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Editorials |3 July 2018

When Given a Lemon, Make Lemonade: Revising Cardiovascular Risk Prediction Scores

Andrew Paul DeFilippis, MD, MSc; Patrick Trainor, MS, MA

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This article was published at Annals.org on 5 June 2018.
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Accurate estimation of cardiac risk is essential to balancing the risks and benefits of preventive therapies. Underestimation of risk results in preventable cardiovascular events, and overestimation results in unnecessary costs and exposure to treatment side effects. In 2013, the American College of Cardiology and American Heart Association published a new risk score for atherosclerotic cardiovascular disease (ASCVD) to guide risk-reducing therapy (1). However, the applicability of these new pooled cohort equations (PCEs) has been questioned because they have been found to overestimate risk (2, 3).
Yadlowsky and colleagues evaluated 2 approaches for improving the PCEs: using the same derivation method as the 2013 PCEs with updated cohort data and using both updated data and new derivation methods (4). The first approach modestly improved discrimination but did not consistently improve calibration, whereas the second approach improved both calibration and discrimination.
The authors' novel approach to deriving a revised model for ASCVD risk prediction included use of elastic net regularization for variable selection and model estimation. Rather than maximizing the accuracy of the model on the derivation cohort, the elastic net seeks a more conservative model that favors more robust relationships, which may improve accuracy outside the derivation cohort. To increase generalization and limit overfitting of the model to the derivation cohort, Yadlowsky and colleagues did not construct separate race models as was done in derivation of the 2013 PCEs. They instead evaluated whether race modulates the association of each risk factor with overall ASCVD...
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DeFilippis AP, Trainor P. When Given a Lemon, Make Lemonade: Revising Cardiovascular Risk Prediction Scores. Ann Intern Med. 2018;169:56–57. [Epub ahead of print 5 June 2018]. doi: https://doi.org/10.7326/M18-1175

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Published: Ann Intern Med. 2018;169(1):56-57.

DOI: 10.7326/M18-1175

Published at www.annals.org on 5 June 2018

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2018 American College of Physicians
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