Underestimation of Cardiovascular Risk by the SCORE2 Model in Primary Care: A Call for Recalibration.

IF 8.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European journal of preventive cardiology Pub Date : 2025-04-27 DOI:10.1093/eurjpc/zwaf253

V M I Voorbrood, A M Bohnen, A P Bosman, P R Rijnbeek, D Rizopoulos, P J E Bindels

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引用次数: 0

Abstract

Background: The SCORE2 model is a derived risk prediction model that estimates the CVE risk. Originally developed with population-based cohort data, this model is also intended to be used in routine primary care to calculate the risk of first-onset CVE and guide treatment decisions.

Aim: In this study, we followed adult patients in the Netherlands who visited their general practitioner (GP) and underwent a CVE risk assessment at their GP office. The aim was to relate the results of the SCORE2 model to the observed risk of a first CVE during follow-up.

Methods: A retrospective cohort study was conducted of 205,548 patients, analyzing factors including age, sex, smoking status, diabetes, total and HDL cholesterol, and mean systolic blood pressure. The performance of the SCORE2 model was assessed using observed-to-expected (O/E) risk ratios, calibration plots, and C-statistics. Analyses were stratified by sex, age groups (< 50 and ≥ 50 years), and low and moderate risk country categories.

Main results: Results indicated a mean observed 10-year risk of 10.1%, notably higher than the model-predicted risk of 6.2%. The O/E ratio in females and men was 1.54 and 1.68 respectively.The mean observed 10-year CVE was in the age groups < 50 years and ≥ 50 years 6.9% and 11%, respectively. (O/E ratio: 1.78 vs. 1.62).Consequently, approximately 35% of patients potentially missed preventive treatments due to SCORE2's underestimation.

Conclusion: These findings suggest the SCORE2 model may underestimate CVE risk in primary care, highlighting the need for calibration in this setting.

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初级保健中SCORE2模型对心血管风险的低估：需要重新校准。

背景：SCORE2模型是估算CVE风险的衍生风险预测模型。该模型最初是根据基于人群的队列数据开发的，也旨在用于常规初级保健，以计算首次发病CVE的风险并指导治疗决策。目的：在这项研究中，我们跟踪了荷兰的成年患者，他们拜访了他们的全科医生（GP），并在他们的GP办公室接受了CVE风险评估。目的是将SCORE2模型的结果与随访期间观察到的首次CVE风险联系起来。方法：对205,548例患者进行回顾性队列研究，分析年龄、性别、吸烟状况、糖尿病、总胆固醇和高密度脂蛋白胆固醇、平均收缩压等因素。SCORE2模型的性能通过观察到的期望（O/E）风险比、校准图和c统计量进行评估。分析按性别、年龄组（< 50岁和≥50岁）、低风险和中等风险国家类别进行分层。主要结果：结果显示平均观察10年风险为10.1%，显著高于模型预测的6.2%。女性和男性的O/E比值分别为1.54和1.68。< 50岁和≥50岁年龄组的平均10年CVE分别为6.9%和11%。（市盈率：1.78 vs. 1.62）。因此，由于SCORE2的低估，大约35%的患者可能错过预防性治疗。结论：这些发现表明，SCORE2模型可能低估了初级保健中CVE的风险，强调了在这种情况下校准的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European journal of preventive cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

12.50

自引率

12.00%

发文量

601

审稿时长

3-8 weeks

期刊介绍： European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.