Reclassification of cardiovascular risk in Europe: application of the updated Systematic COronary Risk Evaluation (SCORE) algorithm incorporating high-density lipoprotein levels

none10Purpose: Cardiovascular disease (CVD) imposes a significant health burden throughout Europe. Cardiovascular risk can be assessed using validated risk prediction models, such as the European Systematic COronary Risk Evaluation (SCORE) algorithm that assesses 10-year risk of cardiovascular mortality. This is also recommended for guiding treatment options. Recently, the SCORE algorithm has been updated to incorporate high-density lipoprotein cholesterol (HDL-C) levels (SCORE-HDL), thus providing a more accurate estimate of risk. We have investigated the proportion of patients who would have their risk classification changed with the SCORE-HDL algorithm when compared to the original SCORE. Methods: The European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA) (NCT00882336) was a cross-sectional study conducted simultaneously in 12 European countries, recruiting 7641 patients aged ≥ 50 years who were free of clinical CVD but had at least one cardiovascular risk factor (dyslipidaemia, hypertension, diabetes mellitus, smoking or obesity). We calculated risk using international SCORE and SCORE-HDL algorithms in patients aged 50–65 years without diabetes and not receiving lipid-lowering therapy. Results: In total, risk was assessed in 2321 patients. According to SCORE, 447 were at low risk (LR), 1409 were at intermediate risk (IR) and 465 were at high risk (HR) of CVD mortality (LR: < 1%; IR: 1–5%; HR ≥ 5% 10-year risk). According to SCORE-HDL, 597 were at LR, 1328 were at IR and 396 were at HR. Of the 447 patients at LR according to SCORE, 11.9% were reclassified by SCORE-HDL as IR and none as HR. Of the 1409 patients at IR according to SCORE, 14.3% and 2.9% were reclassified as LR and HR, respectively. Of the 465 patients at HR according to SCORE, 23.4% and 0.2% were reclassified as IR and LR, respectively. Comparable proportions of males and females at IR according to SCORE were reclassified as HR by SCORE-HDL (3.6 and 2.4%, respectively). However, only 1.9% of males were reclassified from IR to LR, in contrast to 24.9% of females. Conclusions: Assessment of CVD risk using SCORE-HDL in our patient population (aged 50–65 years, with at least one cardiovascular risk factor but no history of CVD, without diabetes and not receiving lipid-lowering therapy) often resulted in cardiovascular risk reclassification when compared with the original SCORE. Reclassification into a lower risk category was more common than into a higher risk category, especially amongst females at IR according to SCORE. Most of our study cohort were categorized as LR or IR by both algorithms.noneHalcox J.P.J.; Tubach F.; Banegas J.R.; Borghi C.; Dallongeville J.; De Backer G.; Guallar E.; Perk J.; Steg P.G.; Rodriguez-Artalejo FHalcox J.P.J.; Tubach F.; Banegas J.R.; Borghi C.; Dallongeville J.; De Backer G.; Guallar E.; Perk J.; Steg P.G.; Rodriguez-Artalejo