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Updated SCORE2 CVD Risk Prediction Algorithms
Quick Takes
- SCORE2, an updated algorithm tailored to European populations, provides risk estimates for the combined outcome of fatal and nonfatal cardiovascular disease (CVD) events, in contrast with SCORE’s use of CVD mortality only.
- SCORE2 better estimates the total burden of CVD, particularly among younger individuals, as well as shows better risk discrimination than original SCORE.
- Overall, SCORE2, a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations, enhances the identification of individuals at higher risk of developing CVD across Europe.
Study Questions:
What is the validity of SCORE2 to estimate 10-year fatal and nonfatal cardiovascular disease (CVD) risk in individuals in Europe without previous CVD or diabetes aged 40–69 years?
Methods:
The investigators derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677,684 individuals, 30,121 CVD events). They used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and high-density lipoprotein (HDL) cholesterol. The authors defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10,776,466 individuals. For external validation, they analyzed data from 25 additional cohorts in 15 European countries (1,133,181 individuals, 43,492 CVD events).
Results:
After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65–0.68) to 0.81 (0.76–0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mm Hg, total cholesterol of 5.5 mmol/L, and HDL cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries.
Conclusions:
The authors concluded that SCORE2 enhances the identification of individuals at higher risk of developing CVD across Europe.
Perspective:
This study reports that SCORE2 provides risk estimates for the combined outcome of fatal and nonfatal CVD events, in contrast with SCORE’s use of CVD mortality only. Furthermore, the analysis suggests that SCORE2 better estimates the total burden of CVD, particularly among younger individuals, as well as shows better risk discrimination than original SCORE. Overall, SCORE2, a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations, enhances the identification of individuals at higher risk of developing CVD across Europe.
Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Smoking
Keywords: Blood Pressure, Cardiovascular Diseases, Cholesterol, Cholesterol, HDL, Diabetes Mellitus, Europe, Middle Aged, Myocardial Ischemia, Primary Prevention, Risk Factors, Smoking, Vascular Diseases
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