Systematic Coronary Risk Evaluation 2 for Older Persons: 10 years risk validation, clinical utility, and potential...

Area of Science:

• Cardiology
• Gerontology
• Epidemiology

Background:

• The European Systematic Coronary Risk Assessment 2 for Older Persons (SCORE2-OP) model has shown variable performance in external validation studies.
• Accurate prediction of 10-year cardiovascular (CV) risk is crucial for preventative strategies in older populations.
• There is a need to evaluate the SCORE2-OP model in representative, low CV risk populations.

Purpose of the Study:

• To assess the predictive performance and clinical utility of the SCORE2-OP model for 10-year CV risk in an unbiased cohort of older individuals from a low CV risk country.
• To explore whether additional clinical or echocardiographic features can enhance the model's predictive accuracy.

Main Methods:

• A prospective cohort study included 791 individuals aged 65 years or older from primary care in Barcelona, without established CV disease.
• The study evaluated the SCORE2-OP model's performance using Harrell's C-statistic for 10-year prediction of major adverse CV events and CV mortality.
• Decision curve analysis was used to assess clinical utility, and the impact of valvular calcification on risk prediction was investigated.

Main Results:

• The SCORE2-OP model demonstrated good discrimination (C-statistic 0.706 for primary endpoint) and calibration, with better performance in females.
• The model underestimated risk in women and systematically underestimated risk for a broader endpoint including heart failure hospitalization.
• Valvular calcification was identified as a significant factor that improved the predictive performance of the SCORE2-OP model for both primary and secondary endpoints.

Conclusions:

• The SCORE2-OP model exhibits notable discrimination and excellent calibration for predicting 10-year CV risk in older adults from a low CV risk setting, particularly in females.
• Incorporating valvular calcification into risk prediction algorithms could enhance accuracy and potentially reduce overtreatment.
• Further refinement of risk scores for older populations, considering factors like valvular calcification, is warranted.