Publications and Research


Lisa Pennells, University of Cambridge
Stephen Kaptoge, University of Cambridge
Angela Wood, University of Cambridge
Mike Sweeting, University of Cambridge
Xiaohui Zhao, University of Cambridge
Ian White, University College London
Stephen Burgess, University of Cambridge
Peter Willeit, University of Cambridge
Thomas Bolton, University of Cambridge
Karel G. M. Moons, University Medical Center Utrecht
Yvonne T. van der Schouw, University Medical Center Utrecht
Randi Selmer, Norwegian Institute of Public Health
Kay-Tee Khaw, University of Cambridge
Vilmundur Gudnason, Hjartavernd Holtasmari
Gerd Assman, Assmann-Foundation for Prevention
Philippe Amouyel, Institut Pasteur de Lille
Veikko Salomaa, National Institute for Health and Welfare, Finland
Mika Kivimaki, University College London
Borge G. Nordestgaard, Copenhagen University Hospital
Michael J. Blaha, John Hopkins Hospital
Lewis H. Kuller, University of Pittsburgh
Hermann Brenner, German Cancer Research Center
Richard F. Gillum, Howard University
Christa Meisinger, German Research Center for Environmental Health
Ian Ford, University of Glasgow
Matthew W. Knuiman, University of Western Australia
Annika Rosengren, University of Gothenberg
Debbie A. Lawlor, University of Bristol
Henry Volzke, University of Greifswald
Cyrus Cooper, University of Southampton
Alejandro Marin Ibañez, San Jose Norte Health Centre
Edoardo Casiglia, University of Padova
Jussi Kauhanen, University of Eastern Finland
Jackie A. Cooper, University College London
Beatriz Rodriguez, University of Hawaii, Hilo
Johan Sundstrom, Uppsala University
Elizabeth Barrett-Connor, University of California San Diego
Rachel Dankner, Sheba Medical Center
Paul J. Nietert, Medical University of South Carolina
Karina W. Davidson, Columbia University Irving Medical Center
Robert B. Wallace, University of Iowa
Dan G. Blazer, Duke University
Cecilia Bjorkelund, University of Gothenburg
Chiara Donfrancesco, Istituto Superiore di Sanita
Harlan M. Krumholz, Yale School of Medicine
Aulikki Nissinen, National Institute for Health and Welfare, Finland
Barry R. Davis, University of Texas School of Public Health
Sean Coady, National Heart, Lung, and Blood Institute
Peter H. Whincup, St. George's University
Torben Jorgensen, Research Centre for Prevention and Health, Denmark
Pierre Ducimetiere, Universite´ Paris Descartes
Maurizo Trevisan, CUNY City CollegeFollow
Gunnar Engstrom, Lund University
Carlos J. Crespo, Portland State University
Tom W. Meade, London School of Hygiene and Tropical Medicine
Marjolein Visser, Vrije Universiteit Amsterdam
Daan Kromhout, University Medical Centre Groningen
Stefan Kiechl, Medical University of Innsbruck
Makoto Daimon, Yamagata University
Jackie F. Price, University of Edinburgh
Agustin Gomez de la Camara, Hospital 12 de Octubre, Av. Cordoba
J. Wouter Jukema, Leiden University
Benoit Lamarche, Universite Laval
Altan Onat, Istanbul University
Leon A. Simons, UNSW, Sydney
Maryam Kavousi, University Medical Center Rotterdam
Yoav Ben-Shlomo, Bristol University
John Gallacher, University of Oxford
Jacqueline M. Dekker, VU University Medical Center
Hisatomi Arima, Kyushu University
Nawar Shara, MedStar Health Research Institute
Robert W. Tipping, Clinical Biostatistics, Merck
Ronan Roussel, Centre de Recherche des Cordeliers
Eric J. Brunner, University College London
Wolfgang Koenig, Technische Universita¨t Mu¨nchen
Masaru Sakurai, Kanazawa Medical University
Jelena Pavlovic, University Medical Center Rotterdam
Ron T. Gansevoort, University of Grogingen
Dorothea Nagel, Ludwig-Maximilians-Universitat
Uri Goldbourt, Tel Aviv University
Elizabeth L. M. Barr, Baker Heart and Diabetes Institute
Luigi Palmieri, Istituto Superiore di Sanita
Inger Njolstad, University of Tromsø
Shinichi Sato, Chiba Prefectural Institute of Public Health
W. M. Monique Verschuren, National Institute for Public Health and the Environment
Cherian V. Varghese, World Health Organization
Ian Graham, University of Dublin, Trinity College
Oyere Onuma, World Health Organization
Philip Greenland, Northwestern University
Mark Woodward, University of New South Wales
Majid Ezzati, Imperial College London
Bruce M. Psaty, University of Washington
Naveed Sattar, University of Glasgow
Rod Jackson, University of Auckland
Paul M. Ridker, Harvard Medical School
Nancy R. Cook, Harvard Medical School
Ralph B. D'Agostino Sr., Boston University
Simone G. Thompson, University of Cambridge
John Danesh, University of Cambridge
Emanuele Di Angelantonio, University of Cambridge

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Publication Date



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 & Results: Using individual-participant data on 360737 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 overpredicted 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 >_40years 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.

Conclusions: 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.


This article was originally published in the European Heart Journal, available at DOI: 10.1093/eurheartj/ehy653.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (



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