Beyond SCORE2: Rethinking Cardiovascular Risk Assessment in a Very-High-Risk European Setting-A Narrative Review and...

Area of Science:

• Cardiovascular Medicine
• Public Health
• Epidemiology

Background:

• Cardiovascular disease (CVD) is the leading cause of mortality in the European Union (EU), with Romania experiencing particularly high rates.
• Existing primary prevention frameworks like SCORE2 and ACC/AHA PCE have limitations in patient selection and risk assessment, especially in diverse European populations.
• Significant east-west gradients in circulatory disease mortality highlight the need for region-specific prevention strategies.

Purpose of the Study:

• To develop a country-specific cardiovascular risk stratification framework for Romania, named ROMA-CV (Risk Of Multifactorial Atherosclerosis-Cardiovascular).
• To address the limitations of existing risk calculators (SCORE2) in the Romanian context, particularly concerning age, calibration, lipoprotein(a), and subclinical atherosclerosis.
• To operationalize existing evidence-based recommendations into a practical framework aligned with national and EU health plans.

Main Methods:

• A structured narrative review of primary prevention guidelines, validation studies, intervention trials, and Romanian epidemiological data was conducted.
• The ROMA-CV framework was developed as a conceptual, country-specific model, integrating SCORE2 with additional elements.
• Key components include a one-time lipoprotein(a) measurement, a mandatory amplifier checklist, and selective use of coronary artery calcium (CAC) or ultrasound imaging.

Main Results:

• Identified four critical limitations of the SCORE2 system in Romania: an inappropriate age floor, country-level calibration, inadequate management of lipoprotein(a), and underutilization of subclinical atherosclerosis imaging.
• Proposed the ROMA-CV algorithm, which retains SCORE2's quantitative core but incorporates specific Romanian epidemiological data and clinical best practices.
• The ROMA-CV framework aims to enhance the identification of individuals requiring primary prevention interventions for cardiovascular disease.

Conclusions:

• ROMA-CV is a hypothesis-generating proposal designed to optimize cardiovascular risk stratification in Romania.
• The framework aligns with the Romanian National Plan for Non-Communicable Diseases and the EU Cardiovascular Health Plan.
• Prospective validation, feasibility, cost-effectiveness, and implementation studies are required before clinical adoption of ROMA-CV.