TY - JOUR
T1 - Validation of the SCORE2 risk prediction algorithm in a Portuguese population
T2 - A new model to estimate 10-year cardiovascular disease incidence in Europe
AU - Temtem, Margarida
AU - Mendonça, Maria Isabel
AU - Santos, Marina
AU - Sá, Débora
AU - Sousa, Francisco
AU - Freitas, Sónia
AU - Borges, Sofia
AU - Henriques, Eva
AU - Rodrigues, Mariana
AU - Soares, Carolina
AU - Rodrigues, Ricardo
AU - Serrão, Marco
AU - Drumond, António
AU - Sousa, Ana Célia
AU - Palma Reis, Roberto
N1 - Publisher Copyright:
© 2024 Sociedade Portuguesa de Cardiologia
PY - 2024/2
Y1 - 2024/2
N2 - Introduction and Objectives: Subjects without cardiovascular (CV) disease (CVD) may suffer from subclinical atherosclerosis, and are at increased risk for atherosclerotic CV events (ASCVE). The ESC/EAS risk SCORE was updated by SCORE2, which estimates 10-year risk of fatal and non-fatal CVD in European populations aged 40–69 years without established CVD or diabetes. Our aim was to compare the two ESC/EAS risk scores and to validate SCORE2 in our population. Methods: A total of 1071 individuals (age 57.2±6.1 years; 75.2% male) without CVD or diabetes, from GENEMACOR study controls, were analyzed over 5.4±3.9 years. The population was stratified into risk categories according to the two scores, and the area under the ROC curve (AUC) and Harrell's C-index assessed the scores’ performance. Calibration was performed using the goodness-of-fit test, and occurrence of the first event assessed by Cox regression. Kaplan–Meier analysis estimated SCORE2 survival. Results: SCORE stratified subjects into four risk categories: low (7.4%), moderate (46.5%), high (25.3%) and very high (20.8%), and SCORE2 into three: low-to-moderate (24.7%), high (59.0%) and very high (16.2%). SCORE presented good discrimination for CV mortality (AUC=0.838; C-index=0.834, 95% CI: 0.728–0.940), as did SCORE2 for total CV events (AUC=0.744; C-index=0.728, 95% CI: 0.648–0.808). Calibration did not show a disparity between observed and expected ASCVE. The probability of ASCVE was eight times higher in very-high-risk SCORE2 (p=0.001), and three times in the high-risk group (p=0.049). Event-free survival was 99%, 90% and 72% in the low-to-moderate, high and very-high-risk categories, respectively (p<0.0001). Conclusions: SCORE2 improved population stratification by identifying higher-risk patients, enabling early preventive measures. It showed good discriminative ability for all ASCVE.
AB - Introduction and Objectives: Subjects without cardiovascular (CV) disease (CVD) may suffer from subclinical atherosclerosis, and are at increased risk for atherosclerotic CV events (ASCVE). The ESC/EAS risk SCORE was updated by SCORE2, which estimates 10-year risk of fatal and non-fatal CVD in European populations aged 40–69 years without established CVD or diabetes. Our aim was to compare the two ESC/EAS risk scores and to validate SCORE2 in our population. Methods: A total of 1071 individuals (age 57.2±6.1 years; 75.2% male) without CVD or diabetes, from GENEMACOR study controls, were analyzed over 5.4±3.9 years. The population was stratified into risk categories according to the two scores, and the area under the ROC curve (AUC) and Harrell's C-index assessed the scores’ performance. Calibration was performed using the goodness-of-fit test, and occurrence of the first event assessed by Cox regression. Kaplan–Meier analysis estimated SCORE2 survival. Results: SCORE stratified subjects into four risk categories: low (7.4%), moderate (46.5%), high (25.3%) and very high (20.8%), and SCORE2 into three: low-to-moderate (24.7%), high (59.0%) and very high (16.2%). SCORE presented good discrimination for CV mortality (AUC=0.838; C-index=0.834, 95% CI: 0.728–0.940), as did SCORE2 for total CV events (AUC=0.744; C-index=0.728, 95% CI: 0.648–0.808). Calibration did not show a disparity between observed and expected ASCVE. The probability of ASCVE was eight times higher in very-high-risk SCORE2 (p=0.001), and three times in the high-risk group (p=0.049). Event-free survival was 99%, 90% and 72% in the low-to-moderate, high and very-high-risk categories, respectively (p<0.0001). Conclusions: SCORE2 improved population stratification by identifying higher-risk patients, enabling early preventive measures. It showed good discriminative ability for all ASCVE.
KW - Cardiovascular disease prevention
KW - Cardiovascular risk
KW - European scores
UR - http://www.scopus.com/inward/record.url?scp=85188450927&partnerID=8YFLogxK
U2 - 10.1016/j.repc.2023.10.011
DO - 10.1016/j.repc.2023.10.011
M3 - Article
AN - SCOPUS:85188450927
SN - 0870-2551
JO - Revista Portuguesa de Cardiologia
JF - Revista Portuguesa de Cardiologia
ER -