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  • 1.
    Cruz-Jentoft, Alfonso J.
    et al.
    Hosp Univ Ramon y Cajal IRYCIS, Serv Geriatr, Madrid, Spain.
    Bahat, Gülistan
    Istanbul Univ, Istanbul Med Sch, Div Geriatr, Dept Internal Med, Istanbul, Turkey.
    Bauer, Jürgen
    Heidelberg Univ, Ctr Geriatr Med, Agaples Bethanien Krankenhaus, Heidelberg, Germany.
    Boirie, Yves
    CHU Clermont Ferrand, Res Dept, Clermont Ferrand, France.
    Bruyere, Olivier
    Univ Liege, Dept Publ Hlth Epidemiol & Hlth Econ, Liege, Belgium.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Theme Ageing, Stockholm, Sweden.
    Cooper, Cyrus
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England;Univ Oxford, Dept Epidemiol, Ox, England.
    Landi, Francesco
    Univ Cattolica Sacro Cuore, Inst Med Interna & Geriatria, Rome, Italy.
    Rolland, Yves
    Hosp & Univ Toulouse, Dept Geriatr, Toulouse, France.
    Sayer, Avan Aihie
    Newcastle Upon Tyne Hosp NHS Fdn Trust, NIHR Newcastle Biomed Res Ctr, Newcastle, England;Newcastle Univ, Fac Med Sci, Newcastle, England.
    Schneider, Stephane M.
    Univ Cote Azur, CHU Nice, Dept Gastroenterol & Clin Nutr, Nice, France.
    Sieber, Cornel C.
    Friedrich Alexander Univ, Inst Biomed & Ageing, Dept Internal Med Geriatr, Erlangen, Germany.
    Topinkova, Eva
    Charles Univ Prague, Fac Med 1, Dept Geriatr, Prague, Czech Republic;Gen Fac Hosp, Prague, Czech Republic.
    Vandewoude, Maurits
    Univ Antwerp, Dept Geriatr, Ziekenhuisnetwerk Antwerpen ZNA, Antwerp, Belgium.
    Visser, Marjolein
    Vrije Univ Amsterdam, Fac Sci, Dept Hlth Sci, Amsterdam, Netherlands;Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands.
    Zamboni, Mauro
    Univ Verona, Geriatr Sect, Dept Med, Verona, Italy.
    Sarcopenia: revised European consensus on definition and diagnosis2019In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 48, no 1, p. 16-31Article in journal (Refereed)
    Abstract [en]

    Background: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings.

    Objectives: To increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia.

    Recommendations: Sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia.

    Conclusions; EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

  • 2.
    Gregson, John
    et al.
    London Sch Hyg & Trop Med, London, England.
    Kaptoge, Stephen
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Univ Cambridge, NIH, Res Blood & Transplant Res Unit Donor Hlth & Geno, Cambridge, England;Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Bolton, Thomas
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Univ Cambridge, NIH, Res Blood & Transplant Res Unit Donor Hlth & Geno, Cambridge, England;Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Pennells, Lisa
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Willeit, Peter
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Med Univ Innsbruck, Innsbruck, Austria.
    Burgess, Stephen
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Univ Cambridge, MRC Biostat Unit, Cambridge, England;Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Bell, Steven
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Univ Cambridge, NIH, Res Blood & Transplant Res Unit Donor Hlth & Geno, Cambridge, England.
    Sweeting, Michael
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England.
    Rimm, Eric B.
    Harvard TH Chan Sch Publ Hlth, Boston, MA USA.
    Kabrhel, Christopher
    Massachusetts Gen Hosp, Boston, MA 02114 USA.
    Zoller, Bengt
    Lund Univ, Dept Clin Sci, Malmo, Sweden.
    Assmann, Gerd
    Assmann Fdn Prevent, Munster, Germany.
    Gudnason, Vilmundur
    Iceland Heart Assoc, Kopavogur, Iceland.
    Folsom, Aaron R.
    Univ Minnesota, Sch Publ Hlth, Minneapolis, MN USA.
    Arndt, Volker
    German Canc Res Ctr, Div Clin Epidemiol & Aging Res, Heidelberg, Germany.
    Fletcher, Astrid
    London Sch Hyg & Trop Med, London, England.
    Norman, Paul E.
    Univ Western Australia, Perth, WA, Australia.
    Nordestgaard, Borge G.
    Copenhagen Univ Hosp, Dept Clin Biochem, Herlev & Gentofte Hosp, Copenhagen, Denmark;Univ Copenhagen, Fac Hlth & Med Sci, Copenhagen, Denmark;Copenhagen Univ Hosp, Copenhagen City Heart Study, Frederiksberg Hosp, Copenhagen, Denmark.
    Kitamura, Akihiko
    Osaka Univ, Osaka, Japan;Tokyo Metropolitan Inst Gerontol, Tokyo, Japan.
    Mahmoodi, Bakhtawar K.
    Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands.
    Whincup, Peter H.
    St Georges Univ London, London, England.
    Knuiman, Matthew
    Univ Western Australia, Perth, WA, Australia.
    Salomaa, Veikko
    Nat Inst Hlth & Welf, Helsinki, Finland;Natl Inst Hlth & Welf, Helsinki, Finland.
    Meisinger, Christa
    Ludwig Maximilian Univ Munich, Munich, Germany;Helmholtz Zentrum Munchen, German Res Ctr Environm Hlth, Neuherberg, Germany.
    Koenig, Wolfgang
    Tech Univ Munich, Deutsch Herzzentrum Munchen, Munich, Germany;German Ctr Cardiovasc Res DZHK, Partner Site Munich Heart Alliance, Munich, Germany;Univ Ulm, Dept Internal Med Cardiol 2, Med Ctr, Ulm, Germany.
    Kavousi, Maryam
    Erasmus Univ, Erasmus Univ Med Ctr, Rotterdam, Netherlands.
    Voelzke, Henry
    Ernst Moritz Arndt Univ Greifswald, Greifswald, Germany.
    Cooper, Jackie A.
    UCL, UCL Med Sch, London, England.
    Ninomiya, Toshiharu
    Kyushu Univ, Fukuoka, Fukuoka, Japan.
    Casiglia, Edoardo
    Univ Padua, Padua, Italy.
    Rodriguez, Beatriz
    Univ Hawaii, Honolulu, HI 96822 USA.
    Ben-Shlomo, Yoav
    Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.
    Despres, Jean-Pierre
    Univ Laval, Inst Nutraceut & Funct Foods, Quebec City, PQ, Canada.
    Simons, Leon
    Univ New South Wales, Sydney, NSW, Australia.
    Barrett-Connor, Elizabeth
    Univ Calif San Diego, San Diego, CA 92103 USA.
    Bjorkelund, Cecilia
    Univ Gothenburg, Gothenburg, Sweden.
    Notdurfter, Marlene
    Bruneck Hosp, Dept Internal Med, Brunico, Italy.
    Kromhout, Daan
    Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands;Wageningen Univ, Wageningen, Netherlands.
    Price, Jackie
    Univ Edinburgh, Edinburgh, Midlothian, Scotland.
    Sutherland, Susan E.
    Med Univ South Carolina, Charleston, SC 29425 USA.
    Sundstroem, Johan
    Ernst Moritz Arndt Univ Greifswald, Greifswald, Germany.
    Kauhanen, Jussi
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Kuopio, Finland.
    Gallacher, John
    Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England;Univ Oxford, Oxford, England.
    Beulens, Joline W. J.
    VU Univ Med Ctr Amsterdam, Amsterdam, Netherlands;Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands.
    Dankner, Rachel
    Tel Aviv Univ, Tel Aviv, Israel.
    Cooper, Cyrus
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England.
    Giampaoli, Simona
    NIH, ISS, Rome, Italy;Natl Hlth Inst Hlth, ISS, Rome, Italy.
    Deen, Jason F.
    Univ Washington, Sch Med, Ctr Hlth Equ Divers & Inclus, Seattle, WA USA.
    Gomez de la Camara, Agustin
    Clin Res & Clin Trials Unit, Plataforma Innovat Tecnol Med & Sanitarias, Madrid, Spain.
    Kuller, Lewis H.
    Univ Pittsburgh, Grad Sch Publ Hlth, Pittsburgh, PA USA.
    Rosengren, Annika
    Univ Gothenburg, Gothenburg, Sweden.
    Svensson, Peter J.
    Lund Univ, Dept Clin Sci, Malmo, Sweden.
    Nagel, Dorothea
    Ludwig Maximilian Univ Munich, Munich, Germany.
    Crespo, Carlos J.
    Portland State Univ, Portland, OR 97207 USA.
    Brenner, Hermann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Univ Minnesota, Sch Publ Hlth, Minneapolis, MN USA.
    Albertorio-Diaz, Juan R.
    US Ctr Dis Control & Prevent, Atlanta, GA USA.
    Atkins, Robert
    Monash Univ, Melbourne, Vic, Australia.
    Brunner, Eric J.
    UCL, Dept Epidemiol & Publ Hlth, London, England;UCL, London, England.
    Shipley, Martin
    UCL, Dept Epidemiol & Publ Hlth, London, England;UCL, London, England.
    Njolstad, Inger
    Norwegian Inst Publ Hlth, Oslo, Norway;Arctic Univ Norway, Tromso, Norway.
    Lawlor, Deborah A.
    Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England;Univ Bristol, MRC Integrat Epidemiol Unit, Bristol, Avon, England;Univ Bristol, Bristol, Avon, England.
    van der Schouw, Yvonne T.
    Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands.
    Selmer, Randi Marie
    Norwegian Inst Publ Hlth, Oslo, Norway.
    Trevisan, Maurizio
    CUNY, Sch Med, New York, NY 10031 USA;CUNY City Coll, New York, NY USA.
    Verschuren, W. M. Monique
    Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands;Natl Inst Publ Hlth & Environm, Ctr Nutr Prevent & Hlth Serv, RIVM, Bilthoven, Netherlands.
    Greenland, Philip
    Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA;Northwestern Univ, Chicago, IL 60611 USA.
    Wassertheil-Smoller, Sylvia
    Albert Einstein Coll Med, New York, NY USA.
    Lowe, Gordon D. O.
    Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland.
    Wood, Angela M.
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Butterworth, Adam S.
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Univ Cambridge, NIH, Res Blood & Transplant Res Unit Donor Hlth & Geno, Cambridge, England;Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Thompson, Simon G.
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Danesh, John
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Univ Cambridge, NIH, Res Blood & Transplant Res Unit Donor Hlth & Geno, Cambridge, England;Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Di Angelantonio, Emanuele
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge CB1 8RN, England;Univ Cambridge, NIH, Res Blood & Transplant Res Unit Donor Hlth & Geno, Cambridge, England;Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Meade, Tom
    London Sch Hyg & Trop Med, London, England.
    Rosamond, Wayne
    Univ N Carolina, Chapel Hill, NC 27515 USA.
    Whitsel, Eric
    Univ N Carolina, Chapel Hill, NC 27515 USA.
    Cushman, Mary
    Univ N Carolina, Chapel Hill, NC 27515 USA.
    Barr, Elizabeth L. M.
    Baker Heart & Diabet Inst, Melbourne, Vic, Australia.
    Shaw, Jonathan E.
    Baker Heart & Diabet Inst, Melbourne, Vic, Australia.
    Zimmet, Paul Z.
    Baker Heart & Diabet Inst, Melbourne, Vic, Australia.
    Kiechl, Stefan
    Bruneck Hosp, Dept Internal Med, Brunico, Italy.
    Weger, Siegfried
    Bruneck Hosp, Dept Internal Med, Brunico, Italy.
    Willeit, Johann
    Bruneck Hosp, Dept Internal Med, Brunico, Italy.
    Amuzu, Antoinette
    UCL, London, England.
    Dale, Caroline
    UCL, London, England.
    Casas, Juan P.
    UCL, London, England.
    Tikhonoff, Valerie
    Univ Padua, Padua, Italy.
    Nietert, Paul
    Med Univ South Carolina, Charleston, SC 29425 USA.
    Tybjaerg-Hansen, Anne
    Univ Copenhagen, Copenhagen, Denmark.
    Frikke-Schmidt, Ruth
    Univ Copenhagen, Copenhagen, Denmark.
    Jensen, Gorm B.
    Univ Copenhagen, Copenhagen, Denmark.
    Lora Pablos, David
    Hosp 12 Octubre, Madrid, Spain.
    Cancelas Navia, Pilar
    Hosp 12 Octubre, Madrid, Spain.
    McLachlan, Stela
    Univ Edinburgh, Edinburgh, Midlothian, Scotland.
    Schoettker, Ben
    German Canc Res Ctr, Heidelberg, Germany.
    Saum, Kai-Uwe
    German Canc Res Ctr, Heidelberg, Germany.
    Holleczek, Bernd
    German Canc Res Ctr, Heidelberg, Germany.
    Ariansen, Inger
    Norwegian Inst Publ Hlth, Oslo, Norway.
    Meyer, Haakon E.
    Norwegian Inst Publ Hlth, Oslo, Norway.
    Haheim, Lise Lund
    Norwegian Inst Publ Hlth, Oslo, Norway.
    Vartiainen, Erkki
    Natl Inst Hlth & Welf, Helsinki, Finland.
    Jousilahti, Pekka
    Natl Inst Hlth & Welf, Helsinki, Finland.
    Harald, Kennet
    Natl Inst Hlth & Welf, Helsinki, Finland.
    Wilhelmsen, Lars
    Univ Gothenburg, Gothenburg, Sweden.
    Dennison, Elaine
    Univ Southampton, Southampton, Hants, England.
    Syddall, Holly
    Univ Southampton, Southampton, Hants, England.
    Westbury, Leo
    Univ Southampton, Southampton, Hants, England.
    Flicker, Leon
    Univ Western Australia, Perth, WA, Australia.
    Hankey, Graeme J.
    Univ Western Australia, Perth, WA, Australia.
    Golledge, Jonathan
    James Cook Univ, Townsville, Qld, Australia.
    Doi, Yasufumi
    Kyushu Univ, Fukuoka, Fukuoka, Japan.
    Kiyohara, Yutaka
    Kyushu Univ, Fukuoka, Fukuoka, Japan.
    Elders, Petra
    Vrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands.
    Stehouwer, Coen
    Vrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands.
    Jensen, Majken
    Harvard TH Chan Sch Publ Hlth, Boston, MA USA.
    Iso, Hiroyasu
    Osaka Univ, Grad Sch Med, Suita, Osaka, Japan.
    Yamagishi, Kazumasa
    Univ Tsukuba, Tsukuba, Ibaraki, Japan.
    Sudhir, Kurl
    Univ Eastern Finland, Keupio, Finland.
    Tuomainen, Tomi-Pekka
    Univ Eastern Finland, Keupio, Finland.
    Salonen, Jukka T.
    Univ Eastern Finland, Keupio, Finland.
    Boer, Jolanda M. A.
    Natl Inst Publ Hlth & Environm, RIVM, Bilthoven, Netherlands.
    Blokstra, Anneke
    Natl Inst Publ Hlth & Environm, RIVM, Bilthoven, Netherlands.
    Melander, Olle
    Lund Univ, Lund, Sweden.
    Nilsson, Peter M.
    Lund Univ, Lund, Sweden.
    Engstrom, Gunnar
    Lund Univ, Lund, Sweden.
    Palmieri, Luigi
    Natl Hlth Inst Hlth, ISS, Rome, Italy.
    Vanuzzo, Diego
    Natl Hlth Inst Hlth, ISS, Rome, Italy.
    Peters, Annette
    German Res Ctr Environm Hlth, Neuherberg, Germany.
    Thorand, Barbara
    German Res Ctr Environm Hlth, Neuherberg, Germany.
    Heier, Margit
    German Res Ctr Environm Hlth, Neuherberg, Germany.
    Hu, Frank B.
    Harvard TH Chan Sch Publ Hlth, Boston, MA USA.
    Manson, JoAnn E.
    Harvard TH Chan Sch Publ Hlth, Boston, MA USA.
    Meijer, Karina
    Univ Groningen, Groningen, Netherlands.
    Gansevoort, Ron T.
    Univ Groningen, Groningen, Netherlands.
    Schulte, Helmut
    Univ Munster, Munster, Germany.
    Sluijs, Ivonne
    Univ Med Ctr Utrecht, Utrecht, Netherlands.
    Cantin, Bernard
    Univ Laval, Quebec City, PQ, Canada.
    Lamarche, Benoit
    Univ Laval, Quebec City, PQ, Canada.
    Dagenais, Gilles R.
    Univ Laval, Quebec City, PQ, Canada.
    McEvoy, Linda
    Univ Calif San Diego, San Diego, CA 92103 USA.
    Laughlin, Gail
    Univ Calif San Diego, San Diego, CA 92103 USA.
    Daniels, Lori B.
    Univ Calif San Diego, San Diego, CA 92103 USA.
    Aspelund, Thor
    Univ Iceland, Reykjavik, Iceland.
    Gudmundsson, Elias Freyr
    Univ Iceland, Reykjavik, Iceland.
    Thorsson, Bolli
    Univ Iceland, Reykjavik, Iceland.
    Leening, Maarten J. G.
    Erasmus MC, Rotterdam, Netherlands.
    Ikram, M. Arfan
    Erasmus MC, Rotterdam, Netherlands.
    Franco, Oscar H.
    Erasmus MC, Rotterdam, Netherlands.
    Tunstall-Pedoe, Hugh
    Dundee Univ, Dundee, Scotland.
    Werner, Andre
    Ernst Moritz Arndt Univ Greifswald, Greifswald, Germany.
    Devereux, Richard
    Weill Cornell Med, New York, NY USA.
    Jolly, Stacey
    Cleveland Clin, Phoenix, AZ USA.
    Smith, George Davey
    Univ Bristol, Bristol, Avon, England.
    Can, Gunay
    Trakya Univ, Edirne, Turkey.
    Yuksel, Husniye
    Atasehir Florence Nightingale Hosp, Istanbul, Turkey.
    Altay, Servet
    Trakya Univ, Edirne, Turkey.
    Ingelsson, Martin
    Arctic Univ Norway, Tromso, Norway.
    Giedraitis, Vilmantas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Claessen, Heiner
    German Canc Res Ctr, Heidelberg, Germany;German Diabet Ctr, Dusseldorf, Germany.
    Rothenbacher, Dietrich
    Univ Ulm, Ulm, Germany.
    Parikh, Nisha, I
    Univ Calif San Francisco, San Francisco, CA 94143 USA.
    Eaton, Charles
    Care New England, Pawtucket, RI USA.
    Kivimaki, Mika
    UCL, London, England.
    Feskens, Edith
    Wageningen Univ, Wageningen, Netherlands.
    Geleijnse, Johanna M.
    Wageningen Univ, Wageningen, Netherlands.
    Spackman, Sarah
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Walker, Matthew
    Univ Cambridge, Dept Publ Hlth & Primary Care, MRC BHF Cardiovasc Epidemiol Unit, Cambridge, England.
    Cardiovascular Risk Factors Associated With Venous Thromboembolism2019In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 4, no 2, p. 163-173Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE). OBJECTIVE To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism.

    DESIGN, SETTING, AND PARTICIPANTS: This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February 2016). Participants without cardiovascular disease at baseline were included. Data were analyzed from June 2017 to September 2018.

    EXPOSURES: A panel of several established cardiovascular risk factors.

    MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) per 1-SD higher usual risk factor levels (or presence/absence). Incident fatal outcomes in ERFC (VTE, 1041; coronary heart disease [CND], 25131) and incident fatal/nonfatal outcomes in UK Biobank (VTE, 2321; CHD, 3385). Hazard ratios were adjusted for age, sex, smoking status, diabetes, and body mass index (BMI).

    RESULTS: Of the 731728 participants from the ERFC. 403 396 (55.1%) were female, and the mean (SD) age at the time of the survey was 51.9 (9.0) years; of the 421537 participants from the UK Biobank, 233 699 (55.4%) were female, and the mean (SD) age at the time of the survey was 56.4 (8.1) years. Risk factors for VTE included older age (ERFC: HR per decade, 2.67; 95% CI, 2.45-2.91; UK Biobank: HR, 1.81; 95% CI, 1.71-1.92), current smoking (ERFC: HR, 1.38; 95% CI, 1.20-1.58; UK Biobank: HR, 1.23; 95% CI, 1.08-1.40), and BMI (ERFC: HR per 1-SD higher BMI, 1.43; 95% CI, 1.35-1.50; UK Biobank: HR, 1.37; 95% CI, 1.32-1.41). For these factors, there were similar HRs for pulmonary embolism and deep vein thrombosis in UK Biobank (except adiposity was more strongly associated with pulmonary embolism) and similar HRs for unprovoked vs provoked VTE. Apart from adiposity, these risk factors were less strongly associated with VTE than CHD. There were inconsistent associations of VTEs with diabetes and blood pressure across ERFC and UK Biobank, and there was limited ability to study lipid and inflammation markers.

    CONCLUSIONS AND RELEVANCE: Older age, smoking, and adiposity were consistently associated with higher VTE risk.

  • 3.
    Harvey, Nicholas C.
    et al.
    Univ Southampton, Lifecourse Epidemiol Unit, MRC, Southampton, Hants, England;Univ Southampton, Southampton Biomed Res Ctr, NIHR, Southampton, Hants, England;Univ Hosp Southampton NHS Fdn Trust, Southampton, Hants, England.
    Oden, Anders
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden;Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England.
    Orwoll, Eric
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA.
    Lapidus, Jodi
    Oregon Hlth & Sci Univ, Div Biostat, Dept Publ Hlth & Prevent Med, Portland, OR 97201 USA.
    Kwok, Timothy
    Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China;Chinese Univ Hong Kong, Sch Publ Hlth, Hong Kong, Hong Kong, Peoples R China.
    Karlsson, Magnus K.
    Lund Univ, Clin & Mol Osteoporosis Res Unit, Lund, Sweden;Skane Univ Hosp, Dept Orthoped, Malmo, Sweden.
    Rosengren, Bjorn E.
    Lund Univ, Clin & Mol Osteoporosis Res Unit, Lund, Sweden;Skane Univ Hosp, Dept Orthoped, Malmo, Sweden.
    Ribom, Eva L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Cooper, Cyrus
    Univ Southampton, Lifecourse Epidemiol Unit, MRC, Southampton, Hants, England;Univ Southampton, Southampton Biomed Res Ctr, NIHR, Southampton, Hants, England;Univ Hosp Southampton NHS Fdn Trust, Southampton, Hants, England;Univ Oxford, Biomed Res Ctr, NIHR, Oxford, England.
    Cawthon, Peggy M.
    Calif Pacific Med Ctr, Res Inst, San Francisco, CA USA;Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA.
    Kanis, John A.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England;Catholic Univ Australia, Inst Hlth & Aging, Melbourne, Vic, Australia.
    Ohlsson, Claes
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden.
    Mellstrom, Dan
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden.
    Johansson, Helena
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden;Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England;Catholic Univ Australia, Inst Hlth & Aging, Melbourne, Vic, Australia.
    McCloskey, Eugene
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England;Univ Sheffield, Ctr Integrated Res Musculoskeletal Ageing CIMA, Mellanby Ctr Bone Res, Sheffield, S Yorkshire, England.
    Measures of Physical Performance and Muscle Strength as Predictors of Fracture Risk Independent of FRAX, Falls, and aBMD: A Meta-Analysis Of The Osteoporotic Fractures In Men (MrOS) Study2018In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 33, no 12, p. 2150-2157Article in journal (Refereed)
    Abstract [en]

    Measures of muscle mass, strength, and function predict risk of incident fractures, but it is not known whether this risk information is additive to that from FRAX (fracture risk assessment tool) probability. In the Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, Hong Kong, United States), we investigated whether measures of physical performance/appendicular lean mass (ALM) by DXA predicted incident fractures in older men, independently of FRAX probability. Baseline information included falls history, clinical risk factors for falls and fractures, femoral neck aBMD, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the relationship between time for five chair stands, walking speed over a 6 m distance, grip strength, ALM adjusted for body size (ALM/height(2)), FRAX probability (major osteoporotic fracture [MOF]) with or without femoral neck aBMD, available in a subset of n = 7531), and incident MOF (hip, clinical vertebral, wrist, or proximal humerus). Associations were adjusted for age and time since baseline, and are reported as hazard ratios (HRs) for first incident fracture per SD increment in predictor using meta-analysis. 5660 men in the United States (mean age 73.5 years), 2764 men in Sweden (75.4 years), and 1987 men in Hong Kong (72.4 years) were studied. Mean follow-up time was 8.7 to 10.9 years. Greater time for five chair stands was associated with greater risk of MOF (HR 1.26; 95% CI, 1.19 to 1.34), whereas greater walking speed (HR 0.85; 95% CI, 0.79 to 0.90), grip strength (HR 0.77; 95% CI, 0.72 to 0.82), and ALM/height(2) (HR 0.85; 95% CI, 0.80 to 0.90) were associated with lower risk of incident MOF. Associations remained largely similar after adjustment for FRAX, but associations between ALM/height(2) and MOF were weakened (HR 0.92; 95% CI, 0.85 to 0.99). Inclusion of femoral neck aBMD markedly attenuated the association between ALM/height(2) and MOF (HR 1.02; 95% CI, 0.96 to 1.10). Measures of physical performance predicted incident fractures independently of FRAX probability. Whilst the predictive value of ALM/height(2) was substantially reduced by inclusion of aBMD requires further study, these findings support the consideration of physical performance in fracture risk assessment.

  • 4.
    Harvey, Nicholas C.
    et al.
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton SO16 6YD, Hants, England.;Univ Southampton, NIHR Southampton Biomed Res Ctr, Southampton, Hants, England.;Univ Hosp Southampton NHS Fdn Trust, Southampton, Hants, England..
    Oden, Anders
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden.;Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Orwoll, Eric
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA..
    Lapidus, Jodi
    Oregon Hlth & Sci Univ, Div Biostat, Dept Publ Hlth & Prevent Med, Portland, OR 97201 USA..
    Kwok, Timothy
    Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China.;Chinese Univ Hong Kong, Sch Publ Hlth, Hong Kong, Hong Kong, Peoples R China..
    Karlsson, Magnus K.
    Lund Univ, Clin & Mol Osteoporosis Res Unit, Dept Clin Sci Malmo, Malmo, Sweden.;Skane Univ Hosp, Dept Orthoped, Malmo, Sweden..
    Rosengren, Björn E.
    Lund Univ, Clin & Mol Osteoporosis Res Unit, Dept Clin Sci Malmo, Malmo, Sweden.;Skane Univ Hosp, Dept Orthoped, Malmo, Sweden..
    Ljunggren, Östen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology and mineral metabolism.
    Cooper, Cyrus
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton SO16 6YD, Hants, England.;Univ Southampton, NIHR Southampton Biomed Res Ctr, Southampton, Hants, England.;Univ Hosp Southampton NHS Fdn Trust, Southampton, Hants, England.;Univ Oxford, NIHR Oxford Biomed Res Ctr, Oxford, England..
    McCloskey, Eugene
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England.;Univ Sheffield, Ctr Integrated Res Musculoskeletal Ageing CIMA, Mellanby Ctr Bone Res, Sheffield, S Yorkshire, England..
    Kanis, John A.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England.;Catholic Univ Australia, Inst Hlth & Aging, Melbourne, Vic, Australia..
    Ohlsson, Claes
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden..
    Mellström, Dan
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden..
    Johansson, Helena
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden.;Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England.;Catholic Univ Australia, Inst Hlth & Aging, Melbourne, Vic, Australia..
    Falls Predict Fractures Independently of FRAX Probability: A Meta-Analysis of the Osteoporotic Fractures in Men (MrOS) Study2018In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 33, no 3, p. 510-516Article in journal (Refereed)
    Abstract [en]

    Although prior falls are a well-established predictor of future fracture, there is currently limited evidence regarding the specific value of falls history in fracture risk assessment relative to that of other clinical risk factors and bone mineral density (BMD) measurement. We therefore investigated, across the three Osteoporotic Fractures in Men (MrOS) Study cohorts, whether past falls predicted future fracture independently of FRAX and whether these associations varied with age and follow-up time. Elderly men were recruited from MrOS Sweden, Hong Kong, and USA. Baseline data included falls history (over the preceding 12 months), clinical risk factors, BMD at femoral neck, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the associations between falls, FRAX probability, and incident fracture, adjusting for age, time since baseline, and cohort in base models; further models were used to investigate interactions with age and follow-up time. Random-effects meta-analysis was used to synthesize the individual country associations. Information on falls and FRAX probability was available for 4365 men in USA (mean age 73.5 years; mean follow-up 10.8 years), 1823 men in Sweden (mean age 75.4 years; mean follow-up 8.7 years), and 1669 men in Hong Kong (mean age 72.4 years; mean follow-up 9.8 years). Rates of past falls were similar at 20%, 16%, and 15%, respectively. Across all cohorts, past falls predicted incident fracture at any site (hazard ratio [HR]=1.69; 95% confidence interval [CI] 1.49, 1.90), major osteoporotic fracture (MOF) (HR=1.56; 95% CI 1.33, 1.83), and hip fracture (HR=1.61; 95% CI 1.27, 2.05). Relationships between past falls and incident fracture remained robust after adjustment for FRAX probability: adjusted HR (95% CI) any fracture: 1.63 (1.45, 1.83); MOF: 1.51 (1.32, 1.73); and hip: 1.54 (1.21, 1.95). In conclusion, past falls predicted incident fracture independently of FRAX probability, confirming the potential value of falls history in fracture risk assessment.

  • 5.
    Pennells, Lisa
    et al.
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England.
    Kaptoge, Stephen
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England.
    Wood, Angela
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England.
    Sweeting, Mike
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England.
    Zhao, Xiaohui
    Univ Cambridge, Dept Physiol Dev & Neurosci, Downing St, Cambridge CB2 3EG, England.
    White, Ian
    UCL, MRC Clin Trials Unit, 90 High Holborn, London WC1V 6LJ, England.
    Burgess, Stephen
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England;Univ Cambridge, Cambridge Inst Publ Hlth, MRC Biostat Unit, Forvie Site,Robinson Way, Cambridge CB2 0SR, England.
    Willeit, Peter
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England;Med Univ Innsbruck, Dept Neurol & Neurosurg, Anichstra 35, A-6020 Innsbruck, Austria.
    Bolton, Thomas
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England.
    Moons, Karel G. M.
    Univ Med Ctr Utrecht, Julius Ctr, Res Program Methodol, Epidemiol Methodol, Heidelberglaan 100, NL-3584 Utrecht, Netherlands.
    van der Schouw, Yvonne T.
    Univ Med Ctr Utrecht, Julius Ctr, Res Program Cardiovasc Epidemiol, Dept Epidemiol, Heidelberglaan 100, NL-3584 Utrecht, Netherlands;ProspectEPIC, Utrecht, Netherlands.
    Selmer, Randi
    Norwegian Inst Publ Hlth, Div Epidemiol, Postboks 222 Skoyen, N-0213 Oslo, Norway.
    Khaw, Kay-Tee
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England;EPICNOR, London, England;RANCHO, Utrecht, Netherlands.
    Gudnason, Vilmundur
    Iceland Heart Assoc, Hjartavernd Holtasmari 1, IS-201 Kopavogur, Iceland;Univ Iceland, Fac Med, Vatnsmyrarvegur 16, IS-101 Reykjavik, Iceland.
    Assmann, Gerd
    Assmann Fdn Prevent, Gronowskistr 33, D-48161 Munster, Germany;PROCAM, Newton, MA USA.
    Amouyel, Philippe
    Inst Pasteur, 1 Rue Professeur Calmette, F-59019 Lille, France;PRIME, Newton, MA USA.
    Salomaa, Veikko
    Nat Inst Hlth & Welf, Mannerheimintie 166, Helsinki 00271, Finland;KAREL72, Isa Town, Bahrain.
    Kivimaki, Mika
    UCL, Dept Epidemiol & Publ Hlth, 1-19 Torrington Pl, London WC1E 7HB, England;WHITE I, Viana Do Castelo, Portugal.
    Nordestgaard, Borge G.
    Copenhagen Univ Hosp, Dept Clin Med, Blegdamsvej 3, DK-2200 Copenhagen, Denmark.
    Blaha, Michael J.
    Johns Hopkins Univ Hosp, Ciccarone Ctr Prevent Heart Dis, 1800 Orleans St, Baltimore, MD 21287 USA.
    Kuller, Lewis H.
    Univ Pittsburgh, Dept Epidemiol, 200 Lothrop St, Pittsburgh, PA 15212 USA;MRFIT, Utrecht, Netherlands.
    Brenner, Hermann
    German Canc Res Ctr, Div Clin Epidemiol & Aging Res, Neuenheimer Feld 581, D-69120 Heidelberg, Germany;Heidelberg Univ, Grabengasse 1, D-69117 Heidelberg, Germany;WCWC, Viana Do Castelo, Portugal.
    Gillum, Richard F.
    Howard Univ, Coll Med, Dept Med, 2041 Georgia Ave, Washington, DC 20060 USA;NHANES III, Utrecht, Netherlands.
    Meisinger, Christa
    German Res Ctr Environm Hlth, Ingolstadter Landstr 1, D-85764 Neuherberg, Germany;MONICA KORA2, Karachi, Pakistan;MONICA KORA3, Karachi, Pakistan.
    Ford, Ian
    Univ Glasgow, Inst Hlth & Wellbeing, Boyd Orr Bldg,Univ Ave, Glasgow G12 8QQ, Lanark, Scotland;WOSCOPS, Viana Do Castelo, Portugal.
    Knuiman, Matthew W.
    Univ Western Australia, Sch Populat & Global Hlth, Fac Hlth & Med Sci, 35 Stirling Highway, Perth, WA 6009, Australia;BHS, London, England.
    Rosengren, Annika
    Univ Gothenburg, Sahlgrenska Acad, Medicinaregatan 3, S-41390 Gothenburg, Sweden;Sahlgrens Univ Hosp, Wallenberg Lab, Bla Stradket 5, S-41345 Gothenburg, Sweden;GOT043, Belfast, Antrim, North Ireland;MOSWEGOT, Utrecht, Netherlands.
    Lawlor, Debbie A.
    Univ Bristol, Dept Social Med, Bristol BS8 2PR, Avon, England.
    Volzke, Henry
    Ernst Moritz Arndt Univ Greifswald, Inst Community Med, Ellernholzstr 1-2, D-17489 Greifswald, Germany.
    Cooper, Cyrus
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Tremona Rd, Southampton SO16 6YD, Hants, England.
    Ibanez, Alejandro Marin
    San Jose Norte Hlth Ctr, 16 Lugar Santuario Cabanas, Zaragoza 50013, Spain.
    Casiglia, Edoardo
    Univ Padua, Dept Med, 2 Via Giustiniani, I-35128 Padua, Italy;CASTEL, New York, NY USA.
    Kauhanen, Jussi
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, 1 Yliopistonranta, Kuopio, Finland.
    Cooper, Jackie A.
    UCL, Ctr Cardiovasc Genet, 5 Univ St, London WC1E 6JF, England;NPHSII, Utrecht, Netherlands.
    Rodriguez, Beatriz
    Univ Hawaii, Dept Geriatr Med, 1960 East West Rd, Honolulu, HI 96822 USA;HONOL, Tokyo, Japan.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Barrett-Connor, Elizabeth
    Univ Calif San Diego, 9500 Gilman Dr, La Jolla, CA 92093 USA.
    Dankner, Rachel
    Gertner Inst Epidemiol & Hlth Policy Res, Sheba Med Ctr, Unit Cardiovasc Epidemiol, IL-52621 Tel Hashomer, Israel;Tel Aviv Univ, Sch Publ Hlth, Sackler Fac Med, Dept Epidemiol & Prevent Med, IL-69978 Tel Aviv, Israel.
    Nietert, Paul J.
    Med Univ South Carolina, Dept Publ Hlth Sci, 135 Cannon St, Charleston, SC 29425 USA;CHARL, Greenville, SC USA.
    Davidson, Karina W.
    Columbia Univ Irving Med Ctr, Dept Med, 622 West 168th St, New York, NY 10032 USA.
    Wallace, Robert B.
    Univ Iowa, Coll Publ Hlth, 145 N Riverside Dr, Iowa City, IA 52242 USA.
    Blazer, Dan G.
    Duke Univ, Med Ctr, Dept Surg, 2301 Erwin Rd, Durham, NC 27707 USA.
    Bjorkelund, Cecilia
    Univ Gothenburg, Dept Publ Hlth & Community Med, Medicinaregatan 16, S-41390 Gothenburg, Sweden;GOTOW, Belfast, Antrim, North Ireland.
    Donfrancesco, Chiara
    ISS, Dysmetabol & Aging Associated Dis, Dept Cardiovasc, 299 Viale Regina Elena, I-00161 Rome, Italy;FINE IT, Heidelberg, Germany.
    Krumholz, Harlan M.
    Yale Sch Med, 1 Church St, New Haven, CT 06510 USA.
    Nissinen, Aulikki
    Nat Inst Hlth & Welf, Mannerheimintie 166, Helsinki 00271, Finland;FINE FIN, Heidelberg, Germany.
    Davis, Barry R.
    Univ Texas Houston, Sch Publ Hlth, Dept Biostat, 1200 Pressler St, Houston, TX 77030 USA.
    Coady, Sean
    NHLBI, Div Cardiovasc Sci, 31 Ctr Dr, Bethesda, MD 20892 USA.
    Whincup, Peter H.
    St Georges Univ London, Populat Hlth Res Inst, Cranmer Terrace, London SW17 0RE, England;BRHS, Bridgewater, MA USA.
    Jorgensen, Torben
    Res Ctr Prevent & Hlth, 5 Oster Farimagsgade, DK-1014 Copenhagen, Denmark;Univ Copenhagen, Dept Publ Hlth, 5 Oster Farimagsgade, DK-1014 Copenhagen, Denmark;Aalborg Univ, Fredrik Bajers Vej 5, DK-9100 Aalborg, Denmark.
    Ducimetiere, Pierre
    Univ Paris 05, Fac Med, 12 Rue Ecole Med, F-75006 Paris, France.
    Trevisan, Maurizio
    CUNY, Sch Med, City Coll New York, 160 Convent Ave, New York, NY 10031 USA;RIFLE, Utrecht, Netherlands.
    Engstrom, Gunnar
    Lund Univ, Dept Clin Sci, Jan Waldenstroms Gata 35, S-20502 Malmo, Sweden.
    Crespo, Carlos J.
    Portland State Univ, Sch Community Hlth, 506 SW Mill St, Portland, OR 97201 USA;PRHHP, Newton, MA USA.
    Meade, Tomw.
    London Sch Hyg & Trop Med, Dept Noncommunicable Dis Epidemiol, Keppel St, London WC1E 7HT, England.
    Visser, Marjolein
    Vrije Univ Amsterdam, VU Univ, Med Ctr, Dept Hlth Sci, De Boelelaan 1085, NL-1081 Amsterdam, Netherlands;LASA, Karachi, Pakistan.
    Kromhout, Daan
    Univ Grogingen, Univ Med Ctr Groningen, Dept Epidemiol, Hanzepl 1, NL-9713 Groningen, Netherlands.
    Kiechl, Stefan
    Med Univ Innsbruck, Dept Neurol & Neurosurg, Anichstra 35, A-6020 Innsbruck, Austria.
    Daimon, Makoto
    Yamagata Univ, Fac Med, 1-4-12 Kojirakawa Machi, Yamagata 9908560, Japan.
    Price, Jackie F.
    Univ Edinburgh, Old Med Sch, Usher Inst Populat Hlth Sci & Informat, Teviot Pl, Edinburgh EH8 9AG, Midlothian, Scotland.
    de la Camara, Agustin Gomez
    Hosp 12 Octubre, Dept Clin Res, Av Cordoba, E-28041 Madrid, Spain;DRECE, Madrid, Spain.
    Jukema, J. Wouter
    Leiden Univ, Med Ctr, Dept Cardiol, Albinusdreef 2, NL-2333 Leiden, Netherlands.
    Lamarche, Benoit
    Univ Laval, Pavillon Ferdinand Vandry,2440 Hochelaga, Quebec City, PQ G1V 0A6, Canada.
    Onat, Altan
    Istanbul Univ, Cerrahpasa Fac Med, Dept Cardiol, TR-34452 Istanbul, Turkey.
    Simons, Leon A.
    UNSW, Fac Med, Sydney, NSW 2052, Australia.
    Kavousi, Maryam
    Univ Med Ctr Rotterdam, Erasmus MC, Dept Epidemiol, Doctor Molewaterpl 40, NL-3015 Rotterdam, Netherlands.
    Ben-Shlomo, Yoav
    Univ Bristol, Bristol Neurosci, Queens Rd, Bristol BS8 1QU, Avon, England;CAPS, Oxford, England.
    Gallacher, John
    Univ Oxford, Warneford Hosp, Dept Psychiat, Warneford Lane, Oxford OX3 7JX, England;CAPS, Oxford, England.
    Dekker, Jacqueline M.
    Vrije Univ Amsterdam, Med Ctr, Inst Hlth & Care Res, De Boelelaan 1085, NL-1081 Amsterdam, Netherlands.
    Arima, Hisatomi
    Kyushu Univ, Nishi Ku, 744 Motooka, Fukuoka, Fukuoka 8190395, Japan.
    Shara, Nawar
    MedStar Hlth Res Inst, Dept Biostat & Bioinformat, 6525 Belcrest Rd, Hyattsville, MD 20782 USA.
    Tipping, RobertW.
    Merck, Clin Biostat, 2000 Galloping Hill Rd, Kenilworth, NJ 07033 USA.
    Roussel, Ronan
    INSERM, Ctr Rech Cordeliers, 15 Rue Ecole Med, F-57006 Paris, France.
    Brunner, Eric J.
    UCL, Inst Epidemiol & Hlth, 1-19 Torrington Pl, London WC1E 7HB, England;WHITE II, Viana Do Castelo, Portugal.
    Koenig, Wolfgang
    Tech Univ Munich, Deutsches Herzzentrum Munchen, 21 Arcisstr, D-80333 Munich, Germany;DZHK German Ctr Cardiovasc Res, Partner Site Munich Heart Alliance, Biedersteiner Str 29, D-80802 Munich, Germany;MONICA KORA2, Karachi, Pakistan;MONICA KORA3, Karachi, Pakistan.
    Sakurai, Masaru
    Kanazawa Med Univ, Dept Social & Environm Med, 1-1 Daigaku, Uchinada, Ishikawa 9200293, Japan.
    Pavlovic, Jelena
    Univ Med Ctr Rotterdam, Erasmus MC, Dept Epidemiol, Doctor Molewaterpl 40, NL-3015 Rotterdam, Netherlands.
    Gansevoort, Ron T.
    Univ Grogingen, Univ Med Ctr Groningen, Dept Internal Med, Hanzeplein 1, NL-9713 Groningen, Netherlands.
    Nagel, Dorothea
    Univ Munich, Klinikum Univ Munchen, 15 Marchioninistr, D-81377 Munich, Germany;GRIPS, Tokyo, Japan.
    Goldbourt, Uri
    Tel Aviv Univ, Sch Publ Hlth, Sackler Fac Med, Dept Epidemiol & Prevent Med, IL-69978 Tel Aviv, Israel.
    Barr, Elizabeth L. M.
    Baker Heart & Diabet Inst, Clin Diabet & Epidemiol, 75 Commercial Rd, Melbourne, Vic 3004, Australia.
    Palmieri, Luigi
    ISS, Dysmetabol & Aging Associated Dis, Dept Cardiovasc, 299 Viale Regina Elena, I-00161 Rome, Italy;CUORE, Madrid, Spain.
    Njolstad, Inger
    Univ Tromso, Dept Publ Hlth, Hansine Hansens Veg 18, Tromso, Norway.
    Sato, Shinichi
    Chiba Prefectural Inst Publ Hlth, Chuo Ku, 666-2 Nito No Machi, Chiba 2608715, Japan;IKNS, Isa Town, Bahrain.
    Verschuren, W. M. Monique
    Natl Inst Publ Hlth & Environm RIVM, Dept Determinants Chron Dis, Antonie Leeuwenhoeklaan 9, NL-3721 Bilthoven, Netherlands;MCVDRFP, Karachi, Pakistan;MORGEN, Utrecht, Netherlands.
    Varghese, Cherian V.
    WHO, Noncommunicable Dis Disabil Violence & Injury Pre, 20 Ave Appia, CH-1211 Geneva 27, Switzerland.
    Graham, Ian
    Univ Dublin, Coll Green, Trinity Coll Dublin, Sch Med, Dublin 2, Ireland.
    Onuma, Oyere
    WHO, Noncommunicable Dis Disabil Violence & Injury Pre, 20 Ave Appia, CH-1211 Geneva 27, Switzerland.
    Greenland, Philip
    Northwestern Univ, Feinberg Sch Med, Dept Prevent Med, 420 East Super St, Chicago, IL 60611 USA.
    Woodward, Mark
    Univ Oxford, George Inst Global Hlth, 75 George St, Oxford OX1 2BQ, England;Univ New South Wales, George Inst Global Hlth, 1 King St Newtown, Sydney, NSW 2042, Australia.
    Ezzati, Majid
    Imperial Coll London, Sch Publ Hlth, Fac Med, Norfolk Pl,St Marys Campus, London W2 1PG, England.
    Psaty, Bruce M.
    Univ Washington, Cardiovasc Hlth Res Unit, 1730 Minor Ave, Seattle, WA 98101 USA;CHS, Inver Grove Hts, MN USA.
    Sattar, Naveed
    Univ Glasgow, Inst Cardiovasc & Med Sci, 126 Univ Pl, Glasgow G12 8TA, Lanark, Scotland;MIDFAM, Karachi, Pakistan;WOSCOPS, Viana Do Castelo, Portugal.
    Jackson, Rod
    Univ Auckland, Fac Med & Hlth Sci, 261 Morrin Rd, Auckland, New Zealand.
    Ridker, Paul M.
    Harvard Med Sch, Brigham & Womens Hosp, 900 Commonwealth Ave, Boston, MA 02215 USA;USPHS2, Viana Do Castelo, Portugal;WHS, Viana Do Castelo, Portugal.
    Cook, Nancy R.
    Harvard Med Sch, Brigham & Womens Hosp, 900 Commonwealth Ave, Boston, MA 02215 USA.
    D'Agostino, Ralph B., Sr.
    Boston Univ, Math & Stat Dept, 111 Cummington Mall, Boston, MA 02215 USA;FRAM, Boston, MA USA;FRAMOFF, Boston, MA USA.
    Thompson, Simon G.
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England.
    Danesh, John
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England.
    Di Angelantonio, Emanuele
    Univ Cambridge, Dept Publ Hlth & Primary Care, 2 Worts Causeway, Cambridge CB1 8RN, England.
    Tipping, Robert W.
    AFTCAPS, Benn, Germany.
    Simpson, Lara M.
    ALLHAT, Bethesda, MD USA.
    Pressel, Sara L.
    ALLHAT, Bethesda, MD USA.
    Couper, David J.
    ARIC, Chapel Hill, NC USA.
    Nambi, Vijay
    ARIC, Chapel Hill, NC USA.
    Matsushita, Kunihiro
    ARIC, Chapel Hill, NC USA.
    Folsom, Aaron R.
    ARIC, Chapel Hill, NC USA.
    Shaw, Jonathan E.
    AUSDIAB, Melbourne, Vic, Australia.
    Magliano, Dianna J.
    AUSDIAB, Melbourne, Vic, Australia.
    Zimmet, Paul Z.
    AUSDIAB, Melbourne, Vic, Australia.
    Wannamethee, S. Goya
    BRHS, Bridgewater, MA USA.
    Willeit, Johann
    BRUN, Bridgewater, MA USA.
    Santer, Peter
    BRUN, Bridgewater, MA USA.
    Egger, Georg
    BRUN, Bridgewater, MA USA.
    Casas, Juan Pablo
    BWHHS, London, England.
    Amuzu, Antointtte
    BWHHS, London, England.
    Tikhonoff, Valerie
    CASTEL, New York, NY USA.
    Sutherland, Susan E.
    CHARL, Greenville, SC USA.
    Cushman, Mary
    CHS, Inver Grove Hts, MN USA.
    Sogaard, Anne Johanne
    CONOR, Tromso, Norway.
    Haheim, Lise Lund
    CONOR, Tromso, Norway.
    Ariansen, Inger
    CONOR, Tromso, Norway.
    Tybjaerg-Hansen, Anne
    COPEN, Copenhagen, Denmark.
    Jensen, Gorm B.
    COPEN, Copenhagen, Denmark.
    Schnohr, Peter
    COPEN, Copenhagen, Denmark.
    Giampaoli, Simona
    CUORE, Madrid, Spain;FINE IT, Heidelberg, Germany.
    Vanuzzo, Diego
    CUORE, Madrid, Spain.
    Panico, Salvatore
    CUORE, Madrid, Spain.
    Balkau, Beverley
    DESIR, Madrid, Spain.
    Bonnet, Fabrice
    DESIR, Madrid, Spain.
    Marre, Michel
    DESIR, Madrid, Spain.
    Herrera, Miguel Angel Rubio
    DRECE, Madrid, Spain.
    Friedlander, Yechiel
    McCallum, John
    McLachlan, Stela
    EAS, Gothenburg, Sweden.
    Guralnik, Jack
    EPESEBOS, London, England;EPESEIOW, Baltimore, MD USA;EPESENCA, Oxford, England;EPESENHA, New York, NY USA.
    Phillips, Caroline L.
    EPESEBOS, London, England.
    Wareham, Nick
    EPICNOR, London, England.
    Schottker, Ben
    ESTHER, Heidelberg, Germany.
    Saum, Kai-Uwe
    ESTHER, Heidelberg, Germany.
    Holleczek, Bernd
    ESTHER, Heidelberg, Germany.
    Tolonen, Hanna
    FINE FIN, Heidelberg, Germany.
    Jousilahti, Pekka
    FINRISK 92 97, Heidelberg, Germany.
    Harald, Kennet
    FINRISK 92 97, Heidelberg, Germany.
    Massaro, Joseph M.
    FRAM, Boston, MA USA;FRAMOFF, Boston, MA USA.
    Pencina, Michael
    FRAM, Boston, MA USA;FRAMOFF, Boston, MA USA.
    Vasan, Ramachandran
    FRAM, Boston, MA USA;FRAMOFF, Boston, MA USA.
    Kayama, Takamasa
    Kato, Takeo
    Oizumi, Toshihide
    Jespersen, Jorgen
    Moller, Lars
    Bladbjerg, Else Marie
    Chetrit, A.
    GOH, Belfast, Antrim, North Ireland.
    Wilhelmsen, Lars
    GOT043, Belfast, Antrim, North Ireland.
    Lissner, Lauren
    GOTOW, Belfast, Antrim, North Ireland.
    Dennison, Elaine
    HCS, Tokyo, Japan.
    Kiyohara, Yutaka
    Ninomiya, Toshiharu
    Doi, Yasufumi
    Nijpels, Giel
    Stehouwer, Coen D. A.
    Kazumasa, Yamagishi
    IKNS, Isa Town, Bahrain.
    Iso, Hiroyasu
    IKNS, Isa Town, Bahrain.
    Vartiainen, Erkki
    FINRISK 92 97, Heidelberg, Germany;KAREL72, Isa Town, Bahrain.
    Kurl, Sudhir
    KIHD, Karachi, Pakistan.
    Tuomainen, Tomi-Pekka
    KIHD, Karachi, Pakistan.
    Salonen, Jukka T.
    KIHD, Karachi, Pakistan.
    Deeg, Dorly J. H.
    LASA, Karachi, Pakistan.
    Nilsson, Peter M.
    Hedblad, Bo
    Melander, Olle
    De Boer, Ian H.
    DeFilippis, Andrew Paul
    Watt, Graham
    MIDFAM, Karachi, Pakistan.
    Verschuren, Monique
    Tverdal, Aage
    NCS, Utrecht, Netherlands.
    Kirkland, Susan
    NSHS, Newton, MA USA.
    Shimbo, Daichi
    NSHS, Newton, MA USA.
    Shaffer, Jonathan
    NSHS, Newton, MA USA.
    Bakker, Stephan J. L.
    PREVEND, Newton, MA USA.
    van der Harst, Pim
    PREVEND, Newton, MA USA.
    Hillege, Hans L.
    PREVEND, Newton, MA USA.
    Dallongeville, Jean
    PRIME, Newton, MA USA.
    Schulte, Helmut
    PROCAM, Newton, MA USA.
    Trompet, Stella
    PROSPER, Newton, MA USA.
    Smit, Roelof A. J.
    PROSPER, Newton, MA USA.
    Stott, David J.
    PROSPER, Newton, MA USA.
    Despres, Jean-Pierre
    Cantin, Bernard
    Dagenais, Gilles R.
    Laughlin, Gail
    RANCHO, Utrecht, Netherlands.
    Wingard, Deborah
    RANCHO, Utrecht, Netherlands.
    Aspelund, Thor
    REYK, Reykjavik, Iceland.
    Eiriksdottir, Gudny
    REYK, Reykjavik, Iceland.
    Gudmundsson, Elias Freyr
    Ikram, Arfan
    van Rooij, Frank J. A.
    Franco, Oscar H.
    Rueda-Ochoa, Oscar L.
    Muka, Taulant
    Glisic, Marija
    Tunstall-Pedoe, Hugh
    Howard, Barbara V.
    Zhang, Ying
    Jolly, Stacey
    Davey-Smith, George
    Can, Gunay
    Yuksel, Husniye
    Nakagawa, Hideaki
    Morikawa, Yuko
    Miura, Katsuyuki
    Ingelsson, Martin
    ULSAM, Viana Do Castelo, Portugal.
    Giedraitis, Vilmantas
    ULSAM, Viana Do Castelo, Portugal.
    Gaziano, J. Michael
    USPHS2, Viana Do Castelo, Portugal.
    Shipley, Martin
    WHITE I, Viana Do Castelo, Portugal;WHITE II, Viana Do Castelo, Portugal.
    Arndt, Volker
    WCWC, Viana Do Castelo, Portugal.
    Cook, Nancy
    WHS, Viana Do Castelo, Portugal.
    Geleijnse, Johanna M.
    ZUTE, Viana Do Castelo, Portugal.
    Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies2019In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no 7, p. 621-+Article in journal (Refereed)
    Abstract [en]

    Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after ‘recalibration’, a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.

    Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at ‘high’ 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29–39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22–24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44–51 such individuals using original algorithms, in contrast to 37–39 individuals with recalibrated algorithms.

    Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need.

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