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Updated: May 13, 2026

An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
Recalibration and external validation of vascular risk calculators for multiple sclerosis: A population-based study
Raffaele Palladino1, Ruth Ann Marrie2, Giuseppina Affinito3
1Department of Primary Care and Public Health, School of Public Health, Imperial College of London, London, UK; Department of Public Health, Federico II University, Naples, Italy.
Vascular risk calculators (VRCs) underestimate macrovascular disease risk in people with multiple sclerosis (MS). Recalibration of the FRS-BMI model improved accuracy, but MS-specific models are needed.
Area of Science:
- Cardiovascular epidemiology
- Neurology
- Biostatistics
Background:
- People with multiple sclerosis (PwMS) face a higher risk of macrovascular disease.
- Existing vascular risk calculators (VRCs) may underestimate this risk as they are validated in the general population.
Purpose of the Study:
- To evaluate, recalibrate, and externally validate five common VRCs in PwMS.
- To assess the performance of VRCs using population-based data from England.
Main Methods:
- Utilized Clinical Practice and Research Datalink (CPRD) GOLD and Aurum for calibration and validation.
- Assessed Atherosclerotic Cardiovascular Disease, Framingham Risk Score (FRS), FRS-BMI, QRESEARCH v3, and SCORE2.
- Employed statistical methods including Somers' D, ROC curve, and Hosmer-Lemeshow tests; recalibration used Cox regression.
Main Results:
- Standard VRCs showed declining discrimination in PwMS.
- Only FRS-BMI was successfully recalibrated, improving discrimination (Somers' D: 0.815) and calibration.
- External validation demonstrated a modest gain in performance (Somers' D: 0.716).
Conclusions:
- General-population VRCs have limitations for PwMS.
- The development of multiple sclerosis-specific vascular risk models is recommended.
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