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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Predict to treat: The SCORE and the ASCVD risk scores in a primary prevention Portuguese population
Session:
CO4 - Prevenção / Reabilitação
Speaker:
Cátia Santos Ferreira
Congress:
CPC 2019
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Cátia Santos Ferreira; Rui Baptista; Manuel Oliveira Santos; Patrícia M. Alves; Ana Vera Marinho; Célia Domingues; Patrícia Dias; José Pereira de Moura; Lino Gonçalves
Abstract
<p><strong>PURPOSE: </strong>The Systematic COronary Risk Evaluation (SCORE) and theAtherosclerotic Cardiovascular (CV) Disease risk (ASCVD) calculators are recommended tools to assess CV risk and to make therapeutic options. We aimed to assess the performance of both risk systems in a Portuguese population, at the predefined 10-year landmark and at a longer, 20-year landmark.</p> <p><strong>METHODS:</strong>We prospectively included 489 CV events-naïve patients treated at a Lipidology Clinic from 1994 to 2007. Patients <40 years were excluded. The median (interquartile range) follow-up time was 14 (11-17) years. Outcomes were matched to those of the risk systems: CV death for SCORE and a combined endpoint of major adverse cardiovascular events (MACE): CV death, myocardial infarction (MI) and stroke for ASCVD. Baseline SCORE (for low-risk countries) and ASCVD risks were calculated. The cohort was stratified in groups based on the SCORE (1%, 5% and 10%) and the ASCVD risk cut points (5%, 7.5% and 10%).</p> <p><strong>RESULTS:</strong>The mean age was 55±10 years; 62% were male. Regarding risk factors, 18% were smokers, 16% type 2 diabetics and 54% were on anti-hypertensive drugs. Mean arterial systolic pressure was 139±20mmHg and mean total cholesterol 272±77mg.dL<sup>-1</sup>. The 10-year incidence rate of CV death, MI and stroke was 1.8%, 4.1% and 3.1%, respectively. The median 10-year CV death risk, estimated by SCORE, was 2.7% (P<sub>25-75</sub>: 0.7-5.1%). The low-risk patients (SCORE<1%) experienced no events at 10 years; in the other risk groups, the observed event rate was slightly lower than estimated (figure). Regarding ASCVD, the median estimated MACE risk was 9.4% (P<sub>25-75</sub>: 4.2-18.9%). Surprisingly, in the group of CV risk <5%, the observed rate was higher than the expected one (3.9% vs 2.8%, p<0.001). In the remaining risk groups, the observed rate was inferior to the estimated rate (figure). The area under the ROC curve (AUC) for SCORE was 0.81 (<em>p</em>=0.003) (endpoint CV death) and 0.64 for ASCVD (p=0.006) (endpoint MACE). Both calculators were well calibrated. At the 20-year landmark analysis, no events were registered in the low-risk SCORE stratum. In the remaining groups of both risk scores, an acceleration of the CV risk was seen, with observed rates 3- to 7-fold higher than the estimated ones for 10 years (figure).</p> <p><strong>CONCLUSION: </strong>In a Portuguese cohort, both the SCORE and the ASCVD systems are well calibrated for CV risk prediction and discriminate correctly the patients. Our results strongly support their use for CV risk assessment.</p>
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