Key result
Adding carotid plaque to SCORE2 significantly improved 10-year CVD risk prediction (C-statistics +2.20%, P<0.0001), correcting SCORE2's under-prediction in patients with plaque.
Why the study?
It was unknown whether and how subclinical carotid atherosclerosis affects the predictive performance of SCORE2 for estimating 10-year first-onset CVD risk.
Does adding carotid ultrasound assessment of plaque and intima media thickness to SCORE2 improve the prediction of 10-year cardiovascular events in non-diabetic adults?
Cohort (n=4,588)
Does adding carotid ultrasound assessment of plaque and intima media thickness to SCORE2 improve the prediction of 10-year cardiovascular events in non-diabetic adults?
Effect estimate: C-statistics improvement 2.20%, IDI 0.70%, NRI 46.1%
p-value: p=< 0.0001
Adding carotid ultrasound assessment of plaque and intima media thickness to the SCORE2 algorithm significantly improves the accuracy of 10-year cardiovascular risk prediction in non-diabetic adults.
Carotid plaque may refine SCORE2 calibration in midlife adults; leaves open whether integration improves outcomes or warrants practice change.
AIMS: Subclinical carotid atherosclerosis adds predictive value to traditional risk factors for cardiovascular diseases (CVDs). Systematic Coronary Risk Assessment 2 (SCORE2), an algorithm composed of traditional risk factors, is a state-of-the-art to estimate the 10-year risk of first-onset CVDs. We aim to investigate whether and how subclinical carotid atherosclerosis affects the performance of SCORE2. METHODS AND RESULTS: Carotid plaque presence and intima media thickness (IMT) were measured with ultrasound. The SCORE2 was calculated in 4588 non-diabetic participants aged 46-68 years. The incremental value for predicting CVD events of adding carotid plaque or IMT to SCORE2 was evaluated using C-statistics, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). The predicted 10-year CVD risk by SCORE2 and the observed event rate were compared between participants with and without carotid plaque. Adding plaque or IMT to SCORE2 significantly improved performance for predicting CVDs. The improvements in C-statistics, IDI, and NRI of adding plaque to SCORE2 for events occurring during the first 10 years were 2.20%, 0.70%, and 46.1%, respectively (all P < 0.0001). The SCORE2 over-predicted the 10-year CVD risk in those without carotid plaque (3.93% observed vs. 5.89% predicted, P < 0.0001) while under-predicted the risk in those with carotid plaque (9.69% observed vs. 8.12% predicted, P = 0.043). CONCLUSION: Carotid ultrasound adds predictive performance to SCORE2 for assessment of CVD risk. Using SCORE2 without considering carotid atherosclerosis could under- or over-estimate the risk. LAY SUMMARIES: Subclinical carotid atherosclerosis is an important consideration in cardiovascular risk estimation by Systematic Coronary Risk Assessment 2 (SCORE2). Carotid ultrasound adds predictive performance to SCORE2 for assessment of cardiovascular risk. SCORE2 over-predicted the 10-year cardiovascular risk in those without carotid plaque while under-predicted the risk in those with carotid plaque.
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Bao et al. (2023) conducted a cohort in Cardiovascular disease risk (n=4,588). Carotid ultrasound (plaque presence and IMT) vs. SCORE2 alone was evaluated on Improvement in predicting 10-year CVD events (C-statistics improvement 2.20%, IDI 0.70%, NRI 46.1%, p=< 0.0001). Adding carotid plaque to SCORE2 significantly improved 10-year CVD risk prediction (C-statistics +2.20%, P<0.0001), correcting SCORE2's under-prediction in patients with plaque.
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