Risk prediction is improved by adding markers of subclinical organ damage to SCORE

Area of Science:

• Cardiovascular Medicine
• Preventive Cardiology
• Biomarkers of Cardiovascular Risk

Background:

• The Systemic Coronary Risk Evaluation (SCORE) is widely used for cardiovascular risk stratification.
• The incremental value of subclinical vascular damage in refining risk prediction for healthy individuals remains unclear.

Purpose of the Study:

• To determine if subclinical vascular damage significantly improves cardiovascular risk prediction beyond the established SCORE system in a general population.

Main Methods:

• A population-based cohort of 1968 healthy subjects (aged 41-71) without prior cardiovascular disease or diabetes was assessed.
• Measurements included traditional risk factors, left ventricular mass index, carotid plaques, pulse wave velocity (PWV), and urine albumin/creatinine ratio (UACR).
• Subjects were followed for a median of 12.8 years for cardiovascular mortality.

Main Results:

• Subclinical organ damage, including left ventricular hypertrophy, carotid plaques, elevated UACR, and increased PWV, independently predicted cardiovascular death.
• Incorporating subclinical organ damage into risk prediction models demonstrated potential to improve specificity or sensitivity depending on the strategy.
• Broadening primary prevention to include individuals with lower SCORE (1-5%) and subclinical damage significantly increased sensitivity for identifying those at risk.

Conclusions:

• Subclinical vascular damage is a significant independent predictor of cardiovascular mortality.
• Combining assessments of subclinical organ damage with the SCORE system offers a promising approach to enhance cardiovascular risk stratification and optimize primary prevention strategies.