Country-specific Risk Research Articles

Heterogeneous courses of cardiovascular disease incidence in Europe 2000-2019 – what are the causes?

Abstract Background Data from the Global Burden of Disease (GBD) project distributed by the Institute for health metrics and evaluation (IHME) include incidence and prevalence data for almost all countries in the world. In course of own research, the data on cardiovascular disease (CVD) incidence in Western European countries were analysed and revealed great variation in the course of CVD incidence, that is difficult to interpret. We want to present the different courses of CVD incidence for selected countries and discuss possible reasons for this diversity with the audience. Methods GBD data on CVD incidence and mortality for 25 European countries from 2000-2019 for men and women were to graphically display courses of CVD incidence for visual analysis. Results The course of CVD incidence in Western Europe is country-specific - and, within a country, even sex-specific. Yet, in many countries besides the Baltic states and Czechia, CVD incidence reaches a minimum in 2010, increasing afterwards again. Different patterns of incident courses were visible: a) wave-shaped courses which increase e.g. in Austria, Belgium, France and in males in Finland only, but decrease for both sexes Germany, Norway, Portugal and Poland, and in males in Denmark b) u-shaped courses in Spain, Great Britain, France, Italy, and for Finnish and Dutch females c) linearly increasing for both sexes in Czechia, the Baltic states and in Swiss males d) linearly decreasing for women Norway, Belgium, Denmark and Austria. Conclusions The patterns of CVD incidence in Europe are multitude and country-specific even between sexes, reaching a minimum in 2010 in most countries. The validity of analyses combining these different patterns for regional analyses of CVD incidence such as in GBD reports do not take account for this diversity. Unless these differences can be explained by country-specific prevention or risk factor profile, the validity of data on CVD incidence seems to be limited. Key messages • CVD incidence in Europe between 2000 and 2019 is country-specific changing and very heterogeneous. • Analyses summarizing data for (Western/Eastern) Europe will miss this heterogeneity and might come to invalid conclusions regarding the development of CVD incidence.

Country-specific determinants for COVID-19 case fatality rate and response strategies from a global perspective: an interpretable machine learning framework

BackgroundThere are significant geographic inequities in COVID-19 case fatality rates (CFRs), and comprehensive understanding its country-level determinants in a global perspective is necessary. This study aims to quantify the country-specific risk of COVID-19 CFR and propose tailored response strategies, including vaccination strategies, in 156 countries.MethodsCross-temporal and cross-country variations in COVID-19 CFR was identified using extreme gradient boosting (XGBoost) including 35 factors from seven dimensions in 156 countries from 28 January, 2020 to 31 January, 2022. SHapley Additive exPlanations (SHAP) was used to further clarify the clustering of countries by the key factors driving CFR and the effect of concurrent risk factors for each country. Increases in vaccination rates was simulated to illustrate the reduction of CFR in different classes of countries.FindingsOverall COVID-19 CFRs varied across countries from 28 Jan 2020 to 31 Jan 31 2022, ranging from 68 to 6373 per 100,000 population. During the COVID-19 pandemic, the determinants of CFRs first changed from health conditions to universal health coverage, and then to a multifactorial mixed effect dominated by vaccination. In the Omicron period, countries were divided into five classes according to risk determinants. Low vaccination-driven class (70 countries) mainly distributed in sub-Saharan Africa and Latin America, and include the majority of low-income countries (95.7%) with many concurrent risk factors. Aging-driven class (26 countries) mainly distributed in high-income European countries. High disease burden-driven class (32 countries) mainly distributed in Asia and North America. Low GDP-driven class (14 countries) are scattered across continents. Simulating a 5% increase in vaccination rate resulted in CFR reductions of 31.2% and 15.0% for the low vaccination-driven class and the high disease burden-driven class, respectively, with greater CFR reductions for countries with high overall risk (SHAP value > 0.1), but only 3.1% for the ageing-driven class.ConclusionsEvidence from this study suggests that geographic inequities in COVID-19 CFR is jointly determined by key and concurrent risks, and achieving a decreasing COVID-19 CFR requires more than increasing vaccination coverage, but rather targeted intervention strategies based on country-specific risks.

