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Published in

Oxford University Press, European Journal of Preventive Cardiology, 2023

DOI: 10.1093/eurjpc/zwad318

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Validation of Systematic Coronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons in the EPIC-Norfolk prospective population cohort

This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

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Abstract

Abstract Aims The European Systematic Coronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons (OP) models are recommended to identify individuals at high 10-year risk for cardiovascular disease (CVD). Independent validation and assessment of clinical utility is needed. This study aims to assess discrimination, calibration, and clinical utility of low-risk SCORE2 and SCORE2-OP. Methods and results Validation in individuals aged 40–69 years (SCORE2) and 70–79 years (SCORE2-OP) without baseline CVD or diabetes from the European Prospective Investigation of Cancer (EPIC) Norfolk prospective population study. We compared 10-year CVD risk estimates with observed outcomes (cardiovascular mortality, non-fatal myocardial infarction, and stroke). For SCORE2, 19 560 individuals (57% women) had 10-year CVD risk estimates of 3.7% [95% confidence interval (CI) 3.6–3.7] vs. observed 3.8% (95% CI 3.6–4.1) [observed (O)/expected (E) ratio 1.0 (95% CI 1.0–1.1)]. The area under the curve (AUC) was 0.75 (95% CI 0.74–0.77), with underestimation of risk in men [O/E 1.4 (95% CI 1.3–1.6)] and overestimation in women [O/E 0.7 (95% CI 0.6–0.8)]. Decision curve analysis (DCA) showed clinical benefit. Systematic Coronary Risk Evaluation 2-Older Persons in 3113 individuals (58% women) predicted 10-year CVD events in 10.2% (95% CI 10.1–10.3) vs. observed 15.3% (95% CI 14.0–16.5) [O/E ratio 1.6 (95% CI 1.5–1.7)]. The AUC was 0.63 (95% CI 0.60–0.65) with underestimation of risk across sex and risk ranges. Decision curve analysis showed limited clinical benefit. Conclusion In a UK population cohort, the SCORE2 low-risk model showed fair discrimination and calibration, with clinical benefit for preventive treatment initiation decisions. In contrast, in individuals aged 70–79 years, SCORE2-OP demonstrated poor discrimination, underestimated risk in both sexes, and limited clinical utility.