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

Pennells, L. et al. (2019) Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies. European Heart Journal, 40(7), pp. 621-631. (doi: 10.1093/eurheartj/ehy653) (PMID:30476079) (PMCID:PMC6374687)

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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.

Item Type:Articles
Additional Information:The work of the co-ordinating centre was funded by the UK Medical Research Council (G0800270), British Heart Foundation (SP/09/002), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, UK National Institute for Health Research Cambridge Biomedical Research Centre, European Research Council (268834), and European Commission Framework Programme 7 (HEALTH-F2-2012-279233). The Emerging Risk Factor Collaboration’s website https://www.phpc.cam.ac.uk/ceu/erfc/list-of-studies/ has compiled a list provided by investigators of some of the funders of the component studies in this analysis. I.W. was supported by the Medical Research Council Unit Programme MC_UU_12023/21. M.K. is supported by the Netherlands Organization for Scientific Research (NWO) Veni grant (Veni, 91616079). J.P. is supported by Erasmus Mundus Western Balkans (ERAWEB), a project funded by the European Commission.
Glasgow Author(s) Enlighten ID:Ford, Professor Ian and Sattar, Professor Naveed
Authors: 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., 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., and Di Angelantonio, E.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN (Online):1522-9645
Published Online:22 November 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in European Heart Journal 40(7): 621-631
Publisher Policy:Reproduced under a Creative Commons License

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