Validation of Systematic Coronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons in the EPIC-Norfolk prospective population cohort

被引：21

作者：

van Trier, Tinka J. ^{[1
]}

Snaterse, Marjolein ^{[1
]}

Boekholdt, S. Matthijs ^{[1
]}

op Reimer, Wilma J. M. Scholte ^{[2
]}

Hageman, Steven H. J. ^{[3
]}

Visseren, Frank L. J. ^{[3
]}

Dorresteijn, Jannick A. N. ^{[3
]}

Peters, Ron J. G. ^{[1
]}

Jorstad, Harald T. ^{[1
]}

机构：

[1] Univ Amsterdam, Amsterdam Univ Med Ctr, Dept Cardiol, Amsterdam Cardiovasc Sci, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands

[2] HU Univ Appl Sci Utrecht, Res Grp Chron Dis, Padualaan 99, NL-3584 CH Utrecht, Netherlands

[3] Univ Med Ctr Utrecht, Dept Vasc Med, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands

来源：

EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY | 2024年 / 31卷 / 02期

基金：

英国医学研究理事会;

关键词：

Risk assessment; Scores; Clinical utility; Primary prevention; Validation; PREDICTION MODELS; HISTORY; DISEASE;

D O I：

10.1093/eurjpc/zwad318

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims The European Systematic Coronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons (OP) models are recommended to identify individuals at high 10-year risk for cardiovascular disease (CVD). Independent validation and assessment of clinical utility is needed. This study aims to assess discrimination, calibration, and clinical utility of low-risk SCORE2 and SCORE2-OP.Methods and results Validation in individuals aged 40-69 years (SCORE2) and 70-79 years (SCORE2-OP) without baseline CVD or diabetes from the European Prospective Investigation of Cancer (EPIC) Norfolk prospective population study. We compared 10-year CVD risk estimates with observed outcomes (cardiovascular mortality, non-fatal myocardial infarction, and stroke). For SCORE2, 19 560 individuals (57% women) had 10-year CVD risk estimates of 3.7% [95% confidence interval (CI) 3.6-3.7] vs. observed 3.8% (95% CI 3.6-4.1) [observed (O)/expected (E) ratio 1.0 (95% CI 1.0-1.1)]. The area under the curve (AUC) was 0.75 (95% CI 0.74-0.77), with underestimation of risk in men [O/E 1.4 (95% CI 1.3-1.6)] and overestimation in women [O/E 0.7 (95% CI 0.6-0.8)]. Decision curve analysis (DCA) showed clinical benefit. Systematic Coronary Risk Evaluation 2-Older Persons in 3113 individuals (58% women) predicted 10-year CVD events in 10.2% (95% CI 10.1-10.3) vs. observed 15.3% (95% CI 14.0-16.5) [O/E ratio 1.6 (95% CI 1.5-1.7)]. The AUC was 0.63 (95% CI 0.60-0.65) with underestimation of risk across sex and risk ranges. Decision curve analysis showed limited clinical benefit.Conclusion In a UK population cohort, the SCORE2 low-risk model showed fair discrimination and calibration, with clinical benefit for preventive treatment initiation decisions. In contrast, in individuals aged 70-79 years, SCORE2-OP demonstrated poor discrimination, underestimated risk in both sexes, and limited clinical utility.

引用

页码：182 / 189

页数：8

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