SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions

Abstract

Aims: The aim of this study was to derive and validate the SCORE2-Older Persons (SCORE2-OP) risk model to estimate 5- and 10-year risk of cardiovascular disease (CVD) in individuals aged over 70 years in four geographical risk regions.

Methods and results: Sex-specific competing risk-adjusted models for estimating CVD risk (CVD mortality, myocardial infarction, or stroke) were derived in individuals aged over 65 without pre-existing atherosclerotic CVD from the Cohort of Norway (28 503 individuals, 10 089 CVD events). Models included age, smoking status, diabetes, systolic blood pressure, and total- and high-density lipoprotein cholesterol. Four geographical risk regions were defined based on country-specific CVD mortality rates. Models were recalibrated to each region using region-specific estimated CVD incidence rates and risk factor distributions. For external validation, we analysed data from 6 additional study populations {338 615 individuals, 33 219 CVD validation cohorts, C-indices ranged between 0.63 [95% confidence interval (CI) 0.61-0.65] and 0.67 (0.64-0.69)}. Regional calibration of expected-vs.-observed risks was satisfactory. For given risk factor profiles, there was substantial variation across the four risk regions in the estimated 10-year CVD event risk.

Conclusions: The competing risk-adjusted SCORE2-OP model was derived, recalibrated, and externally validated to estimate 5- and 10-year CVD risk in older adults (aged 70 years or older) in four geographical risk regions. These models can be used for communicating the risk of CVD and potential benefit from risk factor treatment and may facilitate shared decision-making between clinicians and patients in CVD risk management in older persons.

Keywords: 10-Year CVD risk; Cardiovascular disease; Older persons; Primary prevention; Risk assessment; Risk prediction.

Development process, risk regions and illustrative example for the SCORE2-OP algorithm.

Figure 1

Study design. ARIC, Atherosclerosis Risk in Communities; CONOR = Cohort of Norway; CPRD, Clinical Practice Research Datalink; CVD, cardiovascular disease; MESA, multi-ethnic study of atherosclerosis; NCD-RisC, Non-Communicable Disease Risk Factor Collaboration; PROSPER, PROspective Study of Pravastatin in Elderly at Risk; SPRINT, Systolic Blood Pressure Intervention Trial; WHO, World Health Organisation.

Figure 2

External validation of SCORE2-OP for (A) the estimation of risk for myocardial infarction, stroke, or cardiovascular disease mortality (primary endpoint) and (B) the estimation of risk for myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular disease mortality (cardiovascular disease events including heart failure). Trial populations: HYVET, PROSPER, and SPRINT.

Figure 3

Regional risk charts of predicted 10-year cardiovascular disease risks.

Figure 4

Distribution of estimated 10-year fatal and non-fatal cardiovascular disease events and estimated 10-year absolute risk reduction from blood-pressure lowering in older persons with hypertension (systolic blood pressure >140 mmHg) in the HYVET and SPRINT trials (n = 5579).

Figure 5

Distribution of estimated 10-year non-fatal and fatal cardiovascular disease events and estimated 10-year absolute risk reduction from lipid lowering in older persons with cholesterol >2.6 mmol/L in the PROSPER trial (n = 3051).