Key result
High-risk SCORE predicts fatal CVD well but underestimates Russian and overestimates Czech and Polish risk.
Why the study?
Does the high-risk SCORE scale accurately predict 10-year fatal CVD risk in populations from Central and Eastern Europe and the former Soviet Union?
Cohort (n=35,544)
Yes
Does the high-risk SCORE scale accurately predict 10-year fatal CVD risk in populations from Central and Eastern Europe and the former Soviet Union?
Effect estimate: HR 1.7-6.3 (MONICA) and 2.6-10.5 (HAPIEE)
The high-risk SCORE scale is a significant predictor of CVD mortality in CEE/FSU populations, but its calibration varies, potentially overestimating risk in contemporary Czech and Polish populations.
Warrants caution applying high-risk SCORE in Eastern European populations; leaves open need for local recalibration in contemporary cohorts.
AIMS: The Systematic COronary Risk Evaluation (SCORE) scale assesses 10 year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk SCORE version is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), but its performance has never been systematically assessed in the region. We evaluated SCORE performance in two sets of population-based CEE/FSU cohorts. METHODS AND RESULTS: The cohorts based on the World Health Organization MONitoring of trends and determinants in CArdiovascular disease (MONICA) surveys in the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s. The Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPIEE) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05. In Cox regression analyses, the high-risk SCORE ≥5% at baseline significantly predicted CVD mortality in both MONICA [n = 15 027; hazard ratios (HR), 1.7-6.3] and HAPIEE (n = 20 517; HR, 2.6-10.5) samples. While SCORE calibration was good in most MONICA samples (predicted and observed mortality were close), the risk was underestimated in Russia. In HAPIEE, the high-risk SCORE overpredicted the estimated 10 year mortality for Czech and Polish samples and adequately predicted it for Russia. SCORE discrimination was satisfactory in both MONICA and HAPIEE. CONCLUSION: The high-risk SCORE underestimated the fatal CVD risk in Russian MONICA but performed well in most MONICA samples and Russian HAPIEE. This SCORE version might overestimate the risk in contemporary Czech and Polish populations.
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Vikhireva et al. (2013) conducted a cohort in Cardiovascular disease risk (n=35,544). High-risk SCORE ≥5% vs. Observed mortality was evaluated on CVD mortality (HR 1.7-6.3 (MONICA) and 2.6-10.5 (HAPIEE)). A high-risk SCORE ≥5% significantly predicted 10-year CVD mortality in MONICA (HR 1.7-6.3) and HAPIEE (HR 2.6-10.5) cohorts, though it underestimated risk in Russia and overestimated it elsewhere.
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