, Sara L. ; Couper, David J. ; Nambi, Vijay ; Matsushita, Kunihiro ; Folsom, Aaron R. ; Shaw, Jonathan E. ; Magliano, Dianna J. ; Zimmet, Paul Z. ; Wannamethee, S. Goya ; Willeit, Johann ; Santer, Peter ; Egger, Georg ; Casas, Juan Pablo ; Amuzu, Antointtte ; Tikhonoff, Valérie ; Sutherland, Susan E. ; Cushman, Mary ; Søgaard, Anne Johanne ; Håheim, Lise Lund ; Ariansen, Inger ; Tybjærg-Hansen, Anne ; Jensen, Gorm B. ; Schnohr, Peter ; Giampaoli, Simona ; Vanuzzo, Diego ; Panico, Salvatore ; Balkau, Beverley ; Bonnet, Fabrice ; Marre, Michel ; De La Cámara, Agustin Gómez ; Rubio Herrera, Miguel Angel ; Friedlander, Yechiel ; McCallum, John ; McLachlan, Stela ; Guralnik, Jack ; Phillips, Caroline L. ; Wareham, Nick ; Schöttker, Ben ; Saum, Kai Uwe ; Holleczek, Bernd ; Tolonen, Hanna ; Vartiainen, Erkki ; Jousilahti, Pekka ; Harald, Kennet ; Massaro, Joseph M. ; Pencina, Michael ; Vasan, Ramachandran ; Kayama, Takamasa ; Kato, Takeo ; Oizumi, Toshihide ; Jespersen, Jørgen ; Møller, Lars ; Bladbjerg, Else Marie ; Chetrit, A. ; Wilhelmsen, Lars ; Lissner, Lauren ; Dennison, Elaine ; Kiyohara, Yutaka ; Ninomiya, Toshiharu ; Doi, Yasufumi ; Nijpels, Giel ; Stehouwer, Coen D.A. ; Kazumasa, Yamagishi ; Iso, Hiroyasu ; Kurl, Sudhir ; Tuomainen, Tomi Pekka ; Salonen, Jukka T. ; Deeg, Dorly J.H. ; Nilsson, Peter M. ; Bo, Hedblad ; Melander, Olle ; De Boer, Ian H. ; DeFilippis, Andrew Paul ; Verschuren, W. M.Monique ; Watt, Graham ; Verschuren, W. M.Monique ; Tverdal, Aage ; Kirkland, Susan ; Shimbo, Daichi ; Shaffer, Jonathan ; Bakker, Stephan J.L. ; Van Der Harst, Pim ; Hillege, Hans L. ; Dallongeville, Jean ; Schulte, Helmut ; Trompet, Stella ; Smit, Roelof A.J. ; Stott, David J. ; Després, Jean Pierre ; Cantin, Bernard ; Dagenais, Gilles R. ; Laughlin, Gail ; Wingard, Deborah ; Aspelund, Thor ; Eiriksdottir, Gudny ; Gudmundsson, Elias Freyr ; Ikram, Arfan ; Van Rooij, Frank J.A. ; Franco, Oscar H. ; Rueda-Ochoa, Oscar L. ; Muka, Taulant ; Glisic, Marija ; Tunstall-Pedoe, Hugh ; Howard, Barbara V. ; Ying, Zhang ; Jolly, Stacey ; Davey-Smith, George ; Can, Günay ; Yüksel, Hüsniye ; Nakagawa, Hideaki ; Morikawa, Yuko ; Miura, Katsuyuki ; Ingelsson, Martin ; Giedraitis, Vilmantas ; Gaziano, J. Michael ; Shipley, Martin ; Arndt, Volker ; Ibañez, Alejandro Marín ; Geleijnse, Johanna M. / Equalization of four cardiovascular risk algorithms after systematic recalibration : Individual-participant meta-analysis of 86 prospective studies. In: European Heart Journal. 2019 ; Vol. 40, No. 7. pp. 621-631.
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title = "Equalization of four cardiovascular risk algorithms after systematic recalibration: Individual-participant meta-analysis of 86 prospective studies",
