title: Recalibration of the ACC/AHA Risk Score in Two Population-Based German Cohorts.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.|German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Tonia
authors.initials: T
authors.lastname: de Las Heras Gala
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Marie Henrike
authors.initials: MH
authors.lastname: Geisel
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.|German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Peters
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Thorand
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Baumert
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.|Department of Cardiology, The West-German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.|Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Meisinger
authors.affiliation: Department of Cardiology, The West-German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Amir Abbas
authors.initials: AA
authors.lastname: Mahabadi
authors.affiliation: German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.|Department of Internal Medicine II- Cardiology, University of Ulm, Medical Center, Ulm, Germany.|Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
mesh_terms: D000465:Algorithms; D050197:Atherosclerosis / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors