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Cohort study
Using a multiplier of 10-year cardiovascular mortality underestimates cardiovascular risk in younger individuals and women
  1. Kunal N Karmali,
  2. Donald M Lloyd-Jones
  1. Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
  1. Correspondence to : Professor Donald M Lloyd-Jones, Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA; dlj{at}

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Several cardiovascular disease (CVD) prevention guidelines recommend using risk assessment tools to guide treatment in primary prevention.1–3 These tools, however, differ in terms of the CVD endpoints predicted. Although guidelines in the USA and UK recommend tools that predict risk of fatal and non-fatal CVD events,1 ,2 the 2012 European Society of Cardiology's (ESC) guidelines recommend using the Systematic COronary Risk Evaluation (SCORE) that predicts CVD mortality risk.3 Since non-fatal events are also important to patients, clinicians and health systems, ESC suggests using a fixed multiplier (×3) to estimate total CVD risk …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.