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 = "Calibration, Cardiovascular disease, Discrimination, Risk algorithms, Risk prediction",
author = "Lisa Pennells and Stephen Kaptoge and Angela Wood and Mike Sweeting and Xiaohui Zhao and Ian White and Stephen Burgess and Peter Willeit and Thomas Bolton and Moons, {Karel G.M.} and {Van Der Schouw}, {Yvonne T.} and Randi Selmer and Khaw, {Kay Tee} and Vilmundur Gudnason and Gerd Assmann and Philippe Amouyel and Veikko Salomaa and Mika Kivimaki and Nordestgaard, {B{\o}rge G.} and Blaha, {Michael J.} and Kuller, {Lewis H.} and Hermann Brenner and Gillum, {Richard F.} and Christa Meisinger and Ian Ford and Knuiman, {Matthew W.} and Annika Rosengren and Lawlor, {Debbie A.} and Henry V{\"o}lzke and Cyrus Cooper and {Mar{\'i}n Iba{\~n}ez}, Alejandro and Edoardo Casiglia and Jussi Kauhanen and Cooper, {Jackie A.} and Beatriz Rodriguez and Johan Sundstr{\"o}m and Elizabeth Barrett-Connor and Rachel Dankner and Nietert, {Paul J.} and Davidson, {Karina W.} and Wallace, {Robert B.} and Blazer, {Dan G.} and Cecilia Bj{\"o}rkelund and Chiara Donfrancesco and Krumholz, {Harlan M.} and Aulikki Nissinen and Davis, {Barry R.} and Sean Coady and Whincup, {Peter H.} and Torben J{\o}rgensen and Pierre Ducimetiere and Maurizio Trevisan and Gunnar Engstr{\"o}m and Crespo, {Carlos J.} and Meade, {Tom W.} and Marjolein Visser and Daan Kromhout and Stefan Kiechl and Makoto Daimon and Price, {Jackie F.} and {G{\'o}mez De La C{\'a}mara}, Agustin and {Wouter Jukema}, J. and Beno{\^i}t Lamarche and Altan Onat and Simons, {Leon A.} and Maryam Kavousi and Yoav Ben-Shlomo and John Gallacher and Dekker, {Jacqueline M.} and Hisatomi Arima and Nawar Shara and Tipping, {Robert W.} and Ronan Roussel and Brunner, {Eric J.} and Wolfgang Koenig and Masaru Sakurai and Jelena Pavlovic and Gansevoort, {Ron T.} and Dorothea Nagel and Uri Goldbourt and Barr, {Elizabeth L.M.} and Luigi Palmieri and Inger Nj{\o}lstad and Shinichi Sato and {Monique Verschuren}, {W. M.} and Varghese, {Cherian V.} and Ian Graham and Oyere Onuma and Philip Greenland and Mark Woodward and Majid Ezzati and Psaty, {Bruce M.} and Naveed Sattar and Rod Jackson and Ridker, {Paul M.} and Cook, {Nancy R.} and D'Agostino, {Ralph B.} and Thompson, {Simon G.} and John Danesh and {Di Angelantonio}, Emanuele and Simpson, {Lara M.} and Pressel, {Sara L.} and Couper, {David J.} and Vijay Nambi and Kunihiro Matsushita and Folsom, {Aaron R.} and Shaw, {Jonathan E.} and Magliano, {Dianna J.} and Zimmet, {Paul Z.