Risk prediction of cardiovascular disease in the Asia-Pacific region: the SCORE2 Asia-Pacific model
Authors:   SCORE2 Asia-Pacific writing group, Abdullah Noraidatulakma , Abdul Jalal Muhammad Irfan , Barr Elizabeth L M , Chamnan Parinya , Chong Chean Lin , Cuenza Lucky , Gao Pei , Graham Ian , Hilal Saima , Holtrop Joris , Jamal Rahman , Kalhan Tosha Ashish , Kaneko Hidehiro , LEE Chi-Ho , Lim Charlie G Y , Liu Xiaofei , Magliano Dianna J , Motamed Nima , Moradi-Lakeh Maziar , Ong Sok King , Perera Ruwanthi , Prasad Kameshwar , Shaw Jonathan E , de Silva Janaka , Sim Xueling , Suzuki Yuta , Tan Kathryn C B , Tang Xun , Venkataraman Kavita , Wickremasinghe Rajitha , Yasunaga Hideo , Zamani Farhad , Hageman Steven H J , Huang Zijuan , Lee Hokyou , Kaptoge Stephen , Dorresteijn Jannick A N , Pennells Lisa , Di Angelantonio Emanuele , Visseren Frank L J , Kim Hyeon Chang , Johar Sofian ,   the European Society of Cardiology and European Association of Preventive Cardiology: Cardiovascular Risk Collaboration (ESC CRC), Di Angelantonio Emanuele , Papadakis Michael , Timmis Adam , Aboyans Victor , Vardas Panos , Visseren Frank L J , McEvoy John William , Kavousi Maryam , Ferrieres Jean , Huculeci Radu ,   the ASEAN Federation of Cardiology (AFC), Junia Alex , Krittayaphong Rungroj , Nguyen Quang Ngoc , Raynaldo Abdul Halim , Fong Alan ,   the Asian-Pacific Society of Cardiology (APSC), Kim Hyo-Soo , Tan Jack , Komuro Issei , Almahmeed Wael , Yeo Khung Keong , Ako Junya , Park Kyung Woo 
Published: September 2024

Abstract

Background and Aims
To improve upon the estimation of 10-year cardiovascular disease (CVD) event risk for individuals without prior CVD or diabetes mellitus in the Asia-Pacific region by systematic recalibration of the SCORE2 risk algorithm.

Methods
The sex-specific and competing risk-adjusted SCORE2 algorithms were systematically recalibrated to reflect CVD incidence observed in four Asia-Pacific risk regions, defined according to country-level World Health Organization age- and sex-standardized CVD mortality rates. Using the same approach as applied for the original SCORE2 models, recalibration to each risk region was completed using expected CVD incidence and risk factor distributions from each region.

Results
Risk region-specific CVD incidence was estimated using CVD mortality and incidence data on 8 405 574 individuals (556 421 CVD events). For external validation, data from 9 560 266 individuals without previous CVD or diabetes were analysed in 13 prospective studies from 12 countries (350 550 incident CVD events). The pooled C-index of the SCORE2 Asia-Pacific algorithms in the external validation datasets was .710 [95% confidence interval (CI) .677–.744]. Cohort-specific C-indices ranged from .605 (95% CI .597–.613) to .840 (95% CI .771–.909). Estimated CVD risk varied several-fold across Asia-Pacific risk regions. For example, the estimated 10-year CVD risk for a 50-year-old non-smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and high-density lipoprotein cholesterol of 1.3 mmol/L, ranged from 7% for men in low-risk countries to 14% for men in very-high-risk countries, and from 3% for women in low-risk countries to 13% for women in very-high-risk countries.

Conclusions
The SCORE2 Asia-Pacific algorithms have been calibrated to estimate 10-year risk of CVD for apparently healthy people in Asia and Oceania, thereby enhancing the identification of individuals at higher risk of developing CVD across the Asia-Pacific region.