#294 Pragmatic literature reviews to populate a patient-level model to project the future clinical burden of CKD in low-and middle-income countries

Abstract Background and Aims Chronic Kidney Disease (CKD) affects approximately one in ten people around the world and is associated with an increased risk of adverse cardiorenal outcomes and mortality. In low- and middle-income countries (LMICs), the situation is aggravated by the paucity of kidney replacement therapies (KRTs). The objective of this study was to review the literature around CKD prevalence to understand the future epidemiology and economic burden of CKD in four LMICs from different continents. Method Inside CKD is a project designed to perform a microsimulation on a representative patient cohort to simulate renal disease progression into the future, and to model the effects of interventions based on population and disease characteristics. A pragmatic literature review was performed to obtain the inputs required to adapt the Inside CKD model to project the epidemiological and economic burden of CKD in four World Bank (2022) classified LMICs (Bolivia, Kenya, Sri Lanka and Uzbekistan). Using a data quality scoring system designed for the Inside CKD programme, a model input template was created to guide the country-specific literature search, to identify country demographics, epidemiological data including CKD staging data, renal registries, comorbidities (type 2 diabetes and hypertension), complications data (stroke, myocardial infarction, heart failure) and economic data including health costs and quality-of-life measures. Additional needs, challenges or country specific risk factors have also been identified. Results Literature reviews identified the best sources of demographic, epidemiological data as well as the main drivers of CKD in the four countries (e.g. hypertension, type 2 diabetes, heart failure). In addition, the reviews identified the best proxy data to use when country-specific data was not available. The UN World Prospects database was selected to derive the current and future population dynamics in the four countries. For Kenya, data from local sources, sub-Saharan African and Uganda were utilised to estimate the primary drivers of CKD: a 2018 meta-analysis reported a CKD prevalence of 18% in sub-Saharan Africa and was used to derive the eGFR and UACR data required to project CKD prevalence. CKD prevalence by stage was also identified for Bolivia. A large-scale study across 12 countries with consistent methodology estimated a CKD prevalence of around 5.5% in Bolivia. CKD data from Kazakhstan was selected as a proxy for Uzbekistan, which had a low prevalence of 1.3%. Country-specific challenges were also identified: in Kenya, results showed the importance of malnutrition, infection and climate as key drivers of CKD. In Sri Lanka and Uzbekistan, environmental factors (air and water pollution) and agricultural activity may contribute to high CKD prevalence in rural areas alongside more common risk factors such as hypertension. In Sri Lanka, CKD has been estimated at around 8.2% in the general population versus 15.0% in areas where groundwater is consumed. For Bolivia, additional parameters including occupation, altitude, seasonal weather variation and extreme temperatures may exacerbate CKD risk. Conclusion CKD is a major public health problem in LMICs but with diverse drivers. Local capacities and healthcare financing priorities vary between regions and depend upon competing demands of acute conditions, infections and non-communicable diseases. Forecasting future CKD burden is helpful for policy and planning purposes. There is a clear need to tailor policies beyond early screening and proactive management to tackle country-specific challenges such as occupation, infection, seasonal weather variation and genetics.

Analytical methods, risk assessment, and mitigation strategies for furan in processed foods in various countries.

This article provides an overview of analytical methods for measuring furan levels in food. Given the potential carcinogenicity of furans in humans, several studies have focused on assessing furan levels in various food products. In this review, we specifically examine furan levels in foods that are central to regional culinary traditions and summarize the results of country-specific risk assessments. Consequently, we have identified foods that contribute significantly to dietary furan exposure in each region. Coffee and baby foods, regardless of region, emerged as the primary sources of furan intake among adults and infants, respectively. Several previous studies have been conducted to develop various mitigation strategies aimed at reducing exposure to furan through food intake. Therefore, in this paper, we categorize effective mitigation strategies into two main groups: alterations to processing conditions and the addition or removal of food additives and ingredients.

