Preliminary SCORE2 Latin America and the Caribbean: a region-specific tool to improve cardiovascular risk estimation in clinical practice

Background Guidelines recommend the use of cardiovascular disease (CVD) risk prediction models to identify people at high risk of CVD who may benefit most from preventive action. Most existing CVD prediction models have been developed and validated solely in European or North American populations, despite the substantial CVD burden in Latin America and the Caribbean (LAC) and notable differences in CVD risk factor distributions and CVD incidence patterns. Purpose Our aim was to recalibrate and externally validate the SCORE2 model for Latin America and the Caribbean (SCORE2-LAC) to estimate the 10-year risk of fatal and non-fatal CVD (myocardial infarction and stroke) among adults aged 40–69 years without previous CVD or diabetes in the LAC region. Methods We defined four risk regions according to country-specific CVD mortality rates: low risk (<100 CVD deaths per 100,000), moderate risk (100 to <150 CVD deaths per 100,000), high risk (150 to <300 CVD deaths per 100,000), and very high risk (≥300 CVD deaths per 100,000). The sex-specific and competing-risk–adjusted SCORE2 models were systematically recalibrated to reflect contemporary CVD incidence in LAC clinical practice. Models were recalibrated using risk region-representative data on expected incidence and CVD risk factor distributions, applying the methodological framework previously used in the recalibration of SCORE2 for Europe and the Asia-Pacific region. The recalibrated SCORE2-LAC model was externally validated using LAC cohort data, and discrimination was assessed using Harrell’s C-statistic. Results Region-specific CVD incidence was estimated using country-specific CVD mortality data and the ratios of fatal to total first CVD events from 2,631,397 individuals (239,951 CVD events). External validation was performed on data from 7 additional cohorts across 6 countries, comprising 113,933 individuals and 3,711 CVD events. After applying the preliminarily recalibrated SCORE2 models to the validation cohorts according to their respective risk region, the cohort-specific overall C-indices ranged from 0.668 (95%CI 0.605-0.731) to 0.789 (95%CI 0.747-0.831). Conclusion(s) The preliminary SCORE2-LAC model provides region-specific estimates of 10-year CVD risk among apparently healthy individuals. Future incorporation of LAC-specific registry and cohort data will enable further refinement of the model, thereby improving risk prediction across the LAC region.Latin American Caribbean risk regionsFor image description, please refer to the figure legend and surrounding text. Overall and sex-specific discriminationFor image description, please refer to the figure legend and surrounding text.