} and Wannamethee, {S. Goya} and Johann Willeit and Peter Santer and Georg Egger and Casas, {Juan Pablo} and Antointtte Amuzu and Val{\'e}rie Tikhonoff and Sutherland, {Susan E.} and Mary Cushman and S{\o}gaard, {Anne Johanne} and H{\aa}heim, {Lise Lund} and Inger Ariansen and Anne Tybj{\ae}rg-Hansen and Jensen, {Gorm B.} and Peter Schnohr and Simona Giampaoli and Diego Vanuzzo and Salvatore Panico and Beverley Balkau and Fabrice Bonnet and Michel Marre and {De La C{\'a}mara}, {Agustin G{\'o}mez} and {Rubio Herrera}, {Miguel Angel} and Yechiel Friedlander and John McCallum and Stela McLachlan and Jack Guralnik and Phillips, {Caroline L.} and Nick Wareham and Ben Sch{\"o}ttker and Saum, {Kai Uwe} and Bernd Holleczek and Hanna Tolonen and Erkki Vartiainen and Pekka Jousilahti and Kennet Harald and Massaro, {Joseph M.} and Michael Pencina and Ramachandran Vasan and Takamasa Kayama and Takeo Kato and Toshihide Oizumi and J{\o}rgen Jespersen and Lars M{\o}ller and Bladbjerg, {Else Marie} and A. Chetrit and Lars Wilhelmsen and Lauren Lissner and Elaine Dennison and Yutaka Kiyohara and Toshiharu Ninomiya and Yasufumi Doi and Giel Nijpels and Stehouwer, {Coen D.A.} and Yamagishi Kazumasa and Hiroyasu Iso and Sudhir Kurl and Tuomainen, {Tomi Pekka} and Salonen, {Jukka T.} and Deeg, {Dorly J.H.} and Nilsson, {Peter M.} and Hedblad Bo and Olle Melander and {De Boer}, {Ian H.} and DeFilippis, {Andrew Paul} and Verschuren, {W. M.Monique} and Graham Watt and Verschuren, {W. M.Monique} and Aage Tverdal and Susan Kirkland and Daichi Shimbo and Jonathan Shaffer and Bakker, {Stephan J.L.} and {Van Der Harst}, Pim and Hillege, {Hans L.} and Jean Dallongeville and Helmut Schulte and Stella Trompet and Smit, {Roelof A.J.} and Stott, {David J.} and Despr{\'e}s, {Jean Pierre} and Bernard Cantin and Dagenais, {Gilles R.} and Gail Laughlin and Deborah Wingard and Thor Aspelund and Gudny Eiriksdottir and Gudmundsson, {Elias Freyr} and Arfan Ikram and {Van Rooij}, {Frank J.A.} and Franco, {Oscar H.} and Rueda-Ochoa, {Oscar L.} and Taulant Muka and Marija Glisic and Hugh Tunstall-Pedoe and Howard, {Barbara V.} and Zhang Ying and Stacey Jolly and George Davey-Smith and G{\"u}nay Can and H{\"u}sniye Y{\"u}ksel and Hideaki Nakagawa and Yuko Morikawa and Katsuyuki Miura and Martin Ingelsson and Vilmantas Giedraitis and Gaziano, {J. Michael} and Martin Shipley and Volker Arndt and Iba{\~n}ez, {Alejandro Mar{\'i}n} and Geleijnse, {Johanna M.}",
year = "2019",
month = "2",
day = "14",
doi = "10.1093/eurheartj/ehy653",
language = "English",
volume = "40",
pages = "621--631",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "7",

