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Multicenter Study
. 2014 Mar;35(9):571-7.
doi: 10.1093/eurheartj/eht189. Epub 2013 Jun 20.

SCORE performance in Central and Eastern Europe and former Soviet Union: MONICA and HAPIEE results

Olga Vikhireva  1 , Andrzej Pajak, Grazyna Broda, Sofia Malyutina, Abdonas Tamosiunas, Ruzena Kubinova, Galina Simonova, Zdena Skodova, Martin Bobak, Hynek Pikhart
Affiliations
Multicenter Study

SCORE performance in Central and Eastern Europe and former Soviet Union: MONICA and HAPIEE results

Olga Vikhireva et al. Eur Heart J. 2014 Mar.

Abstract

Aims: The Systematic COronary Risk Evaluation (SCORE) scale assesses 10 year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk SCORE version is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), but its performance has never been systematically assessed in the region. We evaluated SCORE performance in two sets of population-based CEE/FSU cohorts.

Methods and results: The cohorts based on the World Health Organization MONitoring of trends and determinants in CArdiovascular disease (MONICA) surveys in the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s. The Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPIEE) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05. In Cox regression analyses, the high-risk SCORE ≥5% at baseline significantly predicted CVD mortality in both MONICA [n = 15 027; hazard ratios (HR), 1.7-6.3] and HAPIEE (n = 20 517; HR, 2.6-10.5) samples. While SCORE calibration was good in most MONICA samples (predicted and observed mortality were close), the risk was underestimated in Russia. In HAPIEE, the high-risk SCORE overpredicted the estimated 10 year mortality for Czech and Polish samples and adequately predicted it for Russia. SCORE discrimination was satisfactory in both MONICA and HAPIEE.

Conclusion: The high-risk SCORE underestimated the fatal CVD risk in Russian MONICA but performed well in most MONICA samples and Russian HAPIEE. This SCORE version might overestimate the risk in contemporary Czech and Polish populations.

Keywords: Cardiovascular mortality; Cardiovascular risk factors; Central and Eastern Europe; Former Soviet Union; Risk prediction; SCORE risk function.

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Figures

Figure 1
Figure 1
The high-risk SCORE (≥5 vs. <5%) and atherosclerotic cardiovascular mortality in MONICA and HAPIEE men (A) and women (B) hazard ratios (HR) and 95% confidence intervals (CI). CZ, Czech Republic; LT, Lithuania; PL-K, Poland (Krakow); PL-T, Poland (Tarnobrzeg); PL-W, Poland (Warsaw); RU, Russia.
See this image and copyright information in PMC

Comment in

  • Risks in estimating risk.
    Graham IM, Cooney MT. Graham IM, et al. Eur Heart J. 2014 Mar;35(9):537-9. doi: 10.1093/eurheartj/eht286. Epub 2013 Nov 7. Eur Heart J. 2014. PMID: 24204012 No abstract available.

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