Cardiovascular risk estimation in older persons: SCORE O.P

Area of Science:

• Cardiology
• Gerontology
• Public Health

Background:

• European guidelines recommend the Systematic COronary Risk Evaluation (SCORE) for cardiovascular disease risk estimation.
• Current risk estimation systems may be inaccurate in older populations due to assumptions about risk factor function across age groups.

Purpose of the Study:

• To develop and validate a novel risk estimation function, SCORE O.P., specifically for individuals aged 65 and older.
• To address the limitations of existing risk models in accurately assessing cardiovascular risk in the elderly.

Main Methods:

• Utilized data from 20,704 men and 20,121 women aged 65+ from four prospective population studies.
• Employed Cox proportional hazards modeling to identify significant risk factors: age, total cholesterol, HDL cholesterol, systolic blood pressure, smoking status, and diabetes.
• Validated the SCORE O.P. model using receiver operating characteristic curves (AUROC) and Hosmer-Lemeshow goodness of fit tests.

Main Results:

• SCORE O.P. demonstrated good discrimination with an AUROC of 0.74.
• Calibration was reasonable, with Hosmer-Lemeshow tests indicating acceptable fit for both men and women.
• SCORE O.P. showed improved discrimination compared to the original SCORE function when extrapolated to the older age group (p=0.05 for men, p<0.001 for women).

Conclusions:

• SCORE O.P. offers enhanced accuracy for cardiovascular disease risk estimation in individuals aged 65 and older.
• The improved accuracy may lead to a reduction in the over-prescription of medication in this vulnerable demographic.