Evidence map›Paper›PMID 30476079›Full record

SynthesisEuropean heart journal2019

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 and 91 more

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
82citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

82 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Article
  6. Review
  7. Article
  8. Article
  9. Article
  10. Article
  11. Statins for primary prevention of cardiovascular disease in Germany: benefits and costs.Clinical research in cardiology : official journal of the German Cardiac Society · 2026
    Article
  12. Article
  13. Review
  14. Article
  15. Cardiovascular Risk Prediction in Older Adults.Current atherosclerosis reports · 2025
    Review
  16. Tailoring cardiovascular risk prediction to females.The Journal of endocrinology · 2025
    Review
  17. Article
  18. Article
  19. Article
  20. Article

22 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

101 authors.

Lisa PennellsDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
Stephen KaptogeDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
Angela WoodDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
Mike SweetingDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
Xiaohui ZhaoDepartment of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, UK.
Ian WhiteMRC Clinical Trials Unit, University College London, 90 High Holborn, London, UK.
Stephen BurgessDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
Peter WilleitDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
Thomas BoltonDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
Karel G M MoonsEpidemiology: Methodology, Julius Center Research Program Methodology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, the Netherlands.
Yvonne T van der SchouwDepartment of Epidemiology, Julius Center Research Program Cardiovascular Epidemiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, the Netherlands.
Randi SelmerDivision of Epidemiology, Norwegian Institute of Public Health, Postboks 222 Skøyen, Oslo, Norway.
Kay-Tee KhawDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
Vilmundur GudnasonIcelandic Heart Association, Hjartavernd Holtasmá¡ri 1, Kópavogur, Iceland.
Gerd AssmannAssmann-Foundation for Prevention, Gronowskistraße 33, Münster, Germany.
Philippe AmouyelInstitut Pasteur de Lille, 1 rue du Professeur Calmette, Lille, France.
Veikko SalomaaNational Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland.
Mika KivimakiDepartment of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, UK.
Børge G NordestgaardDepartment of Clinical Medicine, Copenhagen University Hospital, Blegdamsvej 3, Copenhagen, Denmark.
Michael J BlahaCiccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, USA.
Lewis H KullerDepartment of Epidemiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA.
Hermann BrennerDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Neuenheimer Feld 581, Heidelberg, Germany.
Richard F GillumDepartment of Medicine, Howard University College of Medicine, 2041 Georgia Avenue, Washington, DC, USA.
Christa MeisingerGerman Research Center for Environmental Health, Ingolstädter Landstraße 1, Neuherberg, Germany.
Ian FordInstitute of Health & Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow, UK.
Matthew W KnuimanFaculty of Health and Medical Sciences, School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Perth, Western Australia, Australia.
Annika RosengrenSahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, Gothenburg, Sweden.
Debbie A LawlorDepartment of Social Medicine, University of Bristol, Bristol, UK.
Henry VölzkeInstitute of Community Medicine, University of Greifswald, Ellernholzstraße 1/2, Greifswald, Germany.
Cyrus CooperMRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Rd, Southampton, UK.
Alejandro Marín IbañezSan Jose Norte Health Centre, 16 Lugar De Santuario Cabañas, Zaragoza, Spain.
Edoardo CasigliaDepartment of Medicine, University of Padova, 2 Via Giustiniani, Padova, Italy.
Jussi KauhanenInstitute of Public Health and Clinical Nutrition, University of Eastern Finland, 1 Yliopistonranta, Kuopio, Finland.
Jackie A CooperCentre for Cardiovascular Genetics, University College London, 5 University Street, London, UK.
Beatriz RodriguezDepartment of Geriatric Medicine, University of Hawaii, 1960 East-West Road, Honolulu, HI, USA.
Johan SundströmDepartment of Medical Sciences, Uppsala University, Ing 40, 5 tr, Uppsala, Sweden.
Elizabeth Barrett-ConnorUniversity of California San Diego, 9500 Gilman Drive, La Jolla, CA, USA.
Rachel DanknerUnit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
Paul J NietertDepartment of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC, USA.
Karina W DavidsonDepartment of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, USA.
Robert B WallaceCollege of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA, USA.
Dan G BlazerDepartment of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, USA.
Cecilia BjörkelundDepartment of Public Health and Community Medicine, University of Gothenburg, Medicinaregatan 16, Gothenburg, Sweden.
Chiara DonfrancescoDepartment of Cardiovascular, Dysmetabolic and Aging-Associated Diseases, Istituto Superiore di Sanità (ISS), 299 Viale Regina Elena, Rome, Italy.
Harlan M KrumholzYale School of Medicine, 1 Church Street, New Haven, CT, USA.
Aulikki NissinenNational Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland.
Barry R DavisDepartment of Biostatistics, The University of Texas School of Public Health, 1200 Pressler Street, Houston, TX, USA.
