title: Prediction models for cardiovascular disease risk in the general population: systematic review.
abstract: OBJECTIVE
  To provide an overview of prediction models for risk of cardiovascular disease (CVD) in the general population.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Medline and Embase until June 2013.
  
  
  METHODS
  Studies describing the development or external validation of a multivariable model for predicting CVD risk in the general population.
  
  
  RESULTS
  9965 references were screened, of which 212 articles were included in the review, describing the development of 363 prediction models and 473 external validations. Most models were developed in Europe (n=167, 46%), predicted risk of fatal or non-fatal coronary heart disease (n=118, 33%) over a 10 year period (n=209, 58%). The most common predictors were smoking (n=325, 90%) and age (n=321, 88%), and most models were sex specific (n=250, 69%). Substantial heterogeneity in predictor and outcome definitions was observed between models, and important clinical and methodological information were often missing. The prediction horizon was not specified for 49 models (13%), and for 92 (25%) crucial information was missing to enable the model to be used for individual risk prediction. Only 132 developed models (36%) were externally validated and only 70 (19%) by independent investigators. Model performance was heterogeneous and measures such as discrimination and calibration were reported for only 65% and 58% of the external validations, respectively.
  
  
  CONCLUSIONS
  There is an excess of models predicting incident CVD in the general population. The usefulness of most of the models remains unclear owing to methodological shortcomings, incomplete presentation, and lack of external validation and model impact studies. Rather than developing yet another similar CVD risk prediction model, in this era of large datasets, future research should focus on externally validating and comparing head-to-head promising CVD risk models that already exist, on tailoring or even combining these models to local settings, and investigating whether these models can be extended by addition of new predictors.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands Cochrane Netherlands, University Medical Center Utrecht, PO Box 85500, Str 6.131, 3508 GA Utrecht, Netherlands j.a.a.damen@umcutrecht.nl.
authors.forename: Johanna A A G
authors.initials: JA
authors.lastname: Damen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands Cochrane Netherlands, University Medical Center Utrecht, PO Box 85500, Str 6.131, 3508 GA Utrecht, Netherlands.
authors.forename: Lotty
authors.initials: L
authors.lastname: Hooft
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands Cochrane Netherlands, University Medical Center Utrecht, PO Box 85500, Str 6.131, 3508 GA Utrecht, Netherlands Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.
authors.forename: Ewoud
authors.initials: E
authors.lastname: Schuit
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands Cochrane Netherlands, University Medical Center Utrecht, PO Box 85500, Str 6.131, 3508 GA Utrecht, Netherlands.
authors.forename: Thomas P A
authors.initials: TP
authors.lastname: Debray
authors.affiliation: Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Collins
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Tzoulaki
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Camille M
authors.initials: CM
authors.lastname: Lassale
authors.affiliation: Department of Cardiology, Bern University Hospital, 3010 Bern, Switzerland.
authors.forename: George C M
authors.initials: GC
authors.lastname: Siontis
authors.affiliation: Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK Surgical Intervention Trials Unit, University of Oxford, Oxford, UK.
authors.forename: Virginia
authors.initials: V
authors.lastname: Chiocchia
authors.affiliation: Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Corran
authors.initials: C
authors.lastname: Roberts
authors.affiliation: Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Michael Maia
authors.initials: MM
authors.lastname: Schlüssel
authors.affiliation: Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Gerry
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: James A
authors.initials: JA
authors.lastname: Black
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands Cochrane Netherlands, University Medical Center Utrecht, PO Box 85500, Str 6.131, 3508 GA Utrecht, Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Heus
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Peelen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands Cochrane Netherlands, University Medical Center Utrecht, PO Box 85500, Str 6.131, 3508 GA Utrecht, Netherlands.
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors