Validation of the SCORE2 risk prediction algorithm in a Portuguese population: A new model to estimate 10-year cardiovascular disease incidence in Europe

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 ye...

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Published inRevista portuguesa de cardiologia Vol. 43; no. 8; pp. 437 - 444
Main Authors Temtem, Margarida, Mendonça, Maria Isabel, Santos, Marina, Sá, Débora, Sousa, Francisco, Freitas, Sónia, Borges, Sofia, Henriques, Eva, Rodrigues, Mariana, Soares, Carolina, Rodrigues, Ricardo, Serrão, Marco, Drumond, António, Sousa, Ana Célia, Palma Reis, Roberto
Format Journal Article
LanguageEnglish
Published Portugal Elsevier España, S.L.U 01.08.2024
Elsevier
Subjects
Aged
Algorithms
Cardiovascular disease prevention
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - mortality
Cardiovascular risk
Europe - epidemiology
European scores
Female
Humans
Incidence
Male
Middle Aged
Portugal - epidemiology
Prevenção cardiovascular
Risco cardiovascular
Risk Assessment - methods
Scores europeus
Time Factors
Portugal
Europe
European scores
Prevenção cardiovascular
Risco cardiovascular
Scores europeus
Cardiovascular disease prevention
Cardiovascular risk
Online AccessGet full text
ISSN0870-2551
2174-2030
2174-2030
DOI10.1016/j.repc.2023.10.011

