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Prevention & lipidsDiagnostic or prognostic study

Improving 10-year cardiovascular risk prediction in apparently healthy people: flexible addition of risk modifiers on top of SCORE2

Eur J Prev CardiolPublished

  • Risk prediction model development and external validation study
  • multicohort
  • competing risk-adjusted Fine and Gray models
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Authors' conclusion

This flexible methodology improves the accuracy of predicted risks and increases applicability of prediction models for individuals with additional risk known modifiers.

Study context

Population
Individuals without previous cardiovascular disease (CVD) or DM (UK Biobank, Atherosclerosis Risk in Communities (ARIC), Multi-Ethnic Study of Atherosclerosis (MESA), EPIC-NL, Heinz Nixdorf Recall (HNR)); external validation in Clinical Practice Research Datalink (CPRD) (UK)external validation n = 518,015
Participants
409,757 individuals
Comparison
SCORE2 adjusted with risk modifiers vs unimproved SCORE2

Performance

As reported in the abstract

C-index (discrimination), external validation (CPRD)

SCORE2 + risk modifiers

0.740

C-index · 95% CI 0.736–0.745

SCORE2

0.737

C-index · 95% CI 0.732–0.741

Increase in discrimination, coronary artery calcium (CAC) percentile
0.0198 [95% CI 0.0115; 0.0281]
Increase in discrimination, hs-Troponin-T
0.0100 (95% CI 0.0063; 0.0137)

Further findings

Outcomeincrease in discrimination (95% CI)
Increase in discrimination by risk modifier (derivation cohorts) — CAC percentile vs Unimproved SCORE20.0198 (0.0115–0.0281)
Increase in discrimination by risk modifier (derivation cohorts) — hs-Troponin-T vs Unimproved SCORE20.0100 (0.0063–0.0137)
  • Increase in discrimination by risk modifier (derivation cohorts): 16 166 CVD events, 19 149 non-CV deaths over 10.0 years

Original publication

Improving 10-year cardiovascular risk prediction in apparently healthy people: flexible addition of risk modifiers on top of SCORE2. Eur J Prev Cardiol. Published 2 June 2023. doi:10.1093/eurjpc/zwad187
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Summarised from the published abstract; every number is checked against it