Systematic Coronary Risk Evaluation Model Research Articles

Associations of 10-year atherosclerotic cardiovascular disease risk scores with cerebral small vessel disease: the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study.

10-year atherosclerotic cardiovascular disease (ASCVD) risk scores were useful for predicting large vessel disease, but the relationships between them and cerebral small vessel disease (CSVD) were unclear. Our study aimed to evaluate associations of 10-year ASCVD risk scores with CSVD and its magnetic resonance imaging (MRI) markers. Community-dwelling residents from the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events study were included in this cross-sectional study. At baseline, we collected data related to the Framingham Risk Score (FRS), pooled cohort equation (PCE), prediction for ASCVD risk in China (China-PAR) and Systematic COronary Risk Evaluation model 2 (SCORE2), and classified participants into low, moderate and high groups. Participants underwent brain MRI scans. We evaluated white matter hyperintensity (WMH), lacunes, cerebral microbleeds (CMBs) and enlarged perivascular spaces in basal ganglia (BG-EPVS) according to criteria of Wardlaw and Rothwell, and calculated total CSVD score and modified total CSVD score. A total of 3063 participants were included, and 53.5% of them were female. A higher FRS was associated with higher total CSVD score (moderate vs. low: cOR 1.89, 95% CI 1.53-2.34; high vs. low: cOR 3.23, 95%CI 2.62-3.97), and the PCE, China-PAR or SCORE2 score was positively related to total CSVD score (P < 0.05). Moreover, higher 10-year ASCVD scores were associated with higher odds of WMH (P < 0.05), lacunes (P < 0.05), CMBs (P < 0.05) and BG-EPVS (P < 0.05). The 10-year ASCVD scores were positively associated with CSVD and its MRI markers. These scores provided a method of risk stratification in the population with CSVD.

European Lipid Guidelines and Cardiovascular Risk Estimation: Current Status and Future Challenges.

Genetic, experimental, epidemiologic, and clinical data support the causal role of elevated levels of low-density lipoprotein cholesterol (LDL-C) in atherosclerosis and cardiovascular disease (CVD). The recommendations of the 2019 European guidelines are based on the concept of differential CV risk, which in turn defines the LDL-C goals that should be achieved. The 2019 ESC/EAS guidelines for dyslipidaemia use the Systematic COronary Risk Evaluation (SCORE) model to assess CV risk, which provides a 10-year risk of fatal CV event. The SCORE model has recently been updated to reflect current rates of cardiovascular disease in Europe. The new SCORE2 model provides estimates of the 10-year risk of fatal and non-fatal CVD events in people aged 40-69 years, thus improving the identification of individuals at higher risk of a CVD event. However, as in the SCORE age is the main determinant of risk, young people have a relatively low estimated 10-year risk of a CV event even with high levels of one or more causal risk factors. Individuals with familial hypercholesterolaemia, who have elevated LDL-C levels from birth and have a high risk of premature CVD, are one example. The concept of cumulative LDL exposure is thus becoming increasingly important. This is also supported by Mendelian randomisation studies showing that carrying genetic variants associated with lower LDL-C levels reduces CV risk. These observations have introduced the concept of "cholesterol-years", which takes into account both LDL-C levels and time of exposure. It is crucial that future European guidelines pay more attention to this point.

Performance of Cardiovascular Risk Prediction Models in Korean Patients With New-Onset Rheumatoid Arthritis: National Cohort Study.

