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May 7, 2021European Heart Journal621 citationsOpen Access

SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions

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TVTamar I. de VriesUtrecht UniversityMCMarie Therese CooneyPreventive CardiologyRSRandi SelmerPreventive Cardiology

Key Result

The SCORE2-OP risk model accurately estimates 5- and 10-year cardiovascular event risk in older adults, showing C-indices between 0.63 and 0.67 across regions.

Key Points

  • The study aimed to create and validate the SCORE2-OP model for estimating 5- and 10-year cardiovascular disease risk in individuals aged over 70.
  • Derived sex-specific competing risk-adjusted models for CVD risk in individuals aged over 65 from the Cohort of Norway (N=28,503).
  • Included factors such as age, smoking status, diabetes, systolic blood pressure, and cholesterol levels.
  • Externally validated with data from 6 additional populations (N=338,615) for generalizability.
  • C-indices for external validation ranged from 0.63 (95% CI 0.61–0.65) to 0.67 (95% CI 0.64–0.69).
  • Models demonstrated significant variation in estimated 10-year CVD event risk across four geographical regions.
  • Regional calibration of expected versus observed risks was deemed satisfactory.

Structured PICO

Does the SCORE2-OP risk model accurately estimate 5- and 10-year incident cardiovascular event risk in older persons without pre-existing atherosclerotic cardiovascular disease across different geographical regions?

P
Population
Individuals aged over 65 (derivation cohort) and over 70 (target/validation) without pre-existing atherosclerotic cardiovascular disease. Derivation cohort n=28,503 (Cohort of Norway); external validation in 6 additional study populations n=338,615.
I
Intervention
SCORE2-Older Persons (SCORE2-OP) risk prediction model (incorporating age, smoking status, diabetes, systolic blood pressure, and total- and high-density lipoprotein cholesterol)
O
Outcome
5- and 10-year risk of cardiovascular disease (composite of CVD mortality, myocardial infarction, or stroke)composite

The SCORE2-OP risk model provides a validated, region-calibrated tool to estimate 5- and 10-year cardiovascular risk in older adults (≥70 years) to guide shared decision-making for risk factor treatment.

Abstract

Abstract Aims The aim of this study was to derive and validate the SCORE2-Older Persons (SCORE2-OP) risk model to estimate 5- and 10-year risk of cardiovascular disease (CVD) in individuals aged over 70 years in four geographical risk regions. Methods and results Sex-specific competing risk-adjusted models for estimating CVD risk (CVD mortality, myocardial infarction, or stroke) were derived in individuals aged over 65 without pre-existing atherosclerotic CVD from the Cohort of Norway (28 503 individuals, 10 089 CVD events). Models included age, smoking status, diabetes, systolic blood pressure, and total- and high-density lipoprotein cholesterol. Four geographical risk regions were defined based on country-specific CVD mortality rates. Models were recalibrated to each region using region-specific estimated CVD incidence rates and risk factor distributions. For external validation, we analysed data from 6 additional study populations 338 615 individuals, 33 219 CVD validation cohorts, C-indices ranged between 0. 63 95% confidence interval (CI) 0. 61–0. 65 and 0. 67 (0. 64–0. 69). Regional calibration of expected-vs. -observed risks was satisfactory. For given risk factor profiles, there was substantial variation across the four risk regions in the estimated 10-year CVD event risk. Conclusions The competing risk-adjusted SCORE2-OP model was derived, recalibrated, and externally validated to estimate 5- and 10-year CVD risk in older adults (aged 70 years or older) in four geographical risk regions. These models can be used for communicating the risk of CVD and potential benefit from risk factor treatment and may facilitate shared decision-making between clinicians and patients in CVD risk management in older persons.

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Cite This Study

Vries et al. (2021) studied this question. The SCORE2-OP risk model accurately estimates 5- and 10-year cardiovascular event risk in older adults, showing C-indices between 0.63 and 0.67 across regions.

synapsesocial.com/papers/697a2e3c4ebe3b298911b22ehttps://doi.org/10.1093/eurheartj/ehab312
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