Nontraded Sector Growth Risks and Economic Sizes in International Asset Pricing

Output fluctuations in nontraded sectors are an important country-specific risk factor because nontraded outputs are only consumed domestically. In interest rate markets, countries with higher nontraded output growth risks are associated with stronger motives for precautionary savings and lower interest rates. In currency markets, strategies with higher exposures to nontraded output growth risks offer higher average excess returns. Economic sizes play an important role in exacerbating the pricing impact of nontraded output growth risks as it requires larger international trades to mitigate nontraded output risks of larger economies. However, because economic sizes are functions of outputs in equilibrium, output growth risks also explain this role of economic sizes in international asset pricing. This paper was accepted by Agostino Capponi, finance. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2022.03697 .

The Macroeconomic Impact of Global and Country-Specific Climate Risk

This paper examines the impact of climate risk on macroeconomic activity for thirty countries using over a century of panel time series data. The key innovation of our paper is to use a factor stochastic volatility approach to decompose climate change into global and country-specific climate risk and to consider their distinct impact upon macroeconomic activity. To allow for country heterogeneity, we also differentiate the impact of climate risk upon advanced and emerging economies. While the existing literature has focused on country based climate risk shocks, our results suggest idiosyncratic or country-specific climate risk shocks are relatively unimportant. Global climate risk, on the other hand, has a negative and relatively more important impact on macroeconomic activity. In particular, we find that both advanced and emerging countries are adversely impacted by global climate risk shocks.

Yield rate in the Warsaw office market and its determinants. Further studies

This article is a continuation and extension of a previous study which, to the best of the author’s knowledge, was the first scientific attempt to identify determinants of the yield rate in the Warsaw office market. The paper is based on the Gordon growth model. In this approach, the yield rate of buildings offering office space to let is a function of the risk-free interest rate, the risk premium and a constant rate of growth of generated cash flows. In the article, five different elements of the risk premium were identified (term structure, alternative investments’, market (country) specific, monetary and local office market capacity risk premium). The Error Correction Model was formulated based on quarterly time series data from 2007Q1 to 2021Q2. Most investors in the office market in Poland are financial institutions representing foreign capital. Therefore, the innovation of the paper and its main goal was to define which factors play key roles in determining yield rates in the Warsaw office space market – national or regional/international. However, the selected group of Polish determinants were indicated as having prevailing an impact on the yield rate in the Warsaw office market than the corresponding determinants from the European Monetary Union and the USA. Based on the model, the lead-lag, as well as asymmetric relations, were depicted. Moreover, the use of dummy variables checks, the Chow test and the Markov switching model indicated the presence of structural breaks and the existence of the two regimes in the model.

COVID-19 Vaccine Effectiveness Among Adolescents.

