This is an interesting simulation study, but the process of variable selection appears to be seriously flawed. The authors state that they chose the variables included "because they can be reliably and easily obtained during an office-based health check", rather than by using empirical methods. In the United Kingdom, deprivation and ethnicity (both of which can easily be obtained during a health check) were included in the QRISK2 model (Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, et al. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ 2008;336, Link: http://www.bmj.com/conten...) as a result of empirical variable selection. These may not be risk factors in the Rotterdam study population, but without a proper variable selection process we will never know.