}

Pennells, L, Kaptoge, S, Wood, A, Sweeting, M, Zhao, X, White, I, Burgess, S, Willeit, P, Bolton, T, Moons, KGM, Van Der Schouw, YT, Selmer, R, Khaw, KT, Gudnason, V, Assmann, G, Amouyel, P, Salomaa, V, Kivimaki, M, Nordestgaard, BG, Blaha, MJ, Kuller, LH, Brenner, H, Gillum, RF, Meisinger, C, Ford, I, Knuiman, MW, Rosengren, A, Lawlor, DA, Völzke, H, Cooper, C, Marín Ibañez, A, Casiglia, E, Kauhanen, J, Cooper, JA, Rodriguez, B, Sundström, J, Barrett-Connor, E, Dankner, R, Nietert, PJ, Davidson, KW, Wallace, RB, Blazer, DG, Björkelund, C, Donfrancesco, C, Krumholz, HM, Nissinen, A, Davis, BR, Coady, S, Whincup, PH, Jørgensen, T, Ducimetiere, P, Trevisan, M, Engström, G, Crespo, CJ, Meade, TW, Visser, M, Kromhout, D, Kiechl, S, Daimon, M, Price, JF, Gómez De La Cámara, A, Wouter Jukema, J, Lamarche, B, Onat, A, Simons, LA, Kavousi, M, Ben-Shlomo, Y, Gallacher, J, Dekker, JM, Arima, H, Shara, N, Tipping, RW, Roussel, R, Brunner, EJ, Koenig, W, Sakurai, M, Pavlovic, J, Gansevoort, RT, Nagel, D, Goldbourt, U, Barr, ELM, Palmieri, L, Njølstad, I, Sato, S, Monique Verschuren, WM, Varghese, CV, Graham, I, Onuma, O, Greenland, P, Woodward, M, Ezzati, M, Psaty, BM, Sattar, N, Jackson, R, Ridker, PM, Cook, NR, D'Agostino, RB, Thompson, SG, Danesh, J, Di Angelantonio, E, Simpson, LM, Pressel, SL, Couper, DJ, Nambi, V, Matsushita, K, Folsom, AR, Shaw, JE, Magliano, DJ, Zimmet, PZ, Wannamethee, SG, Willeit, J, Santer, P, Egger, G, Casas, JP, Amuzu, A, Tikhonoff, V, Sutherland, SE, Cushman, M, Søgaard, AJ, Håheim, LL, Ariansen, I, Tybjærg-Hansen, A, Jensen, GB, Schnohr, P, Giampaoli, S, Vanuzzo, D, Panico, S, Balkau, B, Bonnet, F, Marre, M, De La Cámara, AG, Rubio Herrera, MA, Friedlander, Y, McCallum, J, McLachlan, S, Guralnik, J, Phillips, CL, Wareham, N, Schöttker, B, Saum, KU, Holleczek, B, Tolonen, H, Vartiainen, E, Jousilahti, P, Harald, K, Massaro, JM, Pencina, M, Vasan, R, Kayama, T, Kato, T, Oizumi, T, Jespersen, J, Møller, L, Bladbjerg, EM, Chetrit, A, Wilhelmsen, L, Lissner, L, Dennison, E, Kiyohara, Y, Ninomiya, T, Doi, Y, Nijpels, G, Stehouwer, CDA, Kazumasa, Y, Iso, H, Kurl, S, Tuomainen, TP, Salonen, JT, Deeg, DJH, Nilsson, PM, Bo, H, Melander, O, De Boer, IH, DeFilippis, AP, Verschuren, WMM, Watt, G, Verschuren, WMM, Tverdal, A, Kirkland, S, Shimbo, D, Shaffer, J, Bakker, SJL, Van Der Harst, P, Hillege, HL, Dallongeville, J, Schulte, H, Trompet, S, Smit, RAJ, Stott, DJ, Després, JP, Cantin, B, Dagenais, GR, Laughlin, G, Wingard, D, Aspelund, T, Eiriksdottir, G, Gudmundsson, EF, Ikram, A, Van Rooij, FJA, Franco, OH, Rueda-Ochoa, OL, Muka, T, Glisic, M, Tunstall-Pedoe, H, Howard, BV, Ying, Z, Jolly, S, Davey-Smith, G, Can, G, Yüksel, H, Nakagawa, H, Morikawa, Y, Miura, K, Ingelsson, M, Giedraitis, V, Gaziano, JM, Shipley, M, Arndt, V, Ibañez, AM & Geleijnse, JM 2019, 'Equalization of four cardiovascular risk algorithms after systematic recalibration: Individual-participant meta-analysis of 86 prospective studies' European Heart Journal, vol. 40, no. 7, pp. 621-631. https://doi.org/10.1093/eurheartj/ehy653

