Key result
Obesity is linked to ~2-fold higher 10-year CVD risk, refining HellenicSCORE II+ calibration.
Why the study?
Body mass index is a major modifiable cardiovascular risk factor that is not directly incorporated into most contemporary cardiovascular disease risk prediction scores, prompting an effort to refine the HellenicSCORE II+ with sex-specific BMI conversion factors.
Does applying sex-specific BMI conversion factors to the HellenicSCORE II+ improve the calibration of 10-year cardiovascular event prediction in overweight and obese Greek adults aged 40–69 years?
Cohort (n=1,006)
Does applying sex-specific BMI conversion factors to the HellenicSCORE II+ improve the calibration of 10-year cardiovascular event prediction in overweight and obese Greek adults aged 40–69 years?
Incorporating sex-specific BMI conversion factors into the HellenicSCORE II+ improves the accuracy of 10-year cardiovascular risk prediction in overweight and obese Greek adults, though external validation is needed.
Answers are grounded in this paper and cite their sources.
May enhance HellenicSCORE II+ calibration in Greek adults; hypothesis-generating and requires external validation before practice change.
Introduction: Body mass index (BMI) is a major, modifiable cardiovascular risk factor, yet it is not directly incorporated into most contemporary cardiovascular disease risk prediction scores. The aim of this study was to refine the HellenicSCORE II+ by deriving sex-specific BMI conversion factors for Greek adults aged 40–69 years. Methods: Data from the ATTICA study, a population-based prospective cohort with a 10-year follow-up, were used. The analysis included 1006 participants aged 40–69 years (52% of men). BMI was classified according to the World Health Organization thresholds as normal weight (18.5–24.9 kg/m 2 ), overweight (25–29.9 kg/m 2 ) and obese (≥30 kg/m 2 ). For each sex and BMI category, a conversion factor was derived as the ratio of observed to expected 10-year cardiovascular events, relative to the normal-weight reference, and applied to the HellenicSCORE II+ value. Calibration was assessed with a Poisson model before and after application of the factors. Results: Overweight and obesity were associated with a higher 10-year cardiovascular incidence in both sexes. The conversion factors were 1.28 (95% confidence interval: 0.79–2.07) for overweight and 2.01 (1.21–3.34) for obesity in men and 1.45 (0.82–2.58) and 1.94 (1.11–3.38), respectively, in women; the obesity factors were statistically significant in both sexes. Before adjustment, the observed-to-expected ratio differed across BMI categories; afterward, it no longer differed (all P > 0.68), indicating closer agreement between predicted and observed risks. Conclusions: Simple, sex-specific BMI conversion factors are proposed for the HellenicSCORE II+, bringing predicted risk closer to observed incidence in overweight and obese Greek adults. These factors are exploratory and require external validation before clinical use.
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Kassanis et al. (2026) conducted a cohort in Atherosclerotic cardiovascular disease risk (n=1,006). Overweight (BMI 25–29.9 kg/m2) and obesity (BMI ≥30 kg/m2) vs. Normal weight (BMI 18.5–24.9 kg/m2) was evaluated on Ratio of observed to expected 10-year cardiovascular events (BMI conversion factor for HellenicSCORE II+) (Conversion factor 2.01 (obese men); 1.94 (obese women), 95% CI 1.21-3.34, p=>0.68 after calibration). Obesity significantly increased 10-year observed-to-expected CVD risk vs normal weight in men (factor 2.01; 95% CI 1.21-3.34) and women (1.94; 95% CI 1.11-3.38), improving HellenicSCORE II+ calibration.
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