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Systematic Coronary Risk Evaluation (SCORE): JACC Focus Seminar 4/8
Ian M Graham1, Emanuele Di Angelantonio2, Frank Visseren3
1Trinity College, Dublin, Ireland.
Insights
Clinical risk estimation is unreliable, leading to the development of systems like the European Society of Cardiology
Area of Science:
- Cardiology and Public Health
- Cardiovascular Disease Risk Stratification
Background:
- Clinical estimation of combined cardiovascular risk factors is often unreliable.
- Risk estimation systems are crucial for guiding clinical practice and public health strategies.
Purpose of the Study:
- To review the evolution of the European Society of Cardiology's (ESC) Systematic COronary Risk Evaluation (SCORE) system.
- To outline future directions for cardiovascular risk estimation, including SCORE 2 and personalized lifetime risk assessment.
Main Methods:
- Review of the development and learnings from the ESC's SCORE risk estimation system.
- Description of the ESC's Cardiovascular Risk Collaboration and its research agenda.
Main Results:
- SCORE 2 will provide updated, calibrated risk estimates for total cardiovascular events across European regions.
- Future directions include expressing risk as years of exposure and utilizing genetic data for individualized lifetime risk estimation.
Conclusions:
- Cardiovascular risk estimation is evolving towards more refined and personalized approaches.
- Future systems may incorporate genetic information and lifetime exposure for more accurate risk prediction.
Abstract:
Clinical estimation of the combined effect of several risk factors is unreliable and this resulted in the development of a number of risk estimation systems to guide clinical practice. Here, after defining general principles of risk estimation, the authors describe the evolution of the European Society of Cardiology's (ESC) Systematic COronary Risk Evaluation (SCORE) risk estimation system and some learnings from the data. They move on to describe the establishment of the ESC's Cardiovascular Risk Collaboration and outline its proposed research directions. First among these is the evolution of SCORE 2, which provides updated, calibrated risk estimates for total cardiovascular events for low, moderate, high, and very high-risk regions of Europe. The authors conclude by considering that the future of risk estimation may be to express risk as years of exposure to a cardiovascular risk factor profile rather than risk over a fixed time period, such as 10 years, and how advances in genetics may permit individualized lifetime risk estimation from childhood on.
