Differences in 10-year cardiovascular risk estimation using SCORE and SCORE2 risk prediction tools: a moderate risk country population analysis
Authors: Quintal J , Candjondjo A P , Rato Q , Ferreira E M , Sousa J , Silva M J , Casas J D , Coelho R A , Farinha J M , Esteves A F , Ferreira J S , Duarte T , Goncalves S , Seixo F , Caria R 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular disease (CVD) risk assessment plays a central role in nowadays clinical practice given its burden in morbidity and mortality worldwide. In the 2021 European Society of Cardiology Guidelines on cardiovascular disease prevention a new CVD risk prediction algorithm was presented, the SCORE2. This tool overcomes some of old SCORE limitations by predicting 10-year fatal and non-fatal CVD risk in individuals without previous CVD or diabetes aged 40-65 years and by including contemporary data from epidemiological data of 13 European countries. Differences on 10-year cardiovascular risk category prediction between SCORE and SCORE2 is still scarce.

Purpose
We aimed to compare differences in 10-year cardiovascular disease risk prediction in a Portuguese population using SCORE and SCORE2.

Methods
We conducted a cross-sectional study in a Portuguese population sample. Individuals aged 40-65 years old without known Atherosclerotic Cardiovascular Disease, Diabetes, Chronic Kidney Disease or Familial Hypercholesterolemia were included. The 10-year CVD risk was calculated using SCORE and SCORE2. Based on CVD risk category, patients were stratified into 4 categories - low, moderate, high and very high risk – according to SCORE and in 3 categories - low to moderate, high and very high risk - according to SCORE2 model. Primary outcome was 10-year CVD risk prediction difference between above mentioned models. According to the data distribution, appropriate statistical tests were conducted.

Results
117 individuals were included in the study cohort, 79 (67.5%) of which were women. In our study, the 10-year risk prediction of fatal and non-fatal cardiovascular events was significantly different between SCORE and SCORE2.
When assessing 10-year risk of CVD through SCORE model, 97.1% (n= 100) of the individuals were classified into low and moderate risk categories. On the other hand, when evaluating CVD risk with SCORE2 only 66% (n=62) of the participants were classified into those risk categories, meaning that 30.9% (n=29) of patients were in high and very high-risk categories with SCORE2 (vs. 2.9% with SCORE).
Correlation between SCORE and SCORE2 was verified (R=0.572; p&lt; 0.0001). Regarding cardiovascular risk factors, active smoking was the only independent predictor for 10-year CVD risk in SCORE2 (RR: 3.28, 95% CI: 1.93-4.66, p=0.001). There were no independent predictors for CVD risk in SCORE.

Conclusions
Ten-year cardiovascular risk assessment may be underestimated by SCORE model. In the present study, through SCORE CVD risk classification most of patients were classified into lower risk categories than those obtained through updated SCORE2. SCORE2 is a more up-to-date and more calibrated CVD risk assessment tool than old SCORE, so SCORE2 may contribute to a better reclassification of patients and hereafter allow intensification of CVD protection measures.