Abstract
BackgroundA key strategy for the primary prevention of cardiovascular disease (CVD) is the use of risk prediction algorithms. We aimed to investigate the predictive ability of SCORE (Systematic COronary Risk Estimation) and PCE (Pooled Cohort Equations) systems for atherosclerotic CVD (ASCVD) risk in Portugal, a low CVD risk country, at the 10-year landmark and at a longer, 15-year follow-up.MethodsThe SCORE and PCE 10-year risk estimates were calculated for 455 and 448 patients, respectively. Discrimination was assessed by Harrell’s C-statistic. Calibration was analyzed by standardized incidence ratios (SIR).ResultsDuring the 10-year follow-up, 7 fatal ASCVD events (the SCORE outcome) and 32 any ASCVD events (the PCE outcome) occurred. The SCORE system showed good discrimination (C-statistic 0.83), while the PCE showed poor discrimination (C-statistic 0.62). Calibration was similar for both systems, according to SIR: SCORE, 0.3 (95% CI 0.1–0.7); PCE, 0.5 (95% CI 0.4–0.7). Globally, both 10-year fatal ASCVD risk and any ASCVD risk were overestimated in the overall population and men. However, the risk was underestimated by both systems in women. Despite an overestimation of 15-year fatal ASCVD by SCORE, the 15-year any ASCVD observed incidence was 1.8 times the 10-year incidence among men and 1.4 times among women. This acceleration of CVD risk was more relevant in the lowest classes of ASCVD risk.ConclusionIn this prospective, contemporary, Portuguese cohort, the SCORE had better discriminatory power and similar calibration compared to PCE. However, both risk scores underestimated 10-year ASCVD risk in women.
Highlights
A key strategy for the primary prevention of cardiovascular disease (CVD) is the use of risk prediction algorithms
Discrimination We assessed the ability of Systematic COronary risk estimation (SCORE) and Pooled Cohort Equations (PCE) to discriminate between patients who developed events defined by SCORE and PCE and those who did not, after calculating the 10-year risk for each patient
The C-statistic corresponding to the model with risk score as the only covariate were 0.83 and 0.62 for the SCORE-specific and PCE-specific outcomes, respectively (Table 2)
Summary
A key strategy for the primary prevention of cardiovascular disease (CVD) is the use of risk prediction algorithms. We aimed to investigate the predictive ability of SCORE (Systematic COronary Risk Estimation) and PCE (Pooled Cohort Equations) systems for atherosclerotic CVD (ASCVD) risk in Portugal, a low CVD risk country, at the 10-year landmark and at a longer, 15-year follow-up. Calibration of the risk charts according to cardiovascular mortality levels of each country has been proposed for a more precise prediction of risk estimates [5]. This is of utmost importance in countries not represented in the derivation cohorts, as Portugal
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