For adolescents, data on the long-term effectiveness of the BNT162b2 and mRNA-1273 vaccines against severe COVID-19 outcomes are scarce. Additionally, only a few studies have evaluated vaccine effectiveness (VE) for mRNA-1273 or heterologous mRNA vaccine schedules (ie, mixing BNT162b2 and mRNA-1273). Nationwide register-based 1-to-1 matched cohort analyses were conducted in Denmark, Finland, Norway, and Sweden between May 28, 2021, and April 30, 2023, to estimate VE for primary COVID-19 vaccine (2-dose) schedules among adolescents aged 12 to 17 years. Cumulative incidences of COVID-19-related hospitalization (primary outcome) and laboratory-confirmed SARS-CoV-2 infection (secondary outcome) were compared for vaccinated and unvaccinated at 6 months of follow-up using the Kaplan-Meier estimator. Country-specific VE (1-risk ratio) and risk differences (RD) were combined by random-effects meta-analyses. The study included 526 966 primary schedule vaccinated adolescents. VE against COVID-19-related hospitalization was 72.6% (95% confidence interval [CI], 62.5-82.7) and RD was -2.8 (95% CI, -4.5 to -1.0) per 10 000 vaccinated for BNT162b2 at 6 months of follow-up compared with unvaccinated. The corresponding VE and RD were 86.0% (95% CI, 56.8-100.0) and -2.1 (95% CI, -4.0 to -0.2) per 10 000 vaccinated for mRNA-1273 and 80.7% (95% CI, 58.0-100.0) and -5.5 (95% CI, -15.5 to 4.6) per 10 000 vaccinated for heterologous mRNA vaccine schedules. Estimates were comparable when restricting to a period of omicronpredominance and extending follow-up to 12 months. Across 4 Nordic countries, severe COVID-19 in adolescents was a rare event. Compared with unvaccinated, BNT162b2, mRNA-1273, and heterologous mRNA vaccination schedules provided high protection against COVID-19-related hospitalization, including hospitalizations during the omicronperiod.

The impact of climate change policies on financial stability of China

Climate transition risks pose growing financial stability concerns, but research on quantifying climate policy impacts remains underexplored. This paper helps address this gap by evaluating how carbon tax (CT) and green supporting factor (GSF) influence China’s financial stability. An innovative dynamic stochastic general equilibrium (DSGE) model incorporating the banking sector is developed to quantify transmission channels, improving on conceptual studies. It reveals that more intense climate policies heighten impacts on financial stability, with CT improving it but GSF hampering it in the long run. However, both policies negatively affect stability initially, albeit insignificantly. These diagnostics underscore calibrating policy intensities and sequencing to balance climate and economic objectives. Furthermore, this study reveals asymmetric effects on polluting and non-polluting enterprises, with the former seeing reduced output and lending but the latter gaining. The differentiated approach proposed, tailored to firm emissions levels, provides key insights for unlocking smooth green transitions while maintaining financial system resilience. The paper makes important contributions by bringing together climate policies, adaptation, and financial stability. The findings offer insights into achieving a smooth climate transition while maintaining financial stability. Specific implications include starting with low CT on the heaviest emitters, gradually lowering risk weights for green lending, and using public incentives and investment to aid polluting firms’ transition. This study offers valuable quantitative insights for developing country-specific climate financial risk policies.

Clinical implications of incorporating genetic and non-genetic risk factors in CanRisk-based breast cancer risk prediction

BackgroundBreast cancer (BC) risk prediction models consider cancer family history (FH) and germline pathogenic variants (PVs) in risk genes. It remains elusive to what extent complementation with polygenic risk score (PRS) and non-genetic risk factor (NGRFs) data affects individual intensified breast surveillance (IBS) recommendations according to European guidelines. MethodsFor 425 cancer-free women with cancer FH (mean age 40·6 years, range 21–74), recruited in France, Germany and the Netherlands, germline PV status, NGRFs, and a 306 variant-based PRS (PRS306) were assessed to calculate estimated lifetime risks (eLTR) and estimated 10-year risks (e10YR) using CanRisk. The proportions of women changing country-specific European risk categories for IBS recommendations, i.e. ≥20 % and ≥30 % eLTR, or ≥5 % e10YR were determined. FindingsOf the women with non-informative PV status, including PRS306 and NGRFs changed clinical recommendations for 31·0 %, (57/184, 20 % eLTR), 15·8 % (29/184, 30 % eLTR) and 22·4 % (41/183, 5 % e10YR), respectively whereas of the women tested negative for a PV observed in their family, clinical recommendations changed for 16·7 % (25/150), 1·3 % (2/150) and 9·5 % (14/147). No change was observed for 82 women with PVs in high-risk genes (BRCA1/2, PALB2). Combined consideration of eLTRs and e10YRs identified BRCA1/2 PV carriers benefitting from IBS <30 years, and women tested non-informative/negative for whom IBS may be postponed. InterpretationFor women who tested non-informative/negative, PRS and NGRFs have a considerable impact on IBS recommendations. Combined consideration of eLTRs and e10YRs allows personalizing IBS starting age. FundingHorizon 2020, German Cancer Aid, Federal Ministry of Education and Research, Köln Fortune.

