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Temtem M, Mendonça MI, Santos M, Sá D, Sousa F, Freitas S, Borges S, Henriques E, Rodrigues M, Soares C, Rodrigues R, Serrão M, Drumond A, Sousa AC, Palma Reis R. Validation of the SCORE2 risk prediction algorithm in a Portuguese population: A new model to estimate 10-year cardiovascular disease incidence in Europe. Rev Port Cardiol 2024; 43:437-444. [PMID: 38395299 DOI: 10.1016/j.repc.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 08/05/2023] [Accepted: 10/15/2023] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Subjects without cardiovascular (CV) disease (CVD) may suffer from subclinical atherosclerosis, and are at increased risk for atherosclerotic CV events (ASCVE). The ESC/EAS risk SCORE was updated by SCORE2, which estimates 10-year risk of fatal and non-fatal CVD in European populations aged 40-69 years without established CVD or diabetes. Our aim was to compare the two ESC/EAS risk scores and to validate SCORE2 in our population. METHODS A total of 1071 individuals (age 57.2±6.1 years; 75.2% male) without CVD or diabetes, from GENEMACOR study controls, were analyzed over 5.4±3.9 years. The population was stratified into risk categories according to the two scores, and the area under the ROC curve (AUC) and Harrell's C-index assessed the scores' performance. Calibration was performed using the goodness-of-fit test, and occurrence of the first event assessed by Cox regression. Kaplan-Meier analysis estimated SCORE2 survival. RESULTS SCORE stratified subjects into four risk categories: low (7.4%), moderate (46.5%), high (25.3%) and very high (20.8%), and SCORE2 into three: low-to-moderate (24.7%), high (59.0%) and very high (16.2%). SCORE presented good discrimination for CV mortality (AUC=0.838; C-index=0.834, 95% CI: 0.728-0.940), as did SCORE2 for total CV events (AUC=0.744; C-index=0.728, 95% CI: 0.648-0.808). Calibration did not show a disparity between observed and expected ASCVE. The probability of ASCVE was eight times higher in very-high-risk SCORE2 (p=0.001), and three times in the high-risk group (p=0.049). Event-free survival was 99%, 90% and 72% in the low-to-moderate, high and very-high-risk categories, respectively (p<0.0001). CONCLUSIONS SCORE2 improved population stratification by identifying higher-risk patients, enabling early preventive measures. It showed good discriminative ability for all ASCVE.
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Affiliation(s)
- Margarida Temtem
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal.
| | - Maria Isabel Mendonça
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Marina Santos
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Débora Sá
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Francisco Sousa
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Sónia Freitas
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Sofia Borges
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Eva Henriques
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Mariana Rodrigues
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Carolina Soares
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Ricardo Rodrigues
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Marco Serrão
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - António Drumond
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Ana Célia Sousa
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
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Temtem M, Mendonça MI, Gomes Serrão M, Santos M, Sá D, Sousa F, Soares C, Rodrigues R, Henriques E, Freitas S, Borges S, Rodrigues M, Guerra G, Drumond Freitas A, Sousa AC, Palma Dos Reis R. Predictive improvement of adding coronary calcium score and a genetic risk score to a traditional risk model for cardiovascular event prediction. Eur J Prev Cardiol 2024; 31:709-715. [PMID: 38175668 DOI: 10.1093/eurjpc/zwae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024]
Abstract
AIMS Coronary artery calcium score (CACS) and polygenic risk score have been used as novel markers to predict cardiovascular (CV) events of asymptomatic individuals compared with traditional scores. No previous studies have directly compared the additive capacity of these two markers relative to conventional scores. The aim of the study was to evaluate the change in CV risk prediction ability when CACS, genetic risk score (GRS), or both are added to Systematic Coronary Risk Evaluation 2 (SCORE2). METHODS AND RESULTS In a prospective, observational population-based study, 1002 asymptomatic subjects (mean age 53.1 ± 6.8 years, 73.8% male), free of clinical coronary disease and diabetes, were selected from GENEMACOR-study controls. SCORE2, CACS, and GRS were estimated to evaluate CV events' predictive and discriminative ability through Harrell's C-statistics. Net reclassification improvement (NRI) and integrated discrimination index were used to reclassify the population. Multivariable Cox proportional hazard ratio (HR) analysis assessed the variables independently associated with CV events. C-statistic demonstrated that the discriminative value for CV event occurrence was 0.608 for SCORE2, increasing to 0.749 (P = 0.001) when CACS was added, and improved to 0.802 (P = 0.0008) with GRS, showing a better discriminative capacity for CV events. Continuous NRI reclassified >70% of the population. Cox proportional analysis showed that the highest categories of SCORE2, CACS, and GRS remained in the equation with an HR of 2.9 (P = 0.003), 5.0 (P < 0.0001), and 3.2 (P = 0.003), respectively, when compared with the lowest categories. CONCLUSION In our population, CACS added to SCORE2 had better ability than GRS in CV event risk prediction, discrimination, and reclassification. However, adding the three scores can become clinically relevant, especially in intermediate-risk persons.
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Affiliation(s)
- Margarida Temtem
- Serviço de Cardiologia, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Maria Isabel Mendonça
- Centro de Investigação Dra. Maria Isabel Mendonça, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Marco Gomes Serrão
- Serviço de Cardiologia, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Marina Santos
- Serviço de Cardiologia, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Débora Sá
- Serviço de Cardiologia, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Francisco Sousa
- Serviço de Cardiologia, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Carolina Soares
- Serviço de Cardiologia, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Ricardo Rodrigues
- Serviço de Cardiologia, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Eva Henriques
- Centro de Investigação Dra. Maria Isabel Mendonça, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Sónia Freitas
- Centro de Investigação Dra. Maria Isabel Mendonça, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Sofia Borges
- Centro de Investigação Dra. Maria Isabel Mendonça, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Mariana Rodrigues
- Centro de Investigação Dra. Maria Isabel Mendonça, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Graça Guerra
- Centro de Investigação Dra. Maria Isabel Mendonça, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - António Drumond Freitas
- Serviço de Cardiologia, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
| | - Ana Célia Sousa
- Centro de Investigação Dra. Maria Isabel Mendonça, SESARAM EPERAM, Hospital Central do Funchal, Avenida Luís de Camões, no 57, Funchal 9004-514, Portugal
- Faculdade de Medicina, Universidade da Madeira, Campus da Penteada, Funchal 9020-105, Portugal
| | - Roberto Palma Dos Reis
- Faculdade de Ciências Médicas, NOVA Medical School, Campo dos Mártires da Pátria 130, Lisboa 1169-056, Portugal
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