{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T11:25:20Z","timestamp":1787397920183,"version":"build-2736575974"},"reference-count":40,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"UK MS Society","award":["146"],"award-info":[{"award-number":["146"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>People with multiple sclerosis (PwMS) have an elevated risk of macrovascular disease that may be underestimated by vascular risk calculators (VRCs) validated in the general population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study evaluated, recalibrated and externally validated five commonly used VRCs for PwMS using population-based data from England, 1987\u20132023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>PwMS and matched controls were identified from Clinical Practice and Research Datalink (CPRD) GOLD (calibration) and CPRD Aurum (validation). Exposure variables included multiple sclerosis (MS) status and risk factors as defined in Atherosclerotic Cardiovascular Disease, Framingham Risk Score (FRS), FRS-BMI (body mass index), QRESEARCH risk estimator version 3 score and Systematic Coronary Risk Evaluation version 2 score (SCORE2). Model performance was assessed using Somers\u2019 D statistic, area under the receiver operating characteristic (ROC) curve and Hosmer\u2013Lemeshow chi-square test. VRCs with ROC\u2009&lt;\u20090.70 in PwMS were recalibrated using Cox regression, incorporating MS status. Ten-fold cross-validation was used to estimate Somers\u2019 D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Calibration: 9411 PwMS and 57,805 controls; validation: 45,934 PwMS and 278,452 controls. Discrimination declined with standard thresholds (e.g. SCORE2 sensitivity in PwMS, 30.0%). Only FRS-BMI retained all significant predictors and was successfully recalibrated, improving discrimination (Somers\u2019 D\u2009=\u20090.815 vs. 0.792; \u0394\u2009=\u20090.023) and showing good calibration. External validation showed modest gain (Somers\u2019 D\u2009=\u20090.716; \u0394\u2009=\u20090.003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>These findings underscore the limitations of general-population VRCs in PwMS and support the development of MS-specific vascular risk models.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261444243","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T09:40:58Z","timestamp":1778578858000},"page":"806-817","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Recalibration and external validation of vascular risk calculators for multiple sclerosis: A population-based study using CPRD data in England, 1987\u20132023"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3437-812X","authenticated-orcid":false,"given":"Raffaele","family":"Palladino","sequence":"first","affiliation":[{"name":"Department 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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1855-5595","authenticated-orcid":false,"given":"Ruth Ann","family":"Marrie","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Community Health and Epidemiology, Dalhousie University, Nova Scotia Health, Halifax, NS, Canada; Nova Scotia Health Authority, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina","family":"Affinito","sequence":"additional","affiliation":[{"name":"Department of Public Health, Federico II University, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azeem","family":"Majeed","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, School of Public Health, Imperial College of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen Allan","family":"Schaffer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of Manitoba, St Boniface General Hospital, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Chataway","sequence":"additional","affiliation":[{"name":"Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; National Institute for Health and Care Research, University College London Hospitals Biomedical Research Centre, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.0664"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007251"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(11)70105-3"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2017.33"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.861885"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/13524585231164296"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.2.180"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.699579"},{"key":"e_1_3_2_10_2","article-title":"Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: Prospective cohort study","volume":"357","author":"Hippisley-Cox J","year":"2017","unstructured":"Hippisley-Cox J, Coupland C, Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: Prospective cohort study. BMJ 2017; 357: j2099.","journal-title":"BMJ"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab309"},{"issue":"11","key":"e_1_3_2_12_2","article-title":"2019 ACC\/AHA guideline on the primary prevention of cardiovascular disease: Executive summary: A report of the American College of Cardiology\/American Heart Association Task Force on clinical practice guidelines","volume":"140","author":"Arnett DK","year":"2019","unstructured":"Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC\/AHA guideline on the primary prevention of cardiovascular disease: Executive summary: A report of the American College of Cardiology\/American Heart Association Task Force on clinical practice guidelines. Circulation 2019; 140(11): e563\u2013e595.","journal-title":"Circulation"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kead610"},{"key":"e_1_3_2_14_2","volume-title":"Atlas of MS 2020: Mapping multiple sclerosis around the world","author":"Multiple Sclerosis International Federation","year":"2020","unstructured":"Multiple Sclerosis International Federation. Atlas of MS 2020: Mapping multiple sclerosis around the world. London: Multiple Sclerosis International Federation, 2020."