This study aimed to compare the performance of established cardiovascular risk algorithms in Korean patients with new-onset rheumatoid arthritis. This retrospective cohort study identified patients newly diagnosed with rheumatoid arthritis without a history of cardiovascular diseases between 2013 and 2019 using the National Health Insurance Service database. The cohort was followed up until 2020 for the development of the first major adverse cardiovascular event. General cardiovascular risk prediction algorithms, such as the systematic coronary risk evaluation model, the Korean risk prediction model for atherosclerotic cardiovascular diseases, the American College of Cardiology/American Heart Association pooled equations, and the Framingham Risk Score, were used. The discrimination and calibration of cardiovascular risk prediction models were evaluated. Hazard ratios were estimated using Cox proportional hazards regression. A total of 611 patients among 24 889 patients experienced a major adverse cardiovascular event during follow-up. The median 10-year atherosclerotic cardiovascular diseases risk score was significantly higher in patients with major adverse cardiovascular events than those without. The C-statistics of risk algorithms ranged between 0.72 and 0.74. Compared with the low-risk group, the actual risk of developing major adverse cardiovascular events increased significantly in the intermediate- and high-risk groups for all algorithms. However, the risk predictions calculated from all algorithms overestimated the observed cardiovascular risk in the middle to high deciles, and only the systematic coronary risk evaluation algorithm showed comparable observed and predicted event rates in the low-intermediate deciles with the highest sensitivity. The systematic coronary risk evaluation model algorithm and the general risk prediction models discriminated patients with rheumatoid arthritis appropriately. However, overestimation should be considered when applying the cardiovascular risk prediction model in Korean patients.

Validation of the European SCORE2 models in a Canadian primary care cohort.

Systematic Coronary Risk Evaluation Model 2 (SCORE2) was recently developed to predict atherosclerotic cardiovascular disease (ASCVD) in Europe. Whether these models could be used outside of Europe is not known. The objective of this study was to test the validity of SCORE2 in a large Canadian cohort. A primary care cohort of persons with routinely collected electronic medical record data from 1 January 2010 to 31 December 2014, in Ontario, Canada, was used for validation. The SCORE2 models for younger persons (YP) were applied to 57 409 individuals aged 40-69 while the models for older persons (OPs) were applied to 9885 individuals 70-89 years of age. Five-year ASCVD predictions from both the uncalibrated and low-risk region recalibrated SCORE2 models were evaluated. The C-statistic for SCORE2-YP was 0.74 in women and 0.69 in men. The uncalibrated SCORE2-YP overestimated risk by 17% in women and underestimated by 2% in men. In contrast, the low-risk region recalibrated model demonstrated worse calibration, overestimating risk by 100% in women and 36% in men. The C-statistic for SCORE2-OP was 0.64 and 0.62 in older women and men, respectively. The uncalibrated SCORE2-OP overestimated risk by more than 100% in both sexes. The low-risk region recalibrated model demonstrated improved calibration but still overestimated risk by 60% in women and 13% in men. The performance of SCORE2 to predict ASCVD risk in Canada varied by age group and depended on whether regional calibration was applied. This underscores the necessity for validation assessment of SCORE2 prior to implementation in new jurisdictions.

Cardiovascular risk assessment in periodontitis patients and controls using the European Systematic COronary Risk Evaluation (SCORE) model. A pilot study.

Aim: To investigate the use of the European SCORE model in a dental setting by exploring the frequency of a 'high' and 'very high' 10-year CVD mortality risk in patients with and without periodontitis. The secondary aim was to investigate the association of SCORE with various periodontitis parameters adjusting for remaining potential confounders. Material and methods: In this study, we recruited periodontitis patients and non-periodontitis controls, all aged ≥40years. We determined the 10-year CVD mortality risk per individual with the European Systematic Coronary Risk Evaluation (SCORE) model by using certain patient characteristics and biochemical analyses from blood by finger stick sampling. Results: In total, 105 periodontitis patients (61 localized, 44 generalized stage III/IV) and 88 non-periodontitis controls were included (mean age: 54.4years). The frequency of a 'high' and 'very high' 10-year CVD mortality risk was 43.8% in all periodontitis patients and 30.7% in controls (p = .061). In total, 29.5% generalized periodontitis patients had a 'very high' 10-year CVD mortality risk, compared to 16.4% in localized periodontitis patients and 9.1% in controls (p = .003). After adjustment for potential confounders, the total periodontitis group (OR 3.31; 95% CI 1.35-8.13), generalized periodontitis group (OR 5.32; 95% CI 1.90-14.90), lower number of teeth (OR .83; 95% CI .73-1.00) and higher number of teeth with radiographic bone loss ≥33% (OR 1.06; 95% CI 1.00-1.12) were associated with a "very high" SCORE category. In addition, various biochemical risk markers for CVD were more frequently elevated in periodontitis compared to controls (e.g., total cholesterol, triglycerides, C-reactive protein). Conclusion: The periodontitis group as well as the control group had a sizable frequency of a 'high' and 'very high' 10-year CVD mortality risk. The presence and extent of periodontitis, lower number of teeth and higher number of teeth with bone loss ≥33% are significant risk indicators for a 'very high' 10-year CVD mortality risk. Therefore, SCORE in a dental setting can be a very useful tool to employ for primary and secondary prevention of CVD, especially among the dental attenders who have periodontitis.

Does socioeconomic status make a difference? A register-based study on the extent to which cardiovascular screening in patients with inflammatory arthritis leads to recommended follow-up in general practice

ObjectiveTo investigate to what extent patients with inflammatory arthritis (IA) follow recommendations given in a secondary care nurse-led cardiovascular (CV) risk screening consultation to consult their general practitioner (GP) to...

Estimation of the 10-Year Risk of Cardiovascular Diseases: Using the SCORE, WHO/ISH, and Framingham Models in the Shahrekord Cohort Study in Southwestern Iran.

Background: Predicting the risk of cardiovascular diseases (CVDs) helps the management of high-risk individuals by the health system. We sought to determine the 10-year risk of CVDs in the Shahrekord Cohort Study (SCS). Methods: In this cross-sectional study based on the SCS in the southwest of Iran, the demographic, anthropometric, clinical, and laboratory data of 5152 persons recruited in the SCS by census method from 2016 to 2017 were used. R software was utilized to calculate the 10-year risk of CVDs according to the World Health Organization/International Society of Hypertension (WHO/ISH) chart, the Framingham Risk Score (FRS) model, and the Systematic Coronary Risk Evaluation (SCORE) model. Results: The mean age of the participants was 49.49±9.40 years, and 50.3% of them were female. According to the WHO/ISH chart, 94.1% of the participants were in the low-risk class, 4.1% in the moderate-risk class, and 0.4% in the high-risk class. Based on the FRS model, 72.2% of the participants were in the low-risk class, 18% in the middle-risk class, and 9.8% in the high-risk class. On the basis of the SCORE model for low-risk areas, 55.3% of the participants were in the low-risk class, 39.6% in the moderate-risk class, and 5.1% in the high-risk class. The agreement concerning risk estimation between the models was approximately 70%. Conclusion: The risk estimated in this study was higher than that in other similar studies. For monitoring risk trends over time, it is essential to nativize a valid risk function, including ethnicity and geographical characteristics, for the Iranian population.

THU0147 CARDIOVASCULAR RISK IN RHEUMATOID ARTHRITIS: DO WE ALREADY HAVE A SENSITIVE AND SPECIFIC INSTRUMENT?

