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Stroke risk estimation across nine European countries in the MORGAM project
  1. Anders Borglykke1,
  2. Anne H Andreasen1,
  3. Kari Kuulasmaa2,
  4. Susana Sans3,
  5. Pierre Ducimetière4,
  6. Diego Vanuzzo5,
  7. Marco M Ferrario6,
  8. Luigi Palmieri7,
  9. Juha Karvanen2,
  10. Hugh Tunstall-Pedoe8,
  11. Torben Jørgensen1,
  12. on behalf of the MORGAM Project
  1. 1Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
  2. 2National Institute for Health and Welfare (THL), Helsinki, Finland
  3. 3Institute of Health Studies, Department of Health, Barcelona, Spain
  4. 4Unité 258-INSERM Hôpital Paul Brousse 16, Villejuif Cedex, France
  5. 5Centro Malattie Cardiovascolari, ASS 4 Medio Friuli, c/o Ospedale S. M. Misericordia, P.le S. Maria della Misericordia, Udine, Italy
  6. 6Università degli studi dell'Insubria, Medicina del Lavoro e Preventiva, Viale Borri, Varese, Italy
  7. 7Cerebro and Cardiovascular Epidemiology Unit, National Centre of Epidemiology, Surveillance, and Promotion of Health, National Institute of Health, Rome, Italy
  8. 8Cardiovascular Epidemiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
  1. Correspondence to A Borglykke, Research Centre for Prevention and Health, Glostrup University Hospital, DK-2600 Glostrup, Denmark; andbor01{at}


Background Previous tools for stroke risk assessment have either been developed for specific populations or lack data on non-fatal events or uniform data collection. The purpose of this study was to develop a stepwise model for the estimation of 10 year risk of stroke in nine different countries across Europe.

Methods Using data from the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project, sex-specific models estimating 10 year risk of stroke were developed using a Cox regression model stratified by country and including modelling of competing risks. Models were developed in a stepwise manner first using only data from questionnaires, and then adding data from physical examinations and finally data from blood samples.

Results During 1 176 296 years of observation, 2928 incident fatal and non-fatal events of stroke were registered. The developed model showed good calibration and accuracy of prediction. The discrimination of the model varied between sex and country but increased with increasing number of variables used (area under the receiver operating characteristic curve between 0.77 and 0.79 in men and between 0.75 and 0.80 in women).

Conclusion The present study shows that using a large multicountry cohort from nine European countries it is possible to develop a stepwise risk estimation model for 10 year risk of stroke tailored to different availability of risk factors and still obtain valid measures of risk even in the simplest form of the model, with increasing performance of the model following increasing complexity. The methods chosen which separate this model from previous models (competing risk and stepwise approach) should be considered for future risk estimation models.

  • Stroke
  • risk stratification
  • epidemiology

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  • MORGAM Project participants: see online appendix.

  • Funding This research was part funded through the European Community's Seventh Framework Programme (FP7/2007-2013), ENGAGE project, grant agreement HEALTH-F4-2007-201413.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.