Key result
Recalibrated SCORE2-LAC predicts 10-year CVD risk with moderate-to-good discrimination across Latin American cohorts.
Why the study?
Most existing CVD prediction models were developed and validated solely in European or North American populations, despite the substantial CVD burden and distinct risk factor and incidence patterns in Latin America and the Caribbean.
Does the recalibrated SCORE2-LAC model accurately predict the 10-year risk of fatal and non-fatal cardiovascular disease events in adults aged 40–69 years without previous CVD or diabetes in Latin America and the Caribbean?
Cohort (n=127,581)
Yes
Does the recalibrated SCORE2-LAC model accurately predict the 10-year risk of fatal and non-fatal cardiovascular disease events in adults aged 40–69 years without previous CVD or diabetes in Latin America and the Caribbean?
The recalibrated SCORE2-LAC model provides validated, region-specific 10-year cardiovascular disease risk estimates for apparently healthy adults across Latin America and the Caribbean, demonstrating moderate-to-good discrimination.
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.”
“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 8 countries.”
“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.”
Supports region-specific CVD risk prediction in Latin America; extends SCORE2 but leaves open need for outcome validation before practice change.
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 events (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 40,234,177 individuals (1,281,703 CVD events). External validation was performed on data from 10 additional cohorts across 7 countries, comprising 127,581 individuals and 3,844 CVD events. After applying the 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 SCORE2-LAC model provides region-specific estimates of 10-year CVD risk among apparently healthy individuals in LAC, thereby enhancing the identification of individuals at higher risk of developing CVD across the LAC region.
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Stella Bijkerk (2026) conducted a cohort in Cardiovascular disease risk prediction (n=127,581). SCORE2-LAC risk prediction model was evaluated on 10-year risk of fatal and non-fatal cardiovascular disease events (myocardial infarction and stroke) (C-index 0.668 to 0.789, 95% CI 0.605-0.731 to 0.747-0.831). The recalibrated SCORE2-LAC model estimated 10-year CVD risk across 10 LAC cohorts with C-indices ranging from 0.668 (95% CI 0.605-0.731) to 0.789 (95% CI 0.747-0.831).
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