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In Reply: The relevant end point for cardiovascular risk prediction models must include myocardial infarction, stroke, revascularization procedures, and cardiovascular death; this is what is of concern to patients and is the end point of most intervention trials. We thus disagree with Dr Pencina and colleagues that our data in Table 5 has limited merit. While we agree that Table 4 is more appropriate for model assessment, we included Table 5 because the ATP III model is most often used in clinical practice. Furthermore, as shown in Table 4 where algorithms were directly compared using a common end point, we again found better performance for the new models than for the old. Although they focus on a 54-patient subgroup in the test data set, they do not consider the 415 women in the other 5 cells for whom the vast majority are reclassified correctly. A Hosmer-Lemeshow goodness-of-fit test¹ can formally . . . [Full Text of this Article]

Paul M Ridker, MD
pridker@partners.org

Nancy R. Cook, ScD
Brigham and Women's Hospital
Boston, Massachusetts

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