Equalization of four cardiovascular risk algorithms after systematic recalibration : Individual-participant meta-analysis of 86 prospective studies. / Pennells, Lisa; Kaptoge, Stephen; Wood, Angela; Sweeting, Mike; Zhao, Xiaohui; White, Ian; Burgess, Stephen; Willeit, Peter; Bolton, Thomas; Moons, Karel G.M.; 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 L.M.; Palmieri, Luigi; Njølstad, Inger; Sato, Shinichi; Monique Verschuren, W. M.; 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.; Danesh, John; Di Angelantonio, Emanuele; Simpson, Lara M.; Pressel, Sara L.; Couper, David J.; Nambi, Vijay; Matsushita, Kunihiro; Folsom, Aaron R.; Shaw, Jonathan E.; Magliano, Dianna J.; Zimmet, Paul Z.; Wannamethee, S. Goya; Willeit, Johann; Santer, Peter; Egger, Georg; Casas, Juan Pablo; Amuzu, Antointtte; Tikhonoff, Valérie; Sutherland, Susan E.; Cushman, Mary; Søgaard, Anne Johanne; Håheim, Lise Lund; Ariansen, Inger; Tybjærg-Hansen, Anne; Jensen, Gorm B.; Schnohr, Peter; Giampaoli, Simona; Vanuzzo, Diego; Panico, Salvatore; Balkau, Beverley; Bonnet, Fabrice; Marre, Michel; De La Cámara, Agustin Gómez; Rubio Herrera, Miguel Angel; Friedlander, Yechiel; McCallum, John; McLachlan, Stela; Guralnik, Jack; Phillips, Caroline L.; Wareham, Nick; Schöttker, Ben; Saum, Kai Uwe; Holleczek, Bernd; Tolonen, Hanna; Vartiainen, Erkki; Jousilahti, Pekka; Harald, Kennet; Massaro, Joseph M.; Pencina, Michael; Vasan, Ramachandran; Kayama, Takamasa; Kato, Takeo; Oizumi, Toshihide; Jespersen, Jørgen; Møller, Lars; Bladbjerg, Else Marie; Chetrit, A.; Wilhelmsen, Lars; Lissner, Lauren; Dennison, Elaine; Kiyohara, Yutaka; Ninomiya, Toshiharu; Doi, Yasufumi; Nijpels, Giel; Stehouwer, Coen D.A.; Kazumasa, Yamagishi; Iso, Hiroyasu; Kurl, Sudhir; Tuomainen, Tomi Pekka; Salonen, Jukka T.; Deeg, Dorly J.H.; Nilsson, Peter M.; Bo, Hedblad; Melander, Olle; De Boer, Ian H.; DeFilippis, Andrew Paul; Verschuren, W. M.Monique; Watt, Graham; Verschuren, W. M.Monique; Tverdal, Aage; Kirkland, Susan; Shimbo, Daichi; Shaffer, Jonathan; Bakker, Stephan J.L.; Van Der Harst, Pim; Hillege, Hans L.; Dallongeville, Jean; Schulte, Helmut; Trompet, Stella; Smit, Roelof A.J.; Stott, David J.; Després, Jean Pierre; Cantin, Bernard; Dagenais, Gilles R.; Laughlin, Gail; Wingard, Deborah; Aspelund, Thor; Eiriksdottir, Gudny; Gudmundsson, Elias Freyr; Ikram, Arfan; Van Rooij, Frank J.A.; Franco, Oscar H.; Rueda-Ochoa, Oscar L.; Muka, Taulant; Glisic, Marija; Tunstall-Pedoe, Hugh; Howard, Barbara V.; Ying, Zhang; Jolly, Stacey; Davey-Smith, George; Can, Günay; Yüksel, Hüsniye; Nakagawa, Hideaki; Morikawa, Yuko; Miura, Katsuyuki; Ingelsson, Martin; Giedraitis, Vilmantas; Gaziano, J. Michael; Shipley, Martin; Arndt, Volker; Ibañez, Alejandro Marín; Geleijnse, Johanna M.

In: European Heart Journal, Vol. 40, No. 7, 14.02.2019, p. 621-631.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Equalization of four cardiovascular risk algorithms after systematic recalibration

T2 - Individual-participant meta-analysis of 86 prospective studies

AU - Pennells, Lisa

AU - Kaptoge, Stephen

AU - Wood, Angela

AU - Sweeting, Mike

AU - Zhao, Xiaohui

AU - White, Ian

AU - Burgess, Stephen

AU - Willeit, Peter

AU - Bolton, Thomas

AU - Moons, Karel G.M.

