The Relationship between updated Systemic Coronary Risk Estimation (SCORE 2) and markers of subclinical atherosclerosis and target organ damage in asymptomatic population with metabolic syndrome

The updated SCORE algorithm (SCORE2) estimates an individual’s 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in apparently healthy people aged 40-69 years with risk factors that are untreated or have been stable for several years. Aim of study This study evaluated the association between SCORE 2 and markers of subclinical atherosclerosis and target organ damage in asymptomatic patients with metabolic syndrome (MetSy). Method The study included 131 participants, without manifested cardiovascular disease. The patients were divided into 2 groups. The first group (I) consisted of subjects with MetSy, n=67 (age: 53,5 ± 8,00), the second (II) group is control, without MetSy, n=64. For all patients was determined: presence of risk factors for cardiovascular disease (hypertension, hyperlipidaemia, smoking, diabetes, obesity, age), SCORE and SCORE 2, laboratory analysis, anthropometric measurements, fatty liver index (FLI), microalbuminuria, echocardiographic examination, carotid ultrasound (with measurement intima-media thickness (C-IMT), analysis carotid atherosclerotic plaques), exercise stress testing. Results Subjects with MetSy had a higher average number of risk factors, SCORE and SCORE 2 level (p<0,0001), body mass index (p<0,0001), FLI (p<0,0001), more often present fatty liver (83 vs. 21%, p<0,0001). C-IMT were significantly higher in the group with MetSy (0,80 ± 0,20 vs. 0,60 ± 0,09, p<0,0001). The high C-IMC values (≥0.90) were observed in 26% patients with MetSy, p<0,0001. Patients with MetSy had more frequently one or more carotid plaques (p<0,0001), higher average number of carotid plaques (p = 0,01) and percentage of stenosis (p=0,001). In MetSy group plaques were mostly fibrocalcified (28%), followed by fibrous (22%) and calcified, in non MetSy group were fibrous (14%). Subjects with MetSy had a higher average left ventricular mass (p=0,001); more frequently had diastolic dysfunction (p<0,0001) and left atrial dilation (p<0,0001); 9 subjects (15 %) from the I group had a positive stress test. There was no difference in the frequency of microalbuminuria between the two groups. There is a correlation between SCORE 2 and very high risk level with carotid intima-media thickness and carotid plaques (p<0,0001), left ventricular mass (p=0,01), diastolic dysfunction (p<0,0001), microalbuminuria (p=0,03) and positive stress test (p=0,01). Multivariable logistic regression analysis showed that SCORE 2 was associated with presence of carotid plaques and C-IMT (95 % CI 0,007-0,019; p<0,001). Conclusion Our study showed a significant association between the SCORE 2 and markers of subclinical atherosclerosis and target organ damage in asymptomatic population with metabolic syndrome.