Comparison of Globorisk, SCORE2, and PREVENT in the Stratification of Cardiovascular Risk and its Relationship with End-Organ Damage Among Adults With Arterial Hypertension

Abstract

Arterial hypertension often coexists with comorbidities that increase vascular damage. Although the primary goal is to reduce cardiovascular risk, the available risk scores can produce varying estimates. Here, we aim to compare the prevalence of cardiovascular risk categories using three equations (Globorisk, SCORE2, and PREVENT) in adults living with arterial hypertension and to assess their association as stratification tools for end-organ damage (EOD). To achieve this, we performed a cross-sectional sub-analysis of the RIHTA study, an electronic health record-based registry of adults with arterial hypertension in Mexican primary care centers. EOD was defined as aortic stiffness, reduced eGFR, hypertensive retinopathy, peripheral artery disease, or left ventricular hypertrophy. Inverse probability weighting (IPW) was used to evaluate the association between cardiovascular risk and EOD, adjusting for relevant confounders, and areas under the receiver operator curve (AUROC) were calculated to assess detection capacity. Among 4512 participants (median age 64 years; 61% women), EOD was present in 33% (n = 1492). The PREVENT equation yielded the highest median 10-year risk (15%, IQR 8-24), followed by Globorisk laboratory-based (12%, 7-22), Globorisk office-based (11%, 7-19), and SCORE2 (5.06%, 3.86-7.18). In IPW models, each 1% increase in score was associated with higher odds of EOD (PREVENT OR 1.16, 95% CI 1.15-1.17; Globorisk-office 1.09, 1.08-1.10; Globorisk-lab 1.07, 1.06-1.08; SCORE2 1.04, 1.02-1.06). The PREVENT score demonstrated the strongest discrimination for detecting EOD (AUROC: 0.751, 0.735-0.750). These findings suggest that among adults with arterial hypertension, the PREVENT score identifies high-risk individuals and improves discrimination for EOD.

Keywords: Mexico; arterial hypertension; cardiovascular risk; end‐organ damage; epidemiology.

FIGURE 1

STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) flowchart of our studied population.

FIGURE 2

Prevalence of CVD risk categories among women and men. Error bars represent 95% confidence intervals.

FIGURE 3

Prevalence of CVD risk categories stratified by blood pressure control (<130/80 and ≥130/80 mm Hg) among women and men. Error bars represent 95% confidence intervals.

FIGURE 4

ROC curves for CVD risk prediction models among women (A) and men (B). The area under the receiver operator curve (AUROC) and corresponding 95% confidence intervals are displayed in the table inset.