Key result
Adding physical activity and Mediterranean diet to SCORE2-OP improves ASCVD risk prediction by ~41%.
Why the study?
SCORE2/SCORE2-OP estimates 10-year first ASCVD risk without lifestyle factors, leaving it unclear whether physical activity and Mediterranean diet adherence improve prediction.
Does adding self-reported physical activity and Mediterranean diet adherence to SCORE2/SCORE2-OP improve ASCVD risk prediction in the general population?
Cohort (n=2,587)
Does adding self-reported physical activity and Mediterranean diet adherence to SCORE2/SCORE2-OP improve ASCVD risk prediction in the general population?
Effect estimate: continuous total NRI 41% (95% CI 7-74)
Adding self-reported physical activity and Mediterranean diet adherence to the SCORE2-OP risk model provides modest incremental value for ASCVD risk prediction in adults aged 70 years or older.
May modestly refine ASCVD risk prediction with SCORE2-OP in adults ≥70 years; leaves open external validation before clinical adoption.
Aim The SCORE2/SCORE2-OP, recommended for estimating 10-year risk of first atherosclerotic cardiovascular disease (ASCVD), does not include lifestyle factors. We investigated whether adding self-reported physical activity and Mediterranean diet adherence improves prediction beyond SCORE2/SCORE2-OP. Methods We included participants from the population-based CoLaus|PsyCoLaus cohort with data for the Physical Activity Frequency Questionnaire (PAFQ) and Mediterranean Diet Score (MedDietScore). We fitted Cox-regression models including SCORE2 or SCORE2-OP as covariates, depending on the participants’ age, alone or in addition to PAFQ, MedDietScore or both. We assessed discrimination (Harrell’s C), calibration slope, and net reclassification improvement (NRI) for all models. Results A total of 2,587 participants (59% women) were followed for a median duration of 9.0 years (IQR: 8.13-11.6), during which 145 ASCVD events occurred. 2,348 were younger than 70 years and evaluated using SCORE2, with 106 ASCVD events. The remaining 239 were aged 70 years or older and assessed with SCORE2-OP, with 39 ASCVD events. Adding physical activity or diet or both to SCORE2 did not improve discrimination (Harrell’s C: 0.74 for all models), calibration (slope: 1.06 for all), or reclassification (continuous total NRI: -8.8 to 2.5%). Adding both lifestyle factors to SCORE2-OP improved discrimination (Harrell’s C: 0.63 to 0.66), calibration (slope: 1.34 for SCORE2-OP to 1.16 for full model) and reclassification (continuous total NRI: 41% (95%CI 7–74%) with event NRI of 28% and non-event NRI of 13%). Conclusion The addition of self-reported physical activity and Mediterranean diet may provide modest incremental value to improve ASCVD risk prediction in older adults beyond the traditional SCORE2-OP.
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Artels et al. (2026) conducted a cohort in Cardiovascular risk prediction (n=2,587). Addition of self-reported physical activity and Mediterranean diet adherence to SCORE2/SCORE2-OP vs. SCORE2/SCORE2-OP alone was evaluated on Improvement in ASCVD risk prediction (discrimination, calibration, and reclassification) (continuous total NRI 41%, 95% CI 7-74). Adding self-reported physical activity and Mediterranean diet adherence to SCORE2-OP improved ASCVD risk prediction in older adults (continuous total NRI 41%; 95% CI 7-74%).
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