Poor predictive ability of the risk chart SCORE in a Danish population

In Denmark, the European risk chart Systematic COronary Risk Evaluation (SCORE) from the European Society of Cardiology is recommended for use in cardiovascular prevention. Nevertheless, its predictive ability in a Danish population has never been investigated. The purpose of this study was therefore to assess the predictive ability of the SCORE risk chart with regard to fatal cardiovascular risk according to the socio-demographic factors of age, sex, income and education in a Danish population.

Data from the third Copenhagen City Heart Study (n = 4,224) were linked to the Danish Cause of Death Registry. Calibration (i.e. Hosmer-Lemeshow goodness-of-fit), expected-to-observed (E/O) mortality ratios in the total population and for subgroups, as well as discrimination (i.e. sensitivity, specificity, Area Under the Receiver Operator Characteristic (AUROC) and predictive values) were tested. Both SCORE high-risk and low-risk were applied for comparison.

The results showed that both SCORE high-risk and low-risk performed acceptably in terms of discrimination (AUROC ≈ 0.7-0.8); however, calibration for both SCORE charts was inadequate (χ2 > 20; p < 0.001). E/O-ratios varied with age, sex and socioeconomic status.

There is a need to recalibrate SCORE to risk levels and risk factor distribution in the Danish population.

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