Abstract
AimsCardiovascular disease (CVD) risk prediction models are used in Western European countries, but less so in Eastern European countries where rates of CVD can be two to four times higher. We recalibrated the SCORE prediction model for three Eastern European countries and evaluated the impact of adding seven behavioural and psychosocial risk factors to the model.Methods and resultsWe developed and validated models using data from the prospective HAPIEE cohort study with 14 598 participants from Russia, Poland, and the Czech Republic (derivation cohort, median follow-up 7.2 years, 338 fatal CVD cases) and Estonian Biobank data with 4632 participants (validation cohort, median follow-up 8.3 years, 91 fatal CVD cases). The first model (recalibrated SCORE) used the same risk factors as in the SCORE model. The second model (HAPIEE SCORE) added education, employment, marital status, depression, body mass index, physical inactivity, and antihypertensive use. Discrimination of the original SCORE model (C-statistic 0.78 in the derivation and 0.83 in the validation cohorts) was improved in recalibrated SCORE (0.82 and 0.85) and HAPIEE SCORE (0.84 and 0.87) models. After dichotomizing risk at the clinically meaningful threshold of 5%, and when comparing the final HAPIEE SCORE model against the original SCORE model, the net reclassification improvement was 0.07 [95% confidence interval (CI) 0.02–0.11] in the derivation cohort and 0.14 (95% CI 0.04–0.25) in the validation cohort.ConclusionOur recalibrated SCORE may be more appropriate than the conventional SCORE for some Eastern European populations. The addition of seven quick, non-invasive, and cheap predictors further improved prediction accuracy.
Highlights
The highest rates of cardiovascular disease (CVD) in the world are found in Eastern Europe
Our recalibrated SCORE may be more appropriate than the conventional SCORE for some Eastern European populations
Can CVD risk prediction be more accurate in Eastern Europe, by recalibrating SCORE and adding new factors?
Summary
The highest rates of cardiovascular disease (CVD) in the world are found in Eastern Europe. Age-standardized death rates of CVD (expressed as per 100 000, using 2013 data from the WHO European Mortality Indicator Database) are three to four times higher in Russia (547) when compared to the UK (141), Finland (187), or Germany (200). This calls for an urgent need to strengthen primary prevention in this region. Accurate prediction enables behavioural and medical interventions, such as healthy lifestyle promotion (e.g. smoking cessation) and preventive lipid-lowering, antihypertensive, or anticoagulation medications to be targeted to those of highest risk.1 This agenda can reduce overtreatment and side effects for those at lower risk, while maximizing timely interventions, financial, health and equity gains for those at high risk Accurate prediction enables behavioural and medical interventions, such as healthy lifestyle promotion (e.g. smoking cessation) and preventive lipid-lowering, antihypertensive, or anticoagulation medications to be targeted to those of highest risk. This agenda can reduce overtreatment and side effects for those at lower risk, while maximizing timely interventions, financial, health and equity gains for those at high risk
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