Distribution of cardiovascular risk severity among Egyptian patients with established cardiovascular diseases

The Secondary Manifestations of Arterial Disease (SMART) risk score was recommended by the European Society of Cardiology (ESC) to estimate a 10-year risk for myocardial infarction, stroke, or vascular death in individual patients with clinically manifested atherosclerotic vascular disease (ASCVD).(1) An updated SMART2 algorithm was developed and recalibrated according to the population risks in the different world regions except for Africa. The expected-observed ratio of recurrent ASCVD in the very high-risk region of the SMART2 study was 0.2.(2).

Describe the calculated 10-year risk using the SMART score, and the prevalence of contributing risk factors among a sample of Egyptian patients with ASCVD.

Cross-sectional study included 180 consecutive patients diagnosed with ASCVD and had their first follow-up visit at the Egyptian National Heart Institute. The ESC- certified SMART score web application was used to calculate the estimated 10-year risk of future CV events. The population mean option was used for CRP and serum creatinine as they were not available at the follow-up. All patients were diagnosed within a short duration before the follow-up visit (i.e. 0 years since the first event).

The median and IQR of 10-year risk, using SMART were 17.5 (14-24)%. The percentage of patients who had calculated risk <15% and ≥ 30% were 23% and 13%, respectively. Patients with calculated risk ≥ 30 tend to be older and have more prevalent hypertension, diabetes, and previous statin. Risk factors prevalence and lipid profile medians were elevated in the total study sample (Table).

The calculated risk of recurrent ASCVD among Egyptian patients using the conventional SMART score is beneficial for the individual relative risk assessment but may not reflect the absolute risk among the Egyptian population who have more prevalent risk factors. Large cohort studies are needed in Egypt and other African countries to recalibrate the calculated risk of recurrent ASCVD.