AU - Van Der Schouw, Yvonne T.

AU - Selmer, Randi

AU - Khaw, Kay Tee

AU - Gudnason, Vilmundur

AU - Assmann, Gerd

AU - Amouyel, Philippe

AU - Salomaa, Veikko

AU - Kivimaki, Mika

AU - Nordestgaard, Børge G.

AU - Blaha, Michael J.

AU - Kuller, Lewis H.

AU - Brenner, Hermann

AU - Gillum, Richard F.

AU - Meisinger, Christa

AU - Ford, Ian

AU - Knuiman, Matthew W.

AU - Rosengren, Annika

AU - Lawlor, Debbie A.

AU - Völzke, Henry

AU - Cooper, Cyrus

AU - Marín Ibañez, Alejandro

AU - Casiglia, Edoardo

AU - Kauhanen, Jussi

AU - Cooper, Jackie A.

AU - Rodriguez, Beatriz

AU - Sundström, Johan

AU - Barrett-Connor, Elizabeth

AU - Dankner, Rachel

AU - Nietert, Paul J.

AU - Davidson, Karina W.

AU - Wallace, Robert B.

AU - Blazer, Dan G.

AU - Björkelund, Cecilia

AU - Donfrancesco, Chiara

AU - Krumholz, Harlan M.

AU - Nissinen, Aulikki

AU - Davis, Barry R.

AU - Coady, Sean

AU - Whincup, Peter H.

AU - Jørgensen, Torben

AU - Ducimetiere, Pierre

AU - Trevisan, Maurizio

AU - Engström, Gunnar

AU - Crespo, Carlos J.

AU - Meade, Tom W.

AU - Visser, Marjolein

AU - Kromhout, Daan

AU - Kiechl, Stefan

AU - Daimon, Makoto

AU - Price, Jackie F.

AU - Gómez De La Cámara, Agustin

AU - Wouter Jukema, J.

AU - Lamarche, Benoît

AU - Onat, Altan

AU - Simons, Leon A.

AU - Kavousi, Maryam

AU - Ben-Shlomo, Yoav

AU - Gallacher, John

AU - Dekker, Jacqueline M.

AU - Arima, Hisatomi

AU - Shara, Nawar

AU - Tipping, Robert W.

AU - Roussel, Ronan

AU - Brunner, Eric J.

AU - Koenig, Wolfgang

AU - Sakurai, Masaru

AU - Pavlovic, Jelena

AU - Gansevoort, Ron T.

AU - Nagel, Dorothea

AU - Goldbourt, Uri

AU - Barr, Elizabeth L.M.

AU - Palmieri, Luigi

AU - Njølstad, Inger

AU - Sato, Shinichi

AU - Monique Verschuren, W. M.

AU - Varghese, Cherian V.

AU - Graham, Ian

AU - Onuma, Oyere

AU - Greenland, Philip

AU - Woodward, Mark

AU - Ezzati, Majid

AU - Psaty, Bruce M.

AU - Sattar, Naveed

AU - Jackson, Rod

AU - Ridker, Paul M.

AU - Cook, Nancy R.

AU - D'Agostino, Ralph B.

AU - Thompson, Simon G.

AU - Danesh, John

AU - Di Angelantonio, Emanuele

AU - Simpson, Lara M.

AU - Pressel, Sara L.

AU - Couper, David J.

AU - Nambi, Vijay

AU - Matsushita, Kunihiro

AU - Folsom, Aaron R.

AU - Shaw, Jonathan E.

AU - Magliano, Dianna J.

AU - Zimmet, Paul Z.

AU - Wannamethee, S. Goya

AU - Willeit, Johann

AU - Santer, Peter

AU - Egger, Georg

AU - Casas, Juan Pablo

AU - Amuzu, Antointtte

AU - Tikhonoff, Valérie

AU - Sutherland, Susan E.

AU - Cushman, Mary

AU - Søgaard, Anne Johanne

AU - Håheim, Lise Lund

AU - Ariansen, Inger

AU - Tybjærg-Hansen, Anne

AU - Jensen, Gorm B.

