Performance of SCORE2 to identify silent atherosclerosis in adults aged 60–70 years: a sub-analysis from the REACT study

Background Systematic risk stratification for atherosclerotic cardiovascular disease relies on the SCORE2 algorithm, which can be applied up to age of 70 years before transition to SCORE2-OP. In a large cohort study of asymptomatic individuals, we focused on adults aged 60–70 years, representing the upper age limit of SCORE2, where the yield of supplemental imaging-based screening may be greatest. Purpose To assess the ability of SCORE2 to identify individuals with imaging-based silent atherosclerosis. Methods The REACT Phase I study is a large multinational study of the prevalence of asymptomatic (silent) atherosclerosis utilizing deep phenotyping, targeting >16,000 participants. This preliminary sub-analysis focused on participants aged 60–70 years with confirmed silent atherosclerosis. Bilateral carotid and femoral 3D ultrasound examinations were performed. Subclinical atherosclerosis was defined as atherosclerotic plaque in at least one vascular site (femoral or carotid arteries). SCORE2 values were categorised according to ESC thresholds: Low risk (<5%), moderate risk (5–10%), and high risk (>10%) i.e. above the threshold at which treatment is generally recommended. Results (preliminary) Subclinical atherosclerosis was identified in a total of 1,295 participants in the age group 60-70 years. Plaques were most frequently identified in the carotid arteries. A total of 16% of the participants had a SCORE-2 at the high-risk level (>10%), approximately 50% of the participants were classified as moderate-risk (5-10%) and 35% as low-risk (<5%) (Figure 1). Conclusion Among asymptomatic adults aged 60–70 years with imaging confirmed silent atherosclerosis, SCORE2 only classified 1 in 6 as high-risk, i.e. as candidates for primary prevention, and more than one third as low risk. These findings point toward the potential of imaging-based screening to improve patient selection for primary prevention.