Background:Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disorder with high cardiovascular (CV) risk due to both classic and specific disease risk factors. According to EULAR’s recommendations, all patients should carry out an assessment of their CV risk, however, there are no specific evaluation algorithm’s for RA.Objectives:To assess the efficacy to predict CV risk in RA patients using the Systematic Coronary Risk Evaluation model (SCORE), Modified SCORE (mSCORE), Framingham Risk Score (FRS), Modified Framingham Risk Score (mFRS) and the American College of Cardiology/American Heart Association algorithm (ACC/AHA).Methods:Cross-sectional observational study including patients fulfilling 2010 ACR/EULAR classification criteria for RA and followed in the Rheumatology Department at Guarda Local Health Unit. Clinical records were reviewed and sociodemographic, classic CV risk factors and disease related factors, previous history of CV events and current treatment were collected. Individual CV risk was calculated using aforementioned models. Patients were divided in two groups: group 1 (without CV event history) and group 2 (with a history of CV event). Discriminative capacity tests, sensitivity and specificity were asserted and the different models were compared.Results:A total of 107 patients were included in the study and 10 suffered a CV event. Of 107 patients, 78% are women, the average age is 55.97± 6,78 and the average body mass index is 26,44± 4,43 kg/m2(Table 1). Models evaluated revealed reasonable discriminative capacity with areas under the curve between 0.73 and 0.88 (Figure 1). Regarding sensitivity and specificity we found that SCORE calculator fail to identified high risk in all patients with a CV event, however it presented a specificity of 94%. Others CV risk calculators showed the following sensitivities and specificities: mSCORE 63%, 88%; ACC/AHA 88%, 84%; FRS 63%, 88%; mFRS 88%, 76%.Table 1.Patient characteristicsPatients with RA (N=107)Patients with RA without CVDPatients with RA with CVD (N=10)pAge (years), mean±SD56 ± 6,855,7 ± 6,958,5±5,60,240Female, n(%)83 (77,6)79 (81,4)4 (40)0,003Rheumatoid factor positivity, n(%)36 (37,5)33 (37,9)3 (33,3)0,787Anti-CCP positivity, n (%)34 (37)29 (34,9)5 (55,6)0,226Smoking, n (%)4 (3,7)3 (4,1)1 (10)0,031BMI (weight(Kg)/height(m)2), mean±SD26,4±4,426,2±4,429,7±4,10,040Treatment with statins (%)342890&lt;0,001Figure 1.Receiver operating characteristic curves of the different risk prediction algorithmsConclusion:The five models tested in this study have a relative discriminative capacity. SCORE did not identify any CV event, which may compromise its ability to assess the CV risk in this patients.The most sensitive and specific model was the ACC/AHA, a very restricted model. When applying the multiplication factor of 1.5 recommended by EULAR, there is an improvement in sensitivity, however the specificity decreases.This study proves the limitations of CV risk calculators designed for the general population when applied to patients with RA. In conclusion, CV risk assessment is extremely important and there is still no ideal calculator, which is both sensitive and specific, and easily applicable in a clinical context.

P3397Risk Or Benefit IN Screening for CArdiovascular disease (ROBINSCA): results from screening for a high cardiovascular disease risk by using a risk prediction model or coronary artery calcium scoring

Abstract Introduction The ROBINSCA (Risk Or Benefit IN Screening for CArdiovascular disease) trial is a large-scale population-based randomized controlled screening trial with the aim to investigate whether screening for a high risk of cardiovascular disease (CVD) by means of either the Systematic COronary Risk Evaluation (SCORE) model or coronary artery calcium (CAC) scoring followed by preventive treatment is effective in reducing morbidity and mortality from coronary heart disease (CHD). This study shows the results of the CVD risks as assessed by the two screening tools. Methods Based on the Dutch population registry, 394,058 men aged 45–74 years and women aged 55–74 years received an information brochure, an invitation to participate in the trial, a baseline questionnaire with waist circumference tape and an informed consent form. Eligible individuals with an expected high CVD risk were randomized (1:1:1) into a control arm (n=14,519), intervention arm A (n=14,478) or intervention arm B (n=14,450). In the control arm, usual care was continued. In intervention arm A, participants were screened for a high risk of CVD using the SCORE model based on traditional risk factors. In intervention arm B, CAC scoring after computed tomography scanning was used for screening. After screening en risk communication, preventive treatment according to the Dutch guidelines is advised for high risk persons. Results Screening uptake was 84.2% in intervention arm A and 89.6% in intervention arm B. Of the screened participants, 48.7% was female, median age at screening was 62 (Interquartile Range 10), 35.2% was high educated, 19.6% was baseline smoker and 41.4% had a positive family history of myocardial infarction. The assessed CVD risk status according to SCORE screening was stratified into three risk categories; 45.1% was at low risk (SCORE&lt;10%), 26.5% was at intermediate risk (SCORE 10–20%), and 28.4% was at high risk (SCORE ≥20%). According to CAC screening, 76.0% was at low risk (Agatston &lt;100), 15.1% was at high risk (Agatston 100–399), and 8.9% was at very high risk (Agatston ≥400). Associations between baseline variables and increased CVD risk will be analyzed soon and will be available in summer 2019. Conclusions Using different screening tools resulted in reclassification of the CVD risk. CAC screening caused a substantial shift to more low risk individuals. This might, when screening is found to be effective, lead to less overtreatment in prevention of CVD events. Future 5-year follow-up data should provide evidence about whether population-based screening with subsequent preventive treatment is (cost-)effective in reducing CHD-related morbidity and mortality.

Predictive validity of the risk SCORE model in a Mediterranean population with dyslipidemia

Background and aimsCholesterol treatment for the primary prevention of cardiovascular disease is based on cardiovascular risk, as assessed by the SCORE (Systematic COronary Risk Evaluation) scale. This study aimed to assess the predictive value and clinical utility of the SCORE scale for preventing cardiovascular events and all-cause mortality in people with dyslipidemia and no lipid-lowering treatment. MethodsPatients with dyslipidemia and no lipid-lowering treatment were included from the ESCARVAL-RISK cohort. Cardiovascular risk was calculated by means of the SCORE scale. All deaths and cardiovascular events were recorded for up to five years of follow-up. We calculated sensitivity, specificity and other predictive values for different cut-off points and assessed the effect of different risk factors on the diagnostic accuracy of the SCORE charts. ResultsIn the final cohort of 18,853 patients, there were 1565 cardiovascular events and 268 deaths. The risk value recommended to initiate pharmacological treatment (5%) presented a specificity of 86% for death and 90% for cardiovascular events, and a sensitivity of 53% for death and 32% for cardiovascular events. In addition, the scale classified as low risk 62.8% of the patients who suffered a cardiovascular event and 46.6% of those who died. Antithrombotic treatment, diabetes, hypertension, heart failure, peripheral artery disease and chronic kidney disease were associated with a reduction in the predictive capability of the SCORE scale, whereas metabolic syndrome was related to better risk prediction. ConclusionsThe predictive capability of the SCORE scale for cardiovascular disease and total mortality in patients with dyslipidemia is limited.

VALIDATION OF THE SCORE (SYSTEMATIC CORONARY RISK EVALUATION) MODEL ADJUSTED TO ESTIMATE RISK OF FATAL AND NON-FATAL EVENTS IN A SOUTHERN EUROPEAN COUNTRY

Objective: To conduct an external validation of the modified SCORE (Systematic COronary Risk Evaluation) model for low-risk regions to estimate risk of fatal and non-fatal events among asymptomatic individuals (primary prevention). Design and method: Nationally cross-sectional examination in an occupational cohort with an in-person interview including laboratory tests. Study participants were examined between 2006 and 2007 without previous cardiovascular disease. Main outcomes included fatal and non-fatal cardiovascular events over a 10-year follow-up period. Using already published SCORE risk equations to estimate ten-year risk of fatal cardiovascular disease for low-risk regions, the estimated score including non-fatal events was adjusted by multiplying by 4 in women and by 3 in men. The predictive accuracy of the risk estimated was assessed using both calibration and discrimination. Agreement between predicted and observed events across deciles of predicted risk was graphically evaluated. Discrimination was assessed by plotting the receiver operating characteristic curve and the C-statistic. Results: SCORE was computed for 228,986 subjects, mean age was of 48 (SD 6.2) years and 75.6% were men. Fatal and non-fatal events were recorded in 2.7% of men and 1% of women. Estimated C-statistic was 0.65. Risk scores calibrated well between first and eight deciles, with ratios expected to observed cases ranging from 0.7 up to 1.8, being represented almost 89% of the sample, and showed an overestimation of observed risk at the two highest deciles with ratios between 2 and 3. Conclusions: Estimated risk using SCORE equation for low risk countries adjusted with morbidity data showed a good calibration (it improves when calibration is calculated only with mortality data) and an acceptable discrimination.

Menopause improves the predictive value of common cardiovascular risk scores in women with premature coronary artery disease.