Sean CoadyDivision of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, 31 Center Drive, Bethesda, MD, USA.
Peter H WhincupPopulation Health Research Institute, St George's, University of London, Cranmer Terrace, London, UK.
Torben JørgensenResearch Centre for Prevention and Health, 5 Øster Farimagsgade, Copenhagen, Denmark.
Pierre DucimetiereFaculté de Médecine, Université Paris Descartes, 12 Rue de l'Ecole de Médecine, Paris, France.
Maurizio TrevisanCUNY School of Medicine, City College of New York, 160 Convent Ave, New York, NY, USA.
Gunnar EngströmDepartment of Clinical Sciences, Lund University, Jan Waldenströms gata 35, Malmö, Sweden.
Carlos J CrespoSchool of Community Health, Portland State University, 506 SW Mill St, Portland, OR, USA.
Tom W MeadeDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Marjolein VisserDepartment of Health Sciences, Vrije Universiteit Amsterdam, VU University Medical Center, De Boelelaan 1085, Amsterdam, the Netherlands.
Daan KromhoutDepartment of Epidemiology, University Medical Centre Groningen, University of Grogingen, Hanzeplein 1, Groningen, the Netherlands.
Stefan KiechlDepartment of Neurology and Neurosurgery, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria.
Makoto DaimonFaculty of Medicine, Yamagata University, 1-4-12 Kojirakawa-machi, Yamagata, Japan.
Jackie F PriceUsher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, UK.
Agustin Gómez de la CámaraDepartment of Clinical Research, Hospital 12 de Octubre, Av. Cordoba, Madrid, Spain.
J Wouter JukemaDepartment of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands.
Benoît LamarchePavillon Ferdinand-Vandry, Université Laval, 2440 Hochelaga, Quebec, Canada.
Altan OnatDepartment of Cardiology, Cerrahpaşa Faculty of Medicine, Istanbul University, Beyazıt, Fatih, Istanbul, Turkey.
Leon A SimonsFaculty of Medicine, UNSW, Sydney, Australia.
Maryam KavousiDepartment of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands.
Yoav Ben-ShlomoBristol Neuroscience, Bristol University, Queens Road, Bristol, UK.
John GallacherDepartment of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, UK.
Jacqueline M DekkerThe Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1085, Amsterdam, the Netherlands.
Hisatomi ArimaKyushu University, 744 Motooka Nishi-ku, Fukuoka, Japan.
Nawar SharaDepartment of Biostatistics and Bioinformatics, MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, USA.
Robert W TippingClinical Biostatistics, Merck, 2000 Galloping Hill Road, Kenilworth, NJ, USA.
Ronan RousselCentre de Recherche des Cordeliers, INSERM, 15 rue de l'Ecole de Médecine, Paris, France.
Eric J BrunnerInstitute of Epidemiology & Health, University College London, 1-19 Torrington Place, London, UK.
Wolfgang KoenigDeutsches Herzzentrum München, Technische Universität München, 21 Arcisstraße, Munich, Germany.
Masaru SakuraiDepartment of Social and Environmental Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, Japan.
Jelena PavlovicDepartment of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands.
Ron T GansevoortDepartment of Internal Medicine, University Medical Centre Groningen, University of Grogingen, Hanzeplein 1, Groningen, the Netherlands.
Dorothea NagelKlinikum der Universität München, Ludwig-Maximilians-Universität, 15 Marchioninistraße, Munich, Germany.
Uri GoldbourtDepartment of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
Elizabeth L M BarrClinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Australia.
Luigi PalmieriDepartment of Cardiovascular, Dysmetabolic and Aging-Associated Diseases, Istituto Superiore di Sanità (ISS), 299 Viale Regina Elena, Rome, Italy.
Inger NjølstadDepartment of Public Health, University of Tromsø, Hansine Hansens veg 18, Tromsø, Norway.
Shinichi SatoChiba Prefectural Institute of Public Health, 666-2 Nito-no-machi Chuo-ku, Chiba, Japan.
W M Monique VerschurenDepartment for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, The Netherlands.
Cherian V VargheseNoncommunicable Diseases, Disability, Violence and Injury Prevention Department, World Health Organization, 20 Avenue Appia, Geneva 27, Switzerland.
Ian GrahamSchool of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland.
Oyere OnumaNoncommunicable Diseases, Disability, Violence and Injury Prevention Department, World Health Organization, 20 Avenue Appia, Geneva 27, Switzerland.
Philip GreenlandDepartment of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 420 East Superior Street, Chicago, IL, USA.
Mark WoodwardThe George Institute for Global Health, University of Oxford, 75 George Street, Oxford, UK.
Majid EzzatiFaculty of Medicine, School of Public Health, Norfolk Place, St Mary's Campus, Imperial College London, London, UK.
Bruce M PsatyCardiovascular Health Research Unit, University of Washington, 1730 Minor Avenue, Seattle, WA, USA.
Naveed SattarInstitute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, Glasgow, UK.
Rod JacksonFaculty of Medical and Health Sciences, University of Auckland, 261 Morrin Road, Auckland, New Zealand.
Paul M RidkerBrigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA, USA.
Nancy R CookBrigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue, Boston, MA, USA.
Ralph B D'AgostinoMathematics and Statistics Department, Boston University, 111 Cummington Mall, Boston, MA, USA.
Simon G ThompsonDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
John DaneshDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
Emanuele Di AngelantonioDepartment of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.
Emerging Risk Factors Collaboration

