SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe

Abstract

Aims: The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe.

Methods and results: We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries.

Conclusion: SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe.

Keywords: 10-year CVD risk; Cardiovascular disease; Primary prevention; Risk prediction.

Development process, key features and illustrative example of the SCORE2 risk prediction algorithms for European populations.

Figure 1

Study design.

Figure 2

Risk regions based on standardised cardiovascular disease mortality rates. Countries were grouped into four risk regions according to their most recently reported WHO age- and sex-standardized overall CVD mortality rates per 100,000 population (ICD chapters 9, I00-I99). The four groupings were: 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).

Figure 3

SCORE2 charts for estimation of CVD risk in four European risk regions.

Figure 4

C-index upon assessing ability of the SCORE2 model to discriminate cardiovascular disease in external validation cohorts.

Figure 5

Distribution of 10-year cardiovascular disease risk according to recalibrated SCORE2 models across European countries. The proportion of individuals expected in each risk category was estimated to reflect the age-group and sex-specific risk factor values and specific population structure of each country (Supplementary material online, Methods 1.3).