Menopause, particularly its early stage (≤3 years from onset), may be an important risk factor for premature coronary artery disease. The objective of the study was to assess whether the addition of the presence of menopause in women with premature coronary artery disease could improve the predictive value of the Atherosclerotic Cardiovascular Disease risk estimator and the Systematic COronary Risk Evaluation model. The case-control study included 307 women with coronary artery disease aged 55 or less, and 347 age-matched controls without coronary artery disease. Diagnostic accuracy parameters were evaluated for traditional risk models versus those enriched with menopausal status. Early and late postmenopausal periods were defined as ≤3 and >3 years from the onset of menopause, respectively. Only the addition of the presence of the early postmenopausal stage to the 10-year Atherosclerotic Cardiovascular Disease risk classes resulted in significantly increased c-statistics from 0.66 (95% confidence interval [CI] 0.62-0.7) to 0.705 (95%CI 0.66-0.75) (P = 0.0003) and an increase of accuracy from 61.3% to 63.8% (P = 0.0025).Adding the presence of early postmenopause to the Systematic COronary Risk Evaluation risk classes also resulted in significantly increased c-statistics from 0.59 (95% CI 0.55-0.63) to 0.641 (95%CI 0.6-0.68) (P = 0.0024) and an increase of accuracy from 64.1% versus 57.5% (P = 0.001). Adding the early menopausal period may significantly improve the predictive value of the 10-year Atherosclerotic Cardiovascular Disease risk score and the Systematic COronary Risk Evaluation model in women with premature coronary artery disease.

Estimation and development of 10- and 20-year cardiovascular mortality risk models in an industrial male workers database.

We examined the performance of the Framingham Heart Study (FHS) and the European Systematic Coronary Risk Evaluation (SCORE) models for cardiovascular disease (CVD) mortality prediction in Israeli industrial workers, and developed and validated new risk prediction models for CVD mortality incidence in the same population. Our database was a longitudinal Israeli industrial cohort (CORDIS cohort) of 4809 adult males followed-up for 22years. Performance of the FHS and the SCORE prediction models was analyzed by insertion of the CORDIS cohort measurements to each model separately. The standard prognostic variables and results obtained from the new refined Cox regression analyses were used to construct two new 10- and 20-year CVD mortality risk scoring systems: a modified FHS model (FHS/Cox) and an omnibus model with Cox regression (Omnibus/Cox). The SCORE model of high-risk and low-risk charts yielded 10-year mortality mean risks of 1.12% and 0.64%, respectively, for male subjects aged>30years. The new FHS/Cox and Omnibus/Cox models generated a mean predictive 10-year risk of 1.12% and 1.50%, respectively. The mean 20-year risk predicted by the new FHS/Cox and the Omnibus/Cox models was 2.66% and 3.75%, respectively. Internal validation of both models demonstrated a high and stable area under the receiver operating characteristic curve>0.85. No significant differences were found between the two models. In conclusion, the CVD mortality risk prediction scoring systems tailored for the Israeli workers population demonstrated good performance. Additional studies to externally validate these algorithms will indicate which of these quantitative risk estimation platforms should be used in specific settings.

Cardiovascular risk profiles in a hospital-based population of patients with psoriatic arthritis and ankylosing spondylitis: a cross-sectional study.

The objective of the study was to investigate the frequency of traditional risk factors for the cardiovascular (CV) disease, to calculate the Systematic COronary Risk Evaluation (SCORE) for CV-related mortality in Danish patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS), and to compare with results from patients with rheumatoid arthritis (RA) from the same settlement. All PsA and AS patients aged 18-85years from one outpatient clinic were invited. A rheumatology nurse conducted 30-min screening consultation, preceded by a lipid and glucose profile. High SCORE risk led to recommendation of follow-up by general practitioners. Multiple and logistic regression analyses, adjusted for age and gender, were performed, to compare risk factors and risk SCOREs. Participants were 116 AS (29.3% female) and 170 PsA (54.7% female). AS had opposed PsA patients' lower 10-year risk SCOREs of CV mortality than RA patients: AS versus RA coefficient -0.47 (confidence interval (CI) 95%: -0.84 to -0.) and PsA versus RA -0.14, (-0.43-0.16). Women with PsA and AS had increased waistline compared to women with RA [PsA vs. RA 7.94 (4.51-11.38); AS versus RA 6.67 (1.17-12.17)], and an increased prevalence of hypertension was seen in AS versus RA patients [1.87 (1.15-3.05)]. Traditional, modifiable CV risk factors were present in PsA and AS patients. AS but not PsA patients had an estimated lower 10-year risk of CV mortality than RA patients, according to the SCORE model adjusted for age and gender.

Cardiovascular risk prediction: Can Systematic Coronary Risk Evaluation (SCORE) be improved by adding simple risk markers? Results from the Copenhagen City Heart Study.

