Is Calculated SCORE Risk Reliable in Asymptomatic Atherosclerosis? Sarajevo Survey on Vascular/Heart Ageing

Abstract

Aim: Aim of this article is to present our own, Bosnia and Herzegovina survey in patients with asymptomatic atherosclerosis and to compare European SCORE risk estimation and 2008 Framingham Risk tables on our sample of patients. In fact, 2008 Framingham Risk table included a concept of vascular/heart ageing. On the other hand a European SCORE system was basically aimed to quantify the absolute 10 years (fatal) cardiovascular risk. SCORE risk estimation and vascular ageing was modify in updated version of European guidelines but still it is insufficient. Cuende et al. (2010) suggests a new method of cardiovascular risk evaluation. Materials-Methods: Sarajevo survey was conducted on the sample of completely (100%) asymptomatic patients (n-358). Participants were of 40-69 yrs, average yrs. 57.1 9.2, 142 females and 216 males. We performed non-invasive screening of aorta, carotid, iliac and femoral vessels and found asymptomatic atherosclerotic disease (atheroplaques) in 43,1% individuals and significance was of p<0,001. We found atherosclerotic plaques of various degrees in age subgroups; 40-49 yrs (18,3%), 50-59 yrs (48,9%), 60-69 yrs (32,7%). Calculation of fatal CVD risk on the basis of SCORE scale for high-risk European countries, due to age subgroups, was as follows; 40-49 yrs (2%), 50-59 yrs (3,45%) and 60-69 yrs (8,90%), respectively. Due to Cuende modification of SCORE tables their average vascular/heart age was significantly higher than their actual calendar age, and average vascular/heart age was higher for 14,5 yrs, p<0,001. After this results we underwent recalculating of vascular/heart age according to 2008 Framingham Risk Tables and we found 16,8 yrs higher results i.e. in age subgroup of 50-59 yrs, vascular/heart age was 75,9 yrs, and for age subgroup of 60-69 yrs, vascular/heart age was 85,3 yrs. Conclusion: after these results we can confirm that current SCORE system underestimate real risk, especially in individuals with asymptomatic atherosclerosis and do not “recognized“ them as high risk population. On the other hand it is very clear that official statistics for Bosnia and Herzegovina; morbidity of 11.800/100000 inhabitants, and mortality of 578/100000, are not correct. In fact, morbidity and mortality in our population is much more higher. On the basis of this results and other studies, as well, we must introduced risk estimation of cardiovascular risk factors on the basis of vascular/heart age to achieve real data and real “mirror“ of our cardiovascular situation. We want to underline that we have to focused on identification of risk and highrisk asymptomatic individuals and immediately act in order to decrease our rates of morbidity and mortality.