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.3682"},{"key":"e_1_3_2_16_2","unstructured":"CPRD. Clinical practice research Datalink https:\/\/www.cprd.com"},{"key":"e_1_3_2_17_2","volume-title":"CPRD Aurum data specification (March 2023 database release)","author":"Clinical Practice Research Datalink","year":"2023","unstructured":"Clinical Practice Research Datalink. CPRD Aurum data specification (March 2023 database release), version 2.9. London: Clinical Practice Research Datalink, 2023."},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdt116"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz034"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2018-210961"},{"key":"e_1_3_2_21_2","unstructured":"GOV.UK. English indices of deprivation 2015 https:\/\/www.gov.uk\/government\/statistics\/english-indices-of-deprivation-2015"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.3399\/BJGPO.2020.0117"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0135834"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987319881017"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2019-001061"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/9780470316696"},{"key":"e_1_3_2_27_2","volume-title":"CVD prevention\u2013joint European guidelines on cardiovascular disease prevention in clinical practice","author":"Europe CfPGtitqocpapci","year":"2016","unstructured":"Europe CfPGtitqocpapci. CVD prevention\u2013joint European guidelines on cardiovascular disease prevention in clinical practice. Brussels: European Society of Cardiology, 2016."},{"key":"e_1_3_2_28_2","volume-title":"Cardiovascular disease: Risk assessment and reduction, including lipid modification","author":"National Institute for Health and Care Excellence","year":"2014","unstructured":"National Institute for Health and Care Excellence. Cardiovascular disease: Risk assessment and reduction, including lipid modification. London: National Institute for Health and Care Excellence; 2014."},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.7326\/M14-1281"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-301246"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181c30fb2"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X1001000303"},{"key":"e_1_3_2_33_2","article-title":"Net benefit approaches to the evaluation of prediction models, molecular markers, and diagnostic tests","volume":"352","author":"Vickers AJ","year":"2016","unstructured":"Vickers AJ, Van Calster B, Steyerberg EW. Net benefit approaches to the evaluation of prediction models, molecular markers, and diagnostic tests. BMJ 2016; 352: i6.","journal-title":"BMJ"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.2217\/epi-2019-0102"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30470-2"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(25)00270-4"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00244-0"},{"key":"e_1_3_2_38_2","article-title":"Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: Longitudinal cohort study","volume":"357","author":"Topiwala A","year":"2017","unstructured":"Topiwala A, Allan CL, Valkanova V, et al. Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: Longitudinal cohort study. BMJ 2017; 357: j2353.","journal-title":"BMJ"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458512445407"},{"issue":"5","key":"e_1_3_2_40_2","first-page":"1006","article-title":"Diffusion weighted MR imaging characteristics of an acute strokelike form of multiple sclerosis","volume":"27","author":"Rosso C","year":"2006","unstructured":"Rosso C, Remy P, Creange A, et al. Diffusion weighted MR imaging characteristics of an acute strokelike form of multiple sclerosis. AJNR Am J Neuroradiol 2006; 27(5): 1006\u20131008.","journal-title":"AJNR Am J Neuroradiol"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13244-018-0637-y"}],"container-title":["Multiple Sclerosis Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13524585261444243","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13524585261444243","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13524585261444243","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T11:15:53Z","timestamp":1787397353000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13524585261444243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":40,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/13524585261444243"],"URL":"https:\/\/doi.org\/10.1177\/13524585261444243","relation":{},"ISSN":["1352-4585","1477-0970"],"issn-type":[{"value":"1352-4585","type":"print"},{"value":"1477-0970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]}}}