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Abstract 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. 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. 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). SCORE2 improved population stratification by identifying higher-risk patients, enabling early preventive measures. It showed good discriminative ability for all ASCVE. Indivíduos sem doença cardiovascular (DCV) sintomática podem sofrer de aterosclerose subclínica tendo risco de eventos cardiovasculares (ECV). O SCORE Europeu foi atualizado pelo SCORE2 que estima o risco de DCV fatal e não fatal a 10 anos, nos europeus entre 40 e 69 anos, sem DCV ou diabetes. O objetivo é comparar estes dois scores de risco, validando o SCORE2 na nossa população. 1071 indivíduos (57,2 ± 6,1anos; 75,2% sexo masculino), sem DCV ou diabetes, foram seguidos durante 5,4 ± 3,9 anos e estratificados em categorias de risco. O poder discriminativo dos scores para ECV foi estimado pela área abaixo da curva ROC (AUC) e pelo índice C de Harrell. A calibração foi avaliada pelo Hosmer-Lemeshow; o risco de ocorrência do 1.° evento pela regressão de Cox. Kaplan-Meier estimou a sobrevivência do SCORE2. O SCORE estratificou em quatro categorias de risco, baixo (7,4%), moderado (46,5%), alto (25,3%) e muito alto (20,8%) e o SCORE2 em três, baixo-a-moderado (24,7%), alto (59,0%) e muito alto (16,2%). O SCORE apresentou boa discriminação para mortalidade CV (AUC = 0,838; índiceC = 0,834) e o SCORE2 discriminou para a totalidade dos ECV (AUC = 0,744; índiceC = 0,728). A calibração foi adequada. A probabilidade de ECV aumentou oito vezes na categoria de muito alto risco (p = 0,001) e três vezes na de alto risco (p = 0,049). A sobrevivência livre de eventos foi 99%, 90% e 72% nas categorias de baixo-a-moderado, alto e muito alto risco, respetivamente (p < 0,0001). O SCORE2 melhorou a estratificação ao identificar indivíduos de maior risco, permitindo medidas preventivas precocemente. Mostrou boa capacidade discriminativa para ECV.
AbstractList 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.INTRODUCTION AND OBJECTIVESSubjects 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.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.METHODSA 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.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).RESULTSSCORE 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).SCORE2 improved population stratification by identifying higher-risk patients, enabling early preventive measures. It showed good discriminative ability for all ASCVE.CONCLUSIONSSCORE2 improved population stratification by identifying higher-risk patients, enabling early preventive measures. It showed good discriminative ability for all ASCVE.
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. Resumo: Introdução e objetivos: Indivíduos sem doença cardiovascular (DCV) sintomática podem sofrer de aterosclerose subclínica tendo risco de eventos cardiovasculares (ECV). O SCORE Europeu foi atualizado pelo SCORE2 que estima o risco de DCV fatal e não fatal a 10 anos, nos europeus entre 40 e 69 anos, sem DCV ou diabetes. O objetivo é comparar estes dois scores de risco, validando o SCORE2 na nossa população. Métodos: 1071 indivíduos (57,2 ± 6,1anos; 75,2% sexo masculino), sem DCV ou diabetes, foram seguidos durante 5,4 ± 3,9 anos e estratificados em categorias de risco. O poder discriminativo dos scores para ECV foi estimado pela área abaixo da curva ROC (AUC) e pelo índice C de Harrell. A calibração foi avaliada pelo Hosmer-Lemeshow; o risco de ocorrência do 1.° evento pela regressão de Cox. Kaplan-Meier estimou a sobrevivência do SCORE2. Resultados: O SCORE estratificou em quatro categorias de risco, baixo (7,4%), moderado (46,5%), alto (25,3%) e muito alto (20,8%) e o SCORE2 em três, baixo-a-moderado (24,7%), alto (59,0%) e muito alto (16,2%). O SCORE apresentou boa discriminação para mortalidade CV (AUC = 0,838; índiceC = 0,834) e o SCORE2 discriminou para a totalidade dos ECV (AUC = 0,744; índiceC = 0,728). A calibração foi adequada. A probabilidade de ECV aumentou oito vezes na categoria de muito alto risco (p = 0,001) e três vezes na de alto risco (p = 0,049). A sobrevivência livre de eventos foi 99%, 90% e 72% nas categorias de baixo-a-moderado, alto e muito alto risco, respetivamente (p < 0,0001). Conclusões: O SCORE2 melhorou a estratificação ao identificar indivíduos de maior risco, permitindo medidas preventivas precocemente. Mostrou boa capacidade discriminativa para ECV.
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. 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. 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). SCORE2 improved population stratification by identifying higher-risk patients, enabling early preventive measures. It showed good discriminative ability for all ASCVE.
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. 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. 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). SCORE2 improved population stratification by identifying higher-risk patients, enabling early preventive measures. It showed good discriminative ability for all ASCVE. Indivíduos sem doença cardiovascular (DCV) sintomática podem sofrer de aterosclerose subclínica tendo risco de eventos cardiovasculares (ECV). O SCORE Europeu foi atualizado pelo SCORE2 que estima o risco de DCV fatal e não fatal a 10 anos, nos europeus entre 40 e 69 anos, sem DCV ou diabetes. O objetivo é comparar estes dois scores de risco, validando o SCORE2 na nossa população. 1071 indivíduos (57,2 ± 6,1anos; 75,2% sexo masculino), sem DCV ou diabetes, foram seguidos durante 5,4 ± 3,9 anos e estratificados em categorias de risco. O poder discriminativo dos scores para ECV foi estimado pela área abaixo da curva ROC (AUC) e pelo índice C de Harrell. A calibração foi avaliada pelo Hosmer-Lemeshow; o risco de ocorrência do 1.° evento pela regressão de Cox. Kaplan-Meier estimou a sobrevivência do SCORE2. O SCORE estratificou em quatro categorias de risco, baixo (7,4%), moderado (46,5%), alto (25,3%) e muito alto (20,8%) e o SCORE2 em três, baixo-a-moderado (24,7%), alto (59,0%) e muito alto (16,2%). O SCORE apresentou boa discriminação para mortalidade CV (AUC = 0,838; índiceC = 0,834) e o SCORE2 discriminou para a totalidade dos ECV (AUC = 0,744; índiceC = 0,728). A calibração foi adequada. A probabilidade de ECV aumentou oito vezes na categoria de muito alto risco (p = 0,001) e três vezes na de alto risco (p = 0,049). A sobrevivência livre de eventos foi 99%, 90% e 72% nas categorias de baixo-a-moderado, alto e muito alto risco, respetivamente (p < 0,0001). O SCORE2 melhorou a estratificação ao identificar indivíduos de maior risco, permitindo medidas preventivas precocemente. Mostrou boa capacidade discriminativa para ECV.
Author Mendonça, Maria Isabel
Sousa, Francisco
Rodrigues, Ricardo
Soares, Carolina
Henriques, Eva
Drumond, António
Rodrigues, Mariana
Santos, Marina
Palma Reis, Roberto
Freitas, Sónia
Borges, Sofia
Sá, Débora
Temtem, Margarida
Serrão, Marco
Sousa, Ana Célia
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CitedBy_id crossref_primary_10_1016_j_repc_2024_04_005
crossref_primary_10_1016_j_repc_2024_06_001
crossref_primary_10_20344_amp_21376
crossref_primary_10_1016_j_repc_2024_08_005
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DocumentTitleAlternate Validação do algoritmo de predição de risco do SCORE2 numa população portuguesa: um novo modelo para estimar a incidência da doença cardiovascular a 10 anos na Europa
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IsDoiOpenAccess true
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Issue 8
Keywords European scores
Prevenção cardiovascular
Risco cardiovascular
Scores europeus
Cardiovascular disease prevention
Cardiovascular risk
Language English
License This is an open access article under the CC BY-NC-ND license.
Copyright © 2024 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.
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Snippet Subjects without cardiovascular (CV) disease (CVD) may suffer from subclinical atherosclerosis, and are at increased risk for atherosclerotic CV events...
Introduction and Objectives: Subjects without cardiovascular (CV) disease (CVD) may suffer from subclinical atherosclerosis, and are at increased risk for...
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elsevier
SourceType Open Website
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StartPage 437
SubjectTerms Aged
Algorithms
Cardiovascular disease prevention
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - mortality
Cardiovascular risk
Europe - epidemiology
European scores
Female
Humans
Incidence
Male
Middle Aged
Portugal - epidemiology
Prevenção cardiovascular
Risco cardiovascular
Risk Assessment - methods
Scores europeus
Time Factors
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Title Validation of the SCORE2 risk prediction algorithm in a Portuguese population: A new model to estimate 10-year cardiovascular disease incidence in Europe
URI https://www.clinicalkey.com/#!/content/1-s2.0-S0870255124000660
https://dx.doi.org/10.1016/j.repc.2023.10.011
https://www.ncbi.nlm.nih.gov/pubmed/38395299
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https://doi.org/10.1016/j.repc.2023.10.011
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