European society of cardiology (ESC) guidelines recommend that cardiovascular disease (CVD) risk stratification in asymptomatic individuals is based on the Systematic Coronary Risk Evaluation (SCORE) algorithm, which estimates individual 10-year risk of death from CVD. We assessed the potential improvement in CVD risk stratification of 19 easily available risk markers by adding them to the SCORE algorithm. We followed 8476 individuals without prior CVD or diabetes from the Copenhagen City Heart study. The 19 risk markers were: major and minor electrocardiographic (ECG) abnormalities, heart rate, family history (of ischaemic heart disease), body mass index (BMI), waist-hip ratio, walking duration and pace, leisure time physical activity, forced expiratory volume (FEV)1%pred, household income, education, vital exhaustion, high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), high-sensitive C-reactive protein (hsCRP) and fibrinogen. With the exception of family history, BMI, triglycerides and minor ECG changes, all risk markers remained significantly associated with CVD mortality after adjustment for SCORE variables. However, the addition of the remaining 15 risk markers resulted in only small changes in discrimination calculated by area under the curve (AUC) and integrated discrimination improvement (IDI) and no improvement in net reclassification improvement (NRI). HsCRP improved AUC by 0.006 (p = 0.015) and IDI by 0.012 (p = 0.002); FEV1%pred improved AUC by 0.006 (p = 0.032) and IDI by 0.006 (p = 0.029). In the intermediate risk group FEV1%pred, education, vital exhaustion and ApoA1 all improved NRI but FEV1%pred was the only risk marker to significantly improve both IDI, AUC and NRI. The SCORE algorithm predicted CVD mortality in a Danish cohort well. Despite strong association with CVD mortality, the individual addition of 19 easily available risk makers to the SCORE model resulted in small risk stratification improvements.

Should non-cardiovascular mortality be considered in the SCORE model? Findings from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort.

Competing non-cardiovascular related deaths were not accounted for in the Systematic COronary Risk Evaluation (SCORE) model. In this study we assessed the impact of non-cardiovascular related deaths on the prognostic performance and yield of the SCORE model. 5,752 participants from the Prevention of Renal and Vascular End stage Disease cohort aged 40 years and older who were free of atherosclerotic cardiovascular disease (CVD) at baseline were included. A cause-specific hazards (CSH) CVD-related mortality prediction model that accounted for non-CVD-related deaths was developed. The prognostic performance of this model was then compared with a refitted SCORE model. During a median follow-up period of 12.5 years, 139 CVD and 495 non-CVD-related deaths were reported. Discriminatory performance was comparable between the models (C-index = 0.64). The models showed good calibration although the CSH model underestimated risk in the highest decile while the refitted SCORE model showed overestimation. The CSH model classified more non-events into the low risk group compared to the refitted SCORE model (n = 51), yet it was accompanied by a misclassification of six events into the low risk group. The refitted SCORE model classified more individuals as high risk. However, the potential overtreatment that may result from utilizing the refitted SCORE model, when compared with the CSH model, still falls within acceptable limits. Our findings do not support the incorporation of non-cardiovascular mortality into the estimation of total cardiovascular risk in the SCORE model.

Cardiovascular risk in middle-aged breast cancer survivors: a comparison between two risk models

It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS). This cross-sectional study analyzed 67 BCS, aged 45 -65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI). Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01 -0.2) for populations at high risk for CVD. These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations.

Influence of high cardiovascular risk in asymptomatic people on the duration and cost of sick leave: results of the ICARIA study

We investigated the potential influence of a moderate-to-high cardiovascular (CV) risk (CVR) (defined as a Systematic COronary Risk Evaluation model, or SCORE ≥ 4%), in the absence of an established CV disease, on the duration and cost of CV and non-CV sick leave (SL) resulting from common and occupational accidents or diseases. We conducted a prospective cohort study on 690 135 workers with a 1-year follow-up and examined CV- and non-CV-related SL episodes. To obtain baseline values, CVR factors were initially assessed at the beginning of the year during routine medical examination. The CVR was calculated with the SCORE charts for all subjects. Moderate-to-high CVR was defined as SCORE ≥ 4%. A baseline SCORE ≥ 4% was associated with a higher risk for long-term CV and non-CV SL, as revealed by follow-up assessment. This translated into an increased cost, estimated at €5 801 464.18 per year. Furthermore, pharmacological treatment for hypertension or hyperlipidaemia was significantly associated with longer SL duration. Moderate-to-high CVR in asymptomatic subjects was significantly associated with the duration and cost of CV and non-CV SL. These results constitute the first body of evidence that the SCORE charts can be used to identify people with a non-established CV disease, which might ultimately translate into more lost workdays and therefore increased cost for society.

