A 1 SD increase in PDAY risk score was associated with a 3.15-fold higher risk of CV events over 22 years in 30-year-old Norwegians; no improvement with revised score.
Does the PDAY risk score accurately predict future cardiovascular events in a contemporary cohort of young adults?
The PDAY risk score is modestly associated with long-term cardiovascular event risk in young adults, with no significant difference between the original and revised versions, highlighting the need for improved prediction tools in this population.
Absolute Event Rate: 0% vs 0%
Abstract Background Improved prediction of future cardiovascular (CV) events in young adults is of importance, as preventive strategies might be warranted also in young adults. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) risk score was originally developed based on post-mortem assessment of atherosclerosis in the abdominal aorta and the coronary arteries in individuals aged 15-34 years who died accidentally. Later, a revised score has been launched. The PDAY risk score is also shown to predict clinical CV events among participants in the CARDIA cohort (18-30 years of age) during 30 years of follow-up. Purpose To apply the original and the revised PDAY risk score on a contemporary cohort of 30-year-old Norwegians and validate their respective predictive value by assessing the association with clinical CV events during long-term follow-up. Methods In the year 2000, all inhabitants of our city, Norway, born in 1969 or 1970 were invited to participate in a prospective cohort study (Oslo Health Study). The PDAY risk score includes eight risk factors (age, sex, non-high-density lipoprotein (HDL) cholesterol, HDL cholesterol, smoking, blood pressure, obesity, and hyperglycaemia) and was calculated according to Table 1 for the 5842 participants (mean age 31 years, 56% women). The revised PDAY risk score, additionally including positive family history of CV disease and putting less weight on female sex, was also calculated. The occurrence of CV events during 22 years follow-up was obtained through linkage to Norwegian health registries. The primary outcome was a composite of CV death, non-fatal myocardial infarction, non-fatal ischemic stroke, coronary revascularization and hospitalization due to unstable angina. A one standard deviation (SD) increase in PDAY risk score, with the mean as reference, was set to explore if increased risk of CV events was observed with increasing PDAY risk score. Model discrimination was evaluated with C-statistics for the original and revised PDAY risk score, respectively. Results The PDAY risk score ranged from 13 to 39 points (mean 17.8 ± 4.2). One SD increase in points from mean at baseline was associated with a 3.15-fold increase in the incidence of CV events (HR, 95% CI 2.14-4.63). Unadjusted C-statistic was 0.686 (95% CI 0.634-0.738). When comparing the revised PDAY risk score with the original, prediction of future CV events was not significantly improved (C-statistic 0.707 95% CI 0.654-0.759, P-value 0.0661), as illustrated in Figure 1. Conclusion In our contemporary cohort of 30-year-old individuals, the PDAY risk score was modestly associated with the risk of CV events during long-term follow-up. No difference was found between the original and the revised version. Thus, improved prediction tools for future CV events among young adults are still needed.Table 1 – PDAY risk score Figure 1 - AUC for CV events
Lutterbey et al. (Sat,) reported a other. A 1 SD increase in PDAY risk score was associated with a 3.15-fold higher risk of CV events over 22 years in 30-year-old Norwegians; no improvement with revised score.