SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe
European Heart Journal
Abstract
The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40–69 years in Europe.
We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65–0.68) to 0.81 (0.76–0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries.
SCORE2—a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations—enhances the identification of individuals at higher risk of developing CVD across Europe.
Contributors
Steven Hageman
Author
Lisa Pennells
Author
University of Cambridge Cambridge , United Kingdom of Great Britain & Northern Ireland
Francisco Ojeda
Author
Stephen Kaptoge
Author
Kari Kuulasmaa
Author
Tamar de Vries
Author
Zhe Xu
Author
Frank Kee
Author
Ryan Chung
Author
Angela Wood
Author
John William McEvoy
Author
Thomas Bolton
Author
Stephan Achenbach
Author
Krasimira Aleksandrova
Author
Pilar Amiano
Author
Donostia-San Sebastian
Author
Philippe Amouyel
Author
Jonas Andersson
Author
Stephan J L Bakker
Author
Joline W J Beulens
Author
Michael Blaha
Author
Martin Bobak
Author
Jolanda M A Boer
Author
Catalina Bonet
Author
Fabrice Bonnet
Author
Tonje Braaten
Author
Hermann Brenner
Author
Fabian Brunner
Author
Eric J Brunner
Author
Mattias Brunström
Author
Julie Buring
Author
Adam S Butterworth
Author
Nadezda Capkova
Author
Giancarlo Cesana
Author
Sandra Colorado-Yohar
Author
Nancy R Cook
Author
Cyrus Cooper
Author
Christina C Dahm
Author
Karina Davidson
Author
Elaine Dennison
Author
Augusto Di Castelnuovo
Author
Chiara Donfrancesco
Author
Marcus Dörr
Author
Agnieszka Doryńska
Author
Mats Eliasson
Author
Gunnar Engström
Author
Pietro Ferrari
Author
Marco Ferrario
Author
Ian Ford
Author
Michael Fu
Author
Ron T Gansevoort
Author
Richard F Gillum
Author
Agustin Gómez de la Cámara
Author
Guido Grassi
Author
Per-Olof Hansson
Author
Radu Huculeci
Author
Kristian Hveem
Author
Licia Iacoviello
Author
M Kamran Ikram
Author
Torben Jørgensen
Author
Bijoy Joseph
Author
Pekka Jousilahti
Author
J Wouter Jukema
Author
Rudolf Kaaks
Author
Verena Katzke
Author
Maryam Kavousi
Author
Stefan Kiechl
Author
Jens Klotsche
Author
Wolfgang König
Author
Richard A Kronmal
Author
Ruzena Kubinova
Author
Anna Kucharska-Newton
Author
Kristi Läll
Author
Nils Lehmann
Author
David Leistner
Author
Allan Linneberg
Author
David Lora Pablos
Author
Thiess Lorenz
Author
Wentian Lu
Author
Dalia Luksiene
Author
Magnus Lyngbakken
Author
Christina Magnussen
Author
Sofia Malyutina
Author
Alejandro Marín Ibañez
Author
Giovanna Masala
Author
Ellisiv B Mathiesen
Author
Kuni Matsushita
Author
Tom W Meade
Author
Olle Melander
Author
Haakon E Meyer
Author
Karel G M Moons
Author
Conchi Moreno-Iribas
Author
David Muller
Author
Thomas Münzel
Author
Yury Nikitin
Author
Børge G Nordestgaard
Author
Torbjørn Omland
Author
Charlotte Onland
Author
Kim Overvad
Author
Chris Packard
Author
Andrzej Pająk
Author
Luigi Palmieri
Author
Salvatore Panico
Author
Aurora Perez-Cornago
Author
Annette Peters
Author
Arto Pietilä
Author
, Hynek Pikhart
Author
Bruce M Psaty
Author
Fosca Quarti-Trevano
Author
J Ramón Quirós Garcia
Author
Elio Riboli
Author
Paul M Ridker
Author
Beatriz Rodriguez
Author
Miguel Rodriguez-Barranco
Author
Annika Rosengren
Author
Ronan Roussel
Author
Carlotta Sacerdote
Author
Susana Sans
Author
Naveed Sattar
Author
University of Glasgow Glasgow , United Kingdom of Great Britain & Northern Ireland
Catarina Schiborn
Author
Börge Schmidt
Author
Ben Schöttker
Author
Matthias Schulze
Author
Joseph E Schwartz
Author
Randi Marie Selmer
Author
Steven Shea
Author
Martin J Shipley
Author
Sabina Sieri
Author
Stefan Söderberg
Author
Reecha Sofat
Author
Abdonas Tamosiunas
Author
Barbara Thorand
Author
Taavi Tillmann
Author
Anne Tjønneland
Author
Tammy Y N Tong
Author
Antonia Trichopoulou
Author
Rosario Tumino
Author
Hugh Tunstall-Pedoe
Author
Anne Tybjaerg-Hansen
Author
Joanna Tzoulaki
Author
Amber van der Heijden
Author
Yvonne T van der Schouw
Author
W M Monique Verschuren
Author
National Institute for Public Health and the Environment (RIVM) Bilthoven , Netherlands (The)
Henry Völzke
Author
Christoph Waldeyer
Author
Nicholas J Wareham
Author
Elisabete Weiderpass
Author
Franz Weidinger
Author
Philipp Wild
Author
Johann Willeit
Author
Peter Willeit
Author
Tom Wilsgaard
Author
Mark Woodward
Author
Tanja Zeller
Author
Dudan Zhang
Author
Bin Zhou
Author
Brian A Ference
Author
Adam Timmis
Author
Panos Vardas
Author
John Danesh
Author
Ian Graham
Author
Veikko Salomaa
Author
Frank Visseren
Author
Dirk De Bacquer
Author
Stefan Blankenberg
Author
Emanuele Di Angelantonio
Author
University of Cambridge Cambridge , United Kingdom of Great Britain & Northern Ireland