Riesgo cardiovascular: evaluación del tabaquismo y revisión en atención primaria del tratamiento y orientación sanitaria. Estudio RETRATOS

Aim To evaluate the level of cardiovascular risk in smokers seenin Primary Care clinics. Design Epidemiologic, cross-sectional and multicentre study. Setting Primary Care. Patients Every investigator included 4 consecutive patients (3 smokers, 1 non-smoker) aged 35-50 years, who came to the clinic for any reason. A total of 2,184 patients were included; 2,124 (1,597 smokers; 527 non-smokers) were evaluated and 60 patients were excluded because they did not meet with selection criteria. Measurements The 10-year risk of suffering from a fatal cardiovascular disease (CVDR) was calculated according to the SCORE (Systematic Coronary Risk Evaluation) model. The 10-year lethal CVR according SCORE model, was classified as: very high (> 15%), high (10-14%), slightly high (5-9%), average (3-4%), low (2%), very low (1%) and negligible (< 1%). A logistical regression model was used to estimate the relationship between smoking and prior cardiovascular events. Results 10-year fatal CVDR according to the SCORE model was significantly higher in smokers (40 ± 5.3) vs. non-smokers (1.9 ± 2.5) ( P < .0001). Risk stratification: low (< 3%) [78.0% non-smokers vs. 60.7% smokers ( P < .0001)]; intermediate (3-5%) [11.1% non-smokers vs. 12.6% smokers ( P < .001)]; high (> 5%) [10.9% non-smokers vs. 26.7% smokers ( P < .001)]. The logistical regression model showed that non-smokers vs. smokers had less probability of suffering myocardial infarction (OR 0.3; 95% confidence interval (95% CI): 0.1-0.8; P < .0001), peripheral vascular disease (OR 0.6; 95% CI: 0.4-1.0; P = .0180) and chronic obstructive lung disease (OR 0.18; 95% CI: 0.1-0.2; P = .0507). Conclusions Smoking is related to a high risk of fatal cardiovascular disease. Active promotion in Primary Care clinics of measures aimed at reducing the prevalence of the smoking habit would lead to a lowering of cardiovascular morbidity and mortality.

Effectiveness of Ezetimibe in Reducing the Estimated Risk for Fatal Cardiovascular Events in Hypercholesterolaemic Patients with Inadequate Lipid Control While on Statin Monotherapy as Measured by the SCORE Model

Objectives. The aim of this prospective cohort, multicentre study was to assess the effect of coadministrating ezetimibe 10 mg/day with an ongoing statin on the estimated risk for Cardiovascular (CVD) mortality in patients with persistently elevated LDL-C after statin monotherapy. Methods. The Systematic Coronary Risk Evaluation (SCORE) function was used to estimate the 10-year risk for cardiovascular mortality at baseline and 6 weeks. Primary outcome measures were absolute and percent changes in estimated Coronary Heart Disease (CHD) Mortality Risk, and general CVD Mortality Risk (Total CVD Mortality Risk). Results. 825 patients were included in the analysis. Mean (SD) age was 62 (10.5) years and 62.3% were males. The mean (SD) estimated Total CVD Mortality Risk decreased from 0.068 (0.059) at baseline to 0.053 (0.046) at 6 weeks (RR = 0.77; 95% CI:0.689–0.867), while the estimated CHD Mortality Risk decreased from 0.047 (0.040) at baseline to 0.034 (0.029) at 6 weeks (RR = 0.72; 95% CI:0.624–0.826). Conclusions. Co-administration of ezetimibe with a statin is effective in significantly reducing the estimated risk for cardiovascular mortality as measured by the SCORE model.