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Comment & Response
November 17, 2015

Predicted vs Observed Clinical Event Risk for Cardiovascular Disease—Reply

Author Affiliations
  • 1Cardiology Division, NorthShore University Health System, Evanston, Illinois
  • 2Framingham Heart Study of the National Heart, Lung, and Blood Institute, Framingham, Massachusetts
  • 3Cardiac MR PET CT Program, Massachusetts General Hospital, Boston
JAMA. 2015;314(19):2082-2083. doi:10.1001/jama.2015.12931

In Reply Discrepancies between predicted and observed clinical event risk are a common challenge in cardiovascular medicine not limited to the ASCVD score. Typically, observed event rates are (sometimes significantly) lower than those either predicted by risk prediction instruments or derived from historical cohorts. This phenomenon has been reported in primary prevention cohorts1,2 as well as symptomatic patients3 and constitutes a common issue for power and sample size calculations for clinical trials.