Disentangling the geopolitical risk and its effects on commodities. Evidence from a panel of G8 countries

Geopolitical risk pertains to the potential impact of political, economic, and social factors on the global or regional landscape, giving rise to potential disruptions in the prevailing background. This paper examines the dynamic impact of country-specific geopolitical risk indexes on the G8 countries and commodity market prices. Using a sample of monthly data ranging from January 2001 to October 2022, after estimating a time-varying parameter VAR model, we perform an impulse response analysis that accounts for the major political and economic events that have shaken the past two decades. Our main findings show that geopolitical risk transmission differs from country to country and often depends on geographical proximity, that geopolitical risk appears to affect the energy sector more than metals and food, and that the effects of shocks tend to be absorbed within a year. We also find the magnitude of geopolitical shocks in the US and Russia to be the most relevant, especially after the 2008 global crisis and the Russia–Ukraine conflict in 2022. Our results could provide useful information to financial policymakers and market regulators to face external shocks, thereby achieving greater macroeconomic stability.

The role of booster vaccination in decreasing COVID-19 age-adjusted case fatality rate: Evidence from 32 countries.

The global COVID-19 pandemic is still ongoing, and cross-country and cross-period variation in COVID-19 age-adjusted case fatality rates (CFRs) has not been clarified. Here, we aimed to identify the country-specific effects of booster vaccination and other features that may affect heterogeneity in age-adjusted CFRs with a worldwide scope, and to predict the benefit of increasing booster vaccination rate on future CFR. Cross-temporal and cross-country variations in CFR were identified in 32 countries using the latest available database, with multi-feature (vaccination coverage, demographic characteristics, disease burden, behavioral risks, environmental risks, health services and trust) using Extreme Gradient Boosting (XGBoost) algorithm and SHapley Additive exPlanations (SHAP). After that, country-specific risk features that affect age-adjusted CFRs were identified. The benefit of booster on age-adjusted CFR was simulated by increasing booster vaccination by 1-30% in each country. Overall COVID-19 age-adjusted CFRs across 32 countries ranged from 110 deaths per 100,000 cases to 5,112 deaths per 100,000 cases from February 4, 2020 to Jan 31, 2022, which were divided into countries with age-adjusted CFRs higher than the crude CFRs and countries with age-adjusted CFRs lower than the crude CFRs (n = 9 and n = 23) when compared with the crude CFR. The effect of booster vaccination on age-adjusted CFRs becomes more important from Alpha to Omicron period (importance scores: 0.03-0.23). The Omicron period model showed that the key risk factors for countries with higher age-adjusted CFR than crude CFR are low GDP per capita and low booster vaccination rates, while the key risk factors for countries with higher age-adjusted CFR than crude CFR were high dietary risks and low physical activity. Increasing booster vaccination rates by 7% would reduce CFRs in all countries with age-adjusted CFRs higher than the crude CFRs. Booster vaccination still plays an important role in reducing age-adjusted CFRs, while there are multidimensional concurrent risk factors and precise joint intervention strategies and preparations based on country-specific risks are also essential.

