Impact of using different SCORE tables for estimating cardiovascular risk

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• Various SCORE tables exist for cardiovascular risk assessment in Spain.
• These include tables for low-risk countries, those calibrated for the Spanish population, and those incorporating high-density lipoprotein (HDL) cholesterol levels.
• The clinical impact of utilizing different SCORE tables remains unclear.

Purpose of the Study:

• To evaluate the effect of employing different SCORE risk stratification tables on cardiovascular risk assessment in primary care.
• To compare the number of patients classified as high or very high risk and the subsequent treatment recommendations across various SCORE versions.

Main Methods:

• A cross-sectional study included 3716 individuals aged 40-65 years from two primary care centers.
• Exclusion criteria included diabetes or prior cardiovascular disease.
• Cardiovascular risk was calculated using three SCORE variants: standard for low-risk countries, with HDL cholesterol, and the calibrated Spanish version.

Main Results:

• The calibrated SCORE identified significantly more patients at high/very high risk (15.44%) compared to SCORE with HDL (1.24%) and low-risk SCORE (4.73%).
• Treatment with lipid-lowering drugs would be recommended for 10.23% of patients using the calibrated SCORE, versus 3.12% (low-risk SCORE) and 0.67% (SCORE with HDL).
• These differences were statistically significant (P<.01).

Conclusions:

• The calibrated SCORE table leads to a higher classification of individuals at high cardiovascular risk.
• Its application would necessitate increased prescription of lipid-lowering medications.
• Further validation studies are essential to ascertain the most appropriate SCORE table for the Spanish population.