Nancy R. Cook, ScD; Paul M Ridker, MD
Disclosures: Dr. Ridker reports grants from the NHLBI, Novartis, Pfizer, and Kowa during the conduct of the study. He also has a patent with royalties paid to AstraZeneca and Siemens. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1739.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Requests for Single Reprints: Nancy R. Cook, ScD, Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, MA 02215; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Cook and Ridker: Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, MA 02215.
Author Contributions: Conception and design: N.R. Cook, P.M Ridker.
Analysis and interpretation of the data: N.R. Cook, P.M Ridker.
Drafting of the article: N.R. Cook.
Critical revision for important intellectual content: N.R. Cook, P.M Ridker.
Final approval of the article: N.R. Cook, P.M Ridker.
Statistical expertise: N.R. Cook.
Collection and assembly of data: N.R. Cook, P.M Ridker.
Cook NR, Ridker PM. Calibration of the Pooled Cohort Equations for Atherosclerotic Cardiovascular Disease: An Update. Ann Intern Med. 2016;165:786-794. doi: 10.7326/M16-1739
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Published: Ann Intern Med. 2016;165(11):786-794.
Published at www.annals.org on 11 October 2016
The latest guidelines from the American College of Cardiology and American Heart Association, released in fall 2013, provide a long-anticipated update to the recommendations of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). The guidelines incorporate a new risk score for atherosclerotic cardiovascular disease that includes stroke as well as coronary heart disease. After publication, the new pooled cohort equations (PCEs) were evaluated in 15 studies from the United States and Europe, most of which used cohorts that were more contemporary than those used in developing the guidelines. In almost all of these external validation cohorts, the PCEs overestimated the observed risk. This narrative review provides an update of the published reports, an overview of the strengths and weaknesses of these validation efforts, and a discussion of possible reasons for the discrepancies. These issues may be useful in a recalibration process designed to better match predicted and observed risks relevant for current clinical practice.
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