Cardiovascular Risk Estimation Based on Country-of-Birth- and Country-of-Residence-Specific Scores among Migrants in the Netherlands: The HELIUS Study

Regional and country-specific cardiovascular risk algorithms have been developed to improve CVD risk prediction. But it is unclear whether migrants' country-of-residence or country-of-birth algorithms agree in stratifying the CVD risk of these populations. We evaluated the risk stratification by the different algorithms, by comparing migrant country-of-residence-specific scores to migrant country-of-birth-specific scores for ethnic minority populations in the Netherlands. data from the HELIUS study was used in estimating the CVD risk scores for participants using five laboratory-based (Framingham, Globorisk, Pool Cohort Equation II, SCORE II, and WHO II) and three nonlaboratory-based (Framingham, Globorisk, and WHO II) risk scores with the risk chart for the Netherlands. For the Globorisk, WHO II, and SCORE II risk scores, we also computed the risk scores using risk charts specified for the migrant home country. Risk categorization was first done according to the specification of the risk algorithm and then simplified to low (green), moderate (yellow and orange), and high risk (red). we observed differences in risk categorization for different risk algorithms ranging from 0% (Globorisk) to 13% (Framingham) for the high-risk category, as well as differences in the country-of-residence- and country-of-birth-specific scores. Agreement between different scores ranged from none to moderate. We observed a moderate agreement between the Netherlands-specific SCORE II and the country-of-birth SCORE II for the Turkish and a nonagreement for the Dutch Moroccan population. disparities exist in the use of the country-of-residence-specific, as compared to the country-of-birth, risk algorithms among ethnic minorities living in the Netherlands. Hence, there is a need for further validation of country-of-residence- and country-of-birth-adjusted scores to ascertain appropriateness and reliability.

Modeling the global sovereign credit network under climate change

Climate change is becoming an urgent issue for the global economy. Our study employs a multivariate extreme value regression model that incorporates a LASSO-type estimator to investigate the tail dependence of the global sovereign credit default swap market conditional on climate change. Herein, we propose an extremal connectedness measure based on tail dependence to construct a sovereign credit network. The findings show that extreme weather or climate disasters significantly impact country-specific sovereign risk with heterogeneous network structure outcomes. Specifically, extreme weather conditions have a strong impact on countries' sovereign credit and magnify their influence on the global sovereign credit network. Furthermore, we identify an asymmetric risk spillover effect in the global sovereign credit network, where the degree of risk spillover is higher under extremely hot weather conditions. Our analysis provides new insights into the role of climate change in sovereign risk.

Challenges of Establishing Solar Power Stations in Hungary

In the context of the ever-growing demand for energy, especially electric energy, from renewable sources, there has been great interest in photovoltaic energy generation. The speed at which the penetration of photovoltaic technology can grow, however, does not simply depend on supply and demand but also on the various policies and schemes adopted by countries around the world. These, in turn, play decisive roles in investment decisions and determine how projects are approached. Investors in photovoltaic (PV) systems need to be aware of the country-specific risk factors for investments and the regulatory environment. The aim of this research was to explore which managerial, economic and technical aspects should be considered in a causal approach when designing PV power plants with over 50 kW of capacity in the Hungarian regulatory environment for the success of the project. The innovative significance of the study is that it presents a validated, practically usable model for the realization of PV power plant projects in Hungary, which provides an in-depth description of the causal steps of their planning and establishment, based on real-life experience. The novel, practical benefit of the research is that it updates and clarifies the steps necessary for the design of PV power plants, since nowadays there are no current scientific works that provide knowledge of a sufficient depth regarding such projects, so these characteristics need to be investigated.

Analyses of the impact of country specific macro risk variables on gold futures contract and its position as an asset class: evidence from India

Analyses of the impact of country specific macro risk variables on gold futures contract and its position as an asset class: evidence from India

Analyses of the impact of country specific macro risk variables on gold futures contract and its position as an asset class: evidence from India

Analyses of the impact of country specific macro risk variables on gold futures contract and its position as an asset class: evidence from India

Laboratory-based and office-based Globorisk scores to predict 10-year risk of cardiovascular diseases among Iranians: results from the Fasa PERSIAN cohort

