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Cardiovascular risk reclassification: the impact of the new SCORE2/SCORE2-OP in the Portuguese population
Session:
Posters (Sessão 6 - Écran 5) - Risco Cardiovascular
Speaker:
João Borges Rosa
Congress:
CPC 2023
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.14 Risk Factors and Prevention - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
João Borges-Rosa; Manuel Oliveira-Santos; Ana Rita M. Gomes; Diogo de Almeida Fernandes; Eric Alberto Monteiro; Gil Cunha; Gonçalo Ferraz Costa; Gustavo M. Campos; Joana Guimarães; Rafaela Fernandes; Vanessa Lopes; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background: SCORE2 and SCORE2-OP are new risk prediction algorithms to estimate 10-year fatal and nonfatal cardiovascular (CV) risk in European individuals over 40 years without previous CVD or diabetes. The previous algorithm (SCORE) was developed from cohorts recruited before 1986 and was not ‘recalibrated’ to contemporary CV rates, only predicted fatal CV, and did not include individuals aged over 70 years. We aimed to evaluate the impact of the new risk prediction algorithms in a non-diabetic Portuguese population. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: We retrospectively assessed 663 patients of a primary prevention cohort followed at the Lipidology Clinic of our hospital, with a median follow-up time of 15 (IQR 12-17) years. After excluding patients out of the appropriate age range (n=161) and those with diabetes or chronic kidney disease (n=89), we calculated SCORE (low-risk countries), SCORE2/SCORE2-OP (calibrated 10-year risk estimate according to moderate-risk region-specific scaling factors), and Atherosclerotic Cardiovascular Disease (ASCVD) risk algorithm. We collected data on major CV events (CV death, myocardial infarction, stroke) as a composite outcome.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: We included 413 patients with a mean age of 55.0 ± 9.9 years and 61.5% males. Regarding cardiovascular risk factors, 16.2% were smokers, mean systolic arterial pressure was 138.3 ± 20.2 mmHg (49.9% were under antihypertensive drugs), median body mass index was 27.68 Kg/m2 [IQR 25.56-30.29]. Median total cholesterol was 265.0 mg/dL [IQR 222.0-307.0], median non-HDL cholesterol was 211.0 mg/dL [IQR 176.0-257.0], and a mean LDL cholesterol was 208.0 mg/dL [IQR 165.0-254.2]. The median SCORE was 1.93% [IQR 0.60-4.89] and the median ASCVD risk was 8.87 [IQR 3.98-16.32]. Median SCORE2/SCORE2-OP was 6.32% [IQR 0.88-43.65]. According to SCORE 77.7%, 12.8%, and 9.4% were considered low to moderate, high, or very high-risk patients. According to SCORE2/SCORE2-OP 46.2%, 14.2%, and 39.6% were considered low to moderate, high, or very high-risk patients. Almost half of the patients (47.3%) stepped up in the risk category, 43.2% remained the same, and 9.4% stepped down. The 10-year incidence rate of CV death was 1.9% in agreement with SCORE while the 10-year incidence of the composite outcome was 7.7%, similar to both SCORE2/SCORE2-OP and ASCVD risk algorithm.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: In a Portuguese primary prevention cohort, both scores accurately predicted the 10-year cardiovascular events. However, we hypothesize that the new SCORE2/SCORE2-OP will promote more aggressive preventive measures, by reclassifying patients to higher risk categories, with a future reduction in the burden of CV events.</span></span></p>
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