Funding

Pulmonary Toxicology Facility CoreP30ES005605 · NIEHS · UNIVERSITY OF IOWA · PI Brandi Janssen · 1990 to 2026
$40.5M
CVD in American Indians Study and Data Management Center and OK Field CenterR01HL109284 · NHLBI · UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR · PI STONER, JULIE A · 2013 to 2018
$4.6M
British Heart Foundation CH/12/2/29428British Heart Foundation RG/13/13/30194British Heart Foundation RG/13/16/30528British Heart Foundation RG/13/2/30098British Heart Foundation RG/16/11/32334British Heart Foundation SP/09/002Cancer Research UK 14136Department of Health 10/33/04European Research Council 268834Medical Research Council G0400491Medical Research Council G0401527Medical Research Council G0601019Medical Research Council G0701619Medical Research Council G0800270Medical Research Council G1000143Medical Research Council MC_U147585819Medical Research Council MC_U147585824Medical Research Council MC_U147585827Medical Research Council MC_UP_A620_1014Medical Research Council MC_UP_A620_1015Medical Research Council MC_UU_00002/7Medical Research Council MC_UU_12011/1Medical Research Council MC_UU_12011/2Medical Research Council MC_UU_12013/5Medical Research Council MC_UU_12023/21Medical Research Council MR/K013351/1Medical Research Council MR/K014811/1Medical Research Council MR/L003120/1Medical Research Council MR/N003284/1Medical Research Council MR/R024227/1NHLBI NIH HHS R01 HL109284NIEHS NIH HHS P30 ES005605Versus Arthritis 19583Wellcome Trust 204623/Z/16/ZWorld Health Organization 001
6 · The paper itself

Abstract

aimsThere 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

resultsUsing 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.

conclusionBefore 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.

Indexed as

AlgorithmsAgedCalibrationCardiovascular DiseasesFemaleHumansMaleMiddle AgedProspective StudiesRisk AssessmentCalibrationCardiovascular diseaseDiscriminationRisk algorithmsRisk prediction

Identifiers

PMID30476079
PMCPMC6374687

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.