AU - Schnohr, Peter

AU - Giampaoli, Simona

AU - Vanuzzo, Diego

AU - Panico, Salvatore

AU - Balkau, Beverley

AU - Bonnet, Fabrice

AU - Marre, Michel

AU - De La Cámara, Agustin Gómez

AU - Rubio Herrera, Miguel Angel

AU - Friedlander, Yechiel

AU - McCallum, John

AU - McLachlan, Stela

AU - Guralnik, Jack

AU - Phillips, Caroline L.

AU - Wareham, Nick

AU - Schöttker, Ben

AU - Saum, Kai Uwe

AU - Holleczek, Bernd

AU - Tolonen, Hanna

AU - Vartiainen, Erkki

AU - Jousilahti, Pekka

AU - Harald, Kennet

AU - Massaro, Joseph M.

AU - Pencina, Michael

AU - Vasan, Ramachandran

AU - Kayama, Takamasa

AU - Kato, Takeo

AU - Oizumi, Toshihide

AU - Jespersen, Jørgen

AU - Møller, Lars

AU - Bladbjerg, Else Marie

AU - Chetrit, A.

AU - Wilhelmsen, Lars

AU - Lissner, Lauren

AU - Dennison, Elaine

AU - Kiyohara, Yutaka

AU - Ninomiya, Toshiharu

AU - Doi, Yasufumi

AU - Nijpels, Giel

AU - Stehouwer, Coen D.A.

AU - Kazumasa, Yamagishi

AU - Iso, Hiroyasu

AU - Kurl, Sudhir

AU - Tuomainen, Tomi Pekka

AU - Salonen, Jukka T.

AU - Deeg, Dorly J.H.

AU - Nilsson, Peter M.

AU - Bo, Hedblad

AU - Melander, Olle

AU - De Boer, Ian H.

AU - DeFilippis, Andrew Paul

AU - Verschuren, W. M.Monique

AU - Watt, Graham

AU - Verschuren, W. M.Monique

AU - Tverdal, Aage

AU - Kirkland, Susan

AU - Shimbo, Daichi

AU - Shaffer, Jonathan

AU - Bakker, Stephan J.L.

AU - Van Der Harst, Pim

AU - Hillege, Hans L.

AU - Dallongeville, Jean

AU - Schulte, Helmut

AU - Trompet, Stella

AU - Smit, Roelof A.J.

AU - Stott, David J.

AU - Després, Jean Pierre

AU - Cantin, Bernard

AU - Dagenais, Gilles R.

AU - Laughlin, Gail

AU - Wingard, Deborah

AU - Aspelund, Thor

AU - Eiriksdottir, Gudny

AU - Gudmundsson, Elias Freyr

AU - Ikram, Arfan

AU - Van Rooij, Frank J.A.

AU - Franco, Oscar H.

AU - Rueda-Ochoa, Oscar L.

AU - Muka, Taulant

AU - Glisic, Marija

AU - Tunstall-Pedoe, Hugh

AU - Howard, Barbara V.

AU - Ying, Zhang

AU - Jolly, Stacey

AU - Davey-Smith, George

AU - Can, Günay

AU - Yüksel, Hüsniye

AU - Nakagawa, Hideaki

AU - Morikawa, Yuko

AU - Miura, Katsuyuki

AU - Ingelsson, Martin

AU - Giedraitis, Vilmantas

AU - Gaziano, J. Michael

AU - Shipley, Martin

AU - Arndt, Volker

AU - Ibañez, Alejandro Marín

AU - Geleijnse, Johanna M.

PY - 2019/2/14

Y1 - 2019/2/14

N2 - 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.

AB - 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.

KW - Calibration

KW - Cardiovascular disease

KW - Discrimination

KW - Risk algorithms

KW - Risk prediction

UR - http://www.scopus.com/inward/record.url?scp=85061592905&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061592905&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehy653

DO - 10.1093/eurheartj/ehy653

M3 - Article

VL - 40

SP - 621

EP - 631

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 7

ER -