Recalibration of the ACC/AHA Risk Score in Two Population-Based German Cohorts.
Tonia de Las Heras Gala, Marie Henrike Geisel, Annette Peters, Barbara Thorand, Jens Baumert, Nils Lehmann, Karl-Heinz Jöckel, Susanne Moebus, Raimund Erbel, Christine Meisinger, Amir Abbas Mahabadi, Wolfgang Koenig, KORA Study Group and the Heinz Nixdorf Recall Study Group
PloS one 2016The 2013 ACC/AHA guidelines introduced an algorithm for risk assessment of atherosclerotic cardiovascular disease (ASCVD) within 10 years. In Germany, risk assessment with the ESC SCORE is limited to cardiovascular mortality. Applicability of the novel ACC/AHA risk score to the German population has not yet been assessed. We therefore sought to recalibrate and evaluate the ACC/AHA risk score in two German cohorts and to compare it to the ESC SCORE. We studied 5,238 participants from the KORA surveys S3 (1994-1995) and S4 (1999-2001) and 4,208 subjects from the Heinz Nixdorf Recall (HNR) Study (2000-2003). There were 383 (7.3%) and 271 (6.4%) first non-fatal or fatal ASCVD events within 10 years in KORA and in HNR, respectively. Risk scores were evaluated in terms of calibration and discrimination performance. The original ACC/AHA risk score overestimated 10-year ASCVD rates by 37% in KORA and 66% in HNR. After recalibration, miscalibration diminished to 8% underestimation in KORA and 12% overestimation in HNR. Discrimination performance of the ACC/AHA risk score was not affected by the recalibration (KORA: C = 0.78, HNR: C = 0.74). The ESC SCORE overestimated by 5% in KORA and by 85% in HNR. The corresponding C-statistic was 0.82 in KORA and 0.76 in HNR. The recalibrated ACC/AHA risk score showed strongly improved calibration compared to the original ACC/AHA risk score. Predicting only cardiovascular mortality, discrimination performance of the commonly used ESC SCORE remained somewhat superior to the ACC/AHA risk score. Nevertheless, the recalibrated ACC/AHA risk score may provide a meaningful tool for estimating 10-year risk of fatal and non-fatal cardiovascular disease in Germany.
Citation
Tonia de Las Heras Gala, Marie Henrike Geisel, Annette Peters, Barbara Thorand, Jens Baumert, Nils Lehmann, Karl-Heinz Jöckel, Susanne Moebus, Raimund Erbel, Christine Meisinger, Amir Abbas Mahabadi, Wolfgang Koenig, KORA Study Group and the Heinz Nixdorf Recall Study Group. Recalibration of the ACC/AHA Risk Score in Two Population-Based German Cohorts. PloS one. 2016;11(10):e0164688
Mesh Tags
PMID: 27732641
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