BackgroundGloborisk is a novel risk prediction model for predicting cardiovascular disease (CVD). Globorisk is a country-specific risk prediction model that determines CVD risk for all countries. This model has two versions; laboratory-based and office-based. This study aimed to determine the agreement between laboratory-based and office-based models in a large sample of the general population.MethodsBaseline data from the Fasa cohort study was used for the current study. In total, 6810 participants ≥ 40 years without any history of cardiovascular disease or stroke were included in the study. To determine the laboratory-based risk model, factors include age, sex, current smoking status, history of diabetes, systolic blood pressure (SBP), and total cholesterol. To estimate the office-based risk model, factors were age, sex, current smoking status, SBP, and body mass index (BMI). Kappa statistics was used to distinguish the agreement between grouped scores in these two models. Additionally, correlation coefficients and scatter plots were used to determine the linear correlation between the two models.ResultsIn this study 46.53% of the participants were men. The mean age (SD) of participants was 51.08 (7.88) years. Agreements between the two models were moderate and substantial in all women and all men, respectively. The agreement between the two CVD risk groups was 90.15% (kappa = 0.717) in all men, 92.94% (kappa = 0.571) among men aged < 60 years and 77.60% (kappa = 0.645) in men aged ≥ 60 years. The agreement between the two CVD risk groups was 86.68% (kappa = 0.572) among all women, 93.96% (kappa = 0.274) among women aged < 60 years and 62.46% (kappa = 0.422) among women aged ≥ 60 years. A very strong positive correlation (r = 0.94) was found between the two risk scores in all men, and it was similar among men aged < 60 years (r = 0.84) and men aged > 60 years (r = 0.94). Among all women, there was a very strong positive correlation (r = 0.87), and the strong positive correlation remained among < 60 years old (r = 0.76) and women > 60 years old (r = 0.76).ConclusionThe Globorisk office-based model which is easier to use as it does not require blood testing can determine the risk groups in this population. The Globorisk office-based model may be used for CVD risk screening in low-middle income countries where resources are limited.

The role of dietary and physical activity assessment in the predictive ability of cardiovascular disease risk scores: A narrative review

Due to the increased burden of cardiovascular disease (CVD) around the world, country specific risk prediction models (or scores) of future CVD events have been developed and recommended as screening tools for primary prevention, as well as treatment management. Most of these risk scores include basic demographic characteristics, like age and sex, smoking habits, as well as some clinical and biochemical factors, like blood pressure, cholesterol, and glucose levels. Dietary habits and physical activity status of individuals have consistently shown in many studies during the past years a strong, and independent association with CVD risk. However, their integration in CVD risk scores is rare, even though when used for the assessment of overall CVD risk, the models showed improved classification ability. In this review paper, and in the light of the recent SCORE 2 (2021) tool presented by the European Society of Cardiology, we discuss the benefits from the incorporation of dietary and physical activity assessment in the predictive ability of CVD risk prediction tools.

Cardiovascular Risk Prediction Models and Scores in the Era of Personalized Medicine.

Cardiovascular disease (CVD) is the leading cause of death worldwide. Management of cardiovascular risk factors, particularly hypertension and dyslipidemia, has been shown to reduce cardiovascular morbidity and mortality. However, current guidelines recommend adjusting the intensity of blood pressure- and lipid-lowering treatment according to the cardiovascular risk of the patient. Therefore, cardiovascular risk prediction is a sine qua non for optimizing cardiovascular prevention strategies, particularly in patients without established CVD or type 2 diabetes mellitus (T2DM). As a result, several cardiovascular risk prediction equations have been developed. Nevertheless, it is still unclear which is the optimal prediction risk equation. In the present review, we summarize the current knowledge regarding the accuracy of the most widely used cardiovascular risk prediction equations. Notably, most of these risk scores have not been validated in external cohorts or were shown to over- or underestimate risk in populations other than those in which they derive. Accordingly, country-specific risk scores, where available, should be preferred for cardiovascular risk stratification.