SCORE and SCORE2 in East Asian Population: A Performance Comparison

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• The Systematic COronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons (OP) models are recent tools for assessing cardiovascular disease (CVD) risk.
• Previous iterations, SCORE and SCORE-OP, have been used but require validation in diverse populations.

Purpose of the Study:

• To evaluate the performance of the SCORE, SCORE-OP, SCORE2, and SCORE2-OP risk prediction models in an East Asian population.
• To compare the accuracy and calibration of these models using a large, population-based cohort from South Korea.

Main Methods:

• Utilized data from 324,384 participants in the Korean National Health Insurance Service (NHIS) Health Screening Cohort (2004-2005).
• Risk prediction was calculated using SCORE, SCORE2, SCORE-OP, and SCORE2-OP models, stratified by age and sex.
• Compared predicted risks with observed CVD events over a median 9-year follow-up period.

Main Results:

• Both SCORE/SCORE-OP and SCORE2/SCORE2-OP models generally overestimated CVD risk in the East Asian cohort.
• SCORE/SCORE-OP underestimated risk in younger individuals (men 40-49, women 40-59) and overestimated it in older groups.
• SCORE2/SCORE2-OP consistently overestimated risk across all age groups and sexes, showing no significant improvement in predictive accuracy (C-index) over SCORE/SCORE-OP.

Conclusions:

• Existing SCORE and SCORE2 risk models demonstrate suboptimal performance and overestimate CVD risk in the East Asian population.
• While SCORE2/SCORE2-OP shows marginal improvement over older versions, significant modifications are required for reliable risk assessment in this demographic.
• Further research and recalibration are essential to enhance the clinical utility of these cardiovascular risk prediction tools for East Asian individuals.