Traditional SCORE-based health check fails to identify individuals who develop acute myocardial infarction
Martin B Mortensen1, Kim Sivesgaard, Helle K Jensen
1Kardiologisk Afdeling, Aarhus Universitetshospital, 8200 Aarhus N, Denmark. martin.bodtker.mortensen@ki.au.dk
Insights
The European SCORE system for cardiovascular disease (CVD) risk assessment identified few patients, particularly women, who would benefit from preventive statin therapy before a first acute myocardial infarction (AMI). Traditional risk factor checks have limited preventive potential.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Atherosclerotic cardiovascular disease (CVD), including acute myocardial infarction (AMI), is linked to well-established risk factors.
- While these factors are therapeutic targets, their predictive accuracy for CVD events is debated.
- European guidelines recommend specific risk scoring systems (SCORE) and thresholds for pharmacotherapy.
Purpose of the Study:
- To evaluate the effectiveness of the SCORE system and European guideline-recommended thresholds for identifying patients eligible for preventive pharmacotherapy before a first AMI.
- To assess the predictive value of traditional risk factors in a real-world patient population.
Main Methods:
- Retrospective review of 605 patients hospitalized for their first AMI.
- Exclusion of patients with pre-existing CVD, diabetes, or incomplete risk factor data.
- Risk stratification using the SCORE system for non-statin users based on age and risk factors, with specific thresholds for young (<60 years) and elderly (>60 years) individuals.
Main Results:
- Only 9% of patients used statin therapy before their AMI.
- Among non-statin users, very few young adults (5/109) and elderly (23/284) met the SCORE criteria for preventive medication.
- Among elderly women, only three qualified for treatment.
- The 2011 high-risk country chart would have identified over four times more patients for treatment.
- Novel high-density lipoprotein adjusted SCORE charts showed limited incremental value.
Conclusions:
- A low proportion of patients admitted for a first AMI were on statin therapy.
- The SCORE system and guideline thresholds inadequately identified individuals, especially women and younger men, who would benefit from preventive treatment.
- The study highlights the limited preventive potential of traditional risk factor-based health checks for primary prevention of AMI.
Introduction:
Atherosclerotic cardiovascular disease (CVD), including acute myocardial infarction (AMI), is caused by well-known risk factors. They constitute important therapeutic targets, but their predictive value is disputed. We evaluated the effectiveness of the risk scoring system (SCORE) and thresholds for pharmacotherapy re-commended in the European guidelines on CVD prevention.
Material And Methods:
The medical records of 605 consecutive patients hospitalized for a first AMI were reviewed. Patients with pre-existing CVD, diabetes, or incomplete information on risk factors were excluded. Those not treated with statin before AMI were risk stratified based on risk factors. A SCORE ≥ 5% or ≥ 10% was considered to qualify for preventive medication in young adults (age ≤ 60 years) or elderly (age > 60 years), respectively.
Results:
Before AMI, 40 (9%) used statin. Among non-statin users, only five of the 109 young adults had a SCORE ≥ 5%, and 23 of the 284 elderly had a SCORE ≥ 10%. Among women, only three elderly qualified for treatment. More than four times more patients would have qualified for treatment with the high-risk country chart used in 2011. The incremental value of the novel high-density lipoprotein adjusted SCORE charts was limited.
Conclusion:
Few patients admitted with a first AMI used statin. Among non-statin users, SCORE and the recommended thresholds for pharmacotherapy identified no women and less than one out of ten men who untreated were destined for an AMI before 61 years of age. The preventive potential of a traditional risk factor-based health check is limited.
Funding:
not relevant.
Trial Registration:
not relevant.
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