Key result
SCORE2-LAC models demonstrate good discrimination for ten-year CVD risk with a 0.74 C-index.
Why the study?
Risk prediction models adapted for use in Latin America and the Caribbean populations to estimate 10-year cardiovascular disease risk remain limited despite the high burden of CVD in the region.
Does the SCORE2-LAC model accurately predict 10-year cardiovascular disease risk in individuals without prior CVD or diabetes in Latin America and the Caribbean?
Cohort (n=132,512)
Yes
Does the SCORE2-LAC model accurately predict 10-year cardiovascular disease risk in individuals without prior CVD or diabetes in Latin America and the Caribbean?
Effect estimate: C-index 0.740 (95% CI 0.716-0.763)
The SCORE2-LAC model provides region-specific, contemporary estimates of 10-year CVD risk with good discrimination for apparently healthy individuals in Latin America and the Caribbean.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Models such as SCORE2 were developed using data from European populations. These models can be useful in other regions, but first they must be recalibrated and validated using extensive, high-quality local data to capture important differences in risk factor distributions and CVD incidence patterns. Through the ESC's Cardiovascular Risk Collaboration, we are working in close partnership with the Inter-American Society of Cardiology (SIAC) to develop SCORE2-LAC, a new model that reflects the diversity and realities of cardiovascular risk across Latin America and the Caribbean.”
“This project represents a historic milestone for CVD prevention in our region. For the first time, Latin America and the Caribbean will have a rigorously validated tool, built on local epidemiological data, allowing for more precise and reliable cardiovascular risk assessment. The project also opens up valuable opportunities for research so we can better understand cardiovascular risk across the region and implement further improvement strategies.”
“Average risk factor levels and mortality data from 32 countries in Latin America and the Caribbean have been incorporated and we have begun the process of estimating 10-year CVD incidence based on data from 2.6 million individuals. Over the coming weeks, we will incorporate data from an additional 37 million people from Brazil. External validation is then expected to involve cohorts from at least eight countries.”
SCORE2-LAC supports region-specific 10-year CVD risk estimation in LAC; extends SCORE2 validation but leaves open prospective outcome trials.
BACKGROUND AND AIMS: Despite the high burden of cardiovascular disease (CVD) in Latin America and the Caribbean (LAC), risk prediction models adapted for use in LAC populations remain limited. The aim of this study was to recalibrate the Systematic COronary Risk Evaluation 2 (SCORE2) risk models for estimating 10-year CVD risk in individuals without prior CVD or diabetes mellitus in LAC, resulting in the SCORE2 Latin America and the Caribbean (SCORE2-LAC) models. METHODS: Sex-specific, competing risk-adjusted SCORE2 models were recalibrated to contemporary CVD incidence across four risk regions, defined by country-level age- and sex-standardized CVD mortality rates, using region-specific risk factor distributions. Cardiovascular disease incidence was estimated from CVD mortality data and ratios of the total first-to-fatal CVD events, derived from 40 237 152 individuals (1 261 329 CVD events). External validation included 132 512 individuals without prior CVD or diabetes from 11 cohorts across seven countries (3938 CVD events). Discrimination was assessed using Harrell's C-index. RESULTS: In the external validation datasets, the pooled C-index of SCORE2-LAC was .740 [95% confidence interval (CI) .716-.763], with cohort-specific C-indices ranging from .674 (95% CI .588-.761) to .789 (95% CI .747-.831). Estimated CVD risk varied several-fold across the four LAC risk regions. For a 50-year-old non-smoker with a systolic blood pressure of 140 mmHg, total cholesterol of 213 mg/dL (5.5 mmol/L), and HDL cholesterol of 50 mg/dL (1.3 mmol/L), the predicted risk ranged from 3% in low-risk countries to 10% in very-high-risk countries for women, and from 4% to 10% for men. CONCLUSIONS: The SCORE2-LAC models provide region-specific contemporary estimates of 10-year CVD risk in apparently healthy individuals, enabling identification of individuals at high CVD risk across LAC.
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Bijkerk et al. (2026) conducted a cohort in Without prior cardiovascular disease or diabetes mellitus (n=132,512). SCORE2-LAC models was evaluated on Discrimination for 10-year cardiovascular disease risk (Harrell's C-index) (C-index 0.740, 95% CI 0.716-0.763). The SCORE2-LAC models demonstrated good discrimination for estimating 10-year cardiovascular disease risk, with a pooled C-index of 0.740 (95% CI 0.716-0.763).
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