Impact of lipid-lowering treatment on the performance of SCORE2 algorithms in detecting high-risk individuals

Background and aim Current guidelines state that Systematic Coronary Risk Evaluation 2 (SCORE2) risk algorithms should not be used among persons under lipid-lowering therapy. This study investigated in dyslipidemia-treated individuals the effect of lipid-lowering treatment on SCORE2 calculation and on its performance to detect high risk individuals. Methods and results Analysis included middle-aged individuals (n=417), treated for dyslipidemia, without established cardiovascular disease, diabetes and/or chronic kidney disease, recruited from screening programs in the community [mean age 59.5±6.9 (SD) years, men 48.9%, statin monotherapy 67%, statin/ezetimibe combination 26%]. SCORE2 algorithms were calculated using measured and adjusted (for the lipid-lowering therapy characteristics) lipid levels. SCORE2 and adjusted-SCORE2 were 5.4±2.7% and 6.6±3.3% respectively (P<0.05). Participants classified as low-moderate/high/very-high risk (age-dependent risk thresholds) were 42.2%/51.1%/6.7% with SCORE2, and 28.8%/54.4%/16.8% with adjusted-SCORE2 (agreement 76.5%, weighted kappa 0.73, P<0.05). Using single risk thresholds (<10%, 10% to <20%, and ≥20%), the respective percentages were 93.8%/6.2%/0% and 83.9%/16.1%/0% (agreement 90.2%, kappa 0.52, P<0.05). The agreement between carotid plaque score and SCORE2/adjusted-SCORE2 was 54% (weighted kappa 0.29, P<0.05)/50.1% (weighted kappa 0.25, P<0.05). Conclusions Lipid-lowering treatment appears to have a modest effect on SCORE2 calculation and mainly on its stability to detect high risk individuals.