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Predicting cardiovascular morbidity and mortality with SCORE2 (OP) and Framingham risk estimates in combination with
Anna Tirkkonen1, Jonathan K L Mak2,3, Johan G Eriksson4,5,6
1Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland.
Insights
Biological aging indicators can improve cardiovascular disease (CVD) risk prediction. The Rockwood Frailty Index (FI), a measure of biological aging, enhanced CVD risk assessment beyond traditional scores in middle-aged and older adults.
Area of Science:
- Gerontology and Cardiovascular Medicine
- Biomarkers of Aging
- Epidemiology of Cardiovascular Disease
Background:
- Limited research exists on biological aging (BA) indicators enhancing cardiovascular disease (CVD) risk assessment beyond established scores like Framingham Risk Score (FRS) and SCORE2/SCORE2-OP.
- Investigating the predictive value of the Rockwood Frailty Index (FI) and leukocyte telomere length (TL) for CVD outcomes is crucial.
Purpose of the Study:
- To determine if BA indicators (FI and TL) improve CVD risk prediction in middle-aged and older adults without prior CVD.
- To compare the predictive accuracy of FI and TL against traditional CVD risk scores.
Main Methods:
- Analysis of 14,118 individuals from three population-based cohorts (TwinGene, Health 2000, Helsinki Birth Cohort Study).
- Assessment of incident CVD and CVD mortality over a 10-year follow-up period.
- Utilized Cox regression for risk estimation and Harrell's C-index for predictive accuracy, stratifying by age (<70, 70+).
Main Results:
- A higher FI, but not TL, was significantly associated with increased incident CVD risk (P < .05).
- The FI improved the predictive accuracy of incident CVD when added to FRS or SCORE2/SCORE2-OP models.
- Similar, though less consistent, findings were observed for CVD mortality across cohorts.
Conclusions:
- Robust evidence supports that a higher baseline FI is linked to increased incident CVD risk in older adults, independent of traditional risk scores.
- The FI enhances CVD outcome prediction beyond established risk indicators (FRS, SCORE2/SCORE2-OP).
- The FI demonstrates satisfactory predictive accuracy even when used alone.
Background And Objective:
Previous research assessing whether biological ageing (BA) indicators can enhance the risk assessment of cardiovascular disease (CVD) outcomes beyond established CVD risk indicators, such as Framingham Risk Score (FRS) and Systematic Coronary Risk Evaluation (SCORE2)/SCORE2-Older Persons (OP), is scarce. We explored whether BA indicators, namely the Rockwood Frailty Index (FI) and leukocyte telomere length (TL), improve predictive accuracy of CVD outcomes beyond the traditional CVD risk indicators in general population of middle-aged and older CVD-free individuals.
Methods:
Data included 14 118 individuals from three population-based cohorts: TwinGene, Health 2000 (H2000), and the Helsinki Birth Cohort Study, grouped by baseline age (<70, 70+). The outcomes were incident CVD and CVD mortality with 10-year follow-up. Risk estimations were assessed using Cox regression and predictive accuracies with Harrell's C-index.
Results:
Across the three study cohorts and age groups: (i) a higher FI, but not TL, was associated with a higher occurrence of incident CVD (P < .05), (ii) also when considering simultaneously the baseline CVD risk according to FRS or SCORE2/SCORE2-OP (P < .05) (iii) adding FI to the FRS or SCORE2/SCORE2-OP model improved the predictive accuracy of incident CVD. Similar findings were seen for CVD mortality, but less consistently across the cohorts.
Conclusions:
We show robust evidence that a higher FI value at baseline is associated with an increased risk of incident CVD in middle-aged and older CVD-free individuals, also when simultaneously considering the risk according to the FRS or SCORE2/SCORE2-OP. The FI improved the predictive accuracy of CVD outcomes beyond the traditional CVD risk indicators and demonstrated satisfactory predictive accuracy even when used independently.
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