Abstract
AIMS: The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe.
METHODS AND RESULTS: We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries.
CONCLUSION: SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe.
| Original language | English |
|---|---|
| Pages (from-to) | 2439-2454 |
| Number of pages | 16 |
| Journal | European Heart Journal |
| Volume | 42 |
| Issue number | 25 |
| DOIs | |
| Publication status | Published - 1 Jul 2021 |
Bibliographical note
FundingThe ERFC co-ordinating centre was underpinned by programme grants
from the British Heart Foundation (SP/09/002; RG/13/13/30194; RG/18/
13/33946), BHF Centre of Research Excellence (RE/18/1/34212), the UK
Medical Research Council (MR/L003120/1), and the National Institute for
Health Research (NIHR) Cambridge Biomedical Research Centre (BRC1215-20014), with project-specific support received from the UK NIHR
[*], British United Provident Association UK Foundation and an unrestricted educational grant from GlaxoSmithKline. A variety of funding
sources have supported recruitment, follow-up, and laboratory measurements in the studies contributing data to the ERFC, which are
listed on the ERFC website (www.phpc.cam.ac.uk/ceu/erfc/list-of-studies).
*The views expressed are those of the author(s) and not necessarily
those of the NIHR or the Department of Health and Social Care.
This work was supported by Health Data Research UK, which is funded
by the UK Medical Research Council, Engineering and Physical Sciences
Research Council, Economic and Social Research Council, Department of
Health and Social Care (England), Chief Scientist Office of the Scottish
Government Health and Social Care Directorates, Health and Social Care
Research and Development Division (Welsh Government), Public Health
Agency (Northern Ireland), British Heart Foundation, and Wellcome.
The MORGAM Project has received funding from EU projects
MORGAM (Biomed BMH4-CT98-3183), GenomEUtwin (FP5, QLG2-
CT-2002-01254), ENGAGE (FP7, HEALTH-F4-2007-201413),
CHANCES (FP7, HEALTH-F3-2010-242244), BiomarCaRE (FP7,
HEALTH-F2-2011-278913), euCanSHare (Horizon 2020, No. 825903)
and AFFECT-EU (Horizon 2020, No. 847770); and Medical Research
Council, London (G0601463, No. 80983: Biomarkers in the MORGAM
Populations). This has supported central coordination, workshops and
part of the activities of the MORGAM Data Centre, the MORGAM
Laboratories and the MORGAM Participating Centres
EPIC-CVD was funded by the European Research Council (268834),
and the European Commission Framework Programme 7 (HEALTH-F2-
2012-279233).
This work was supported by the Estonian Research Council grant
PUTs (PRG687, PUT1660, PUT1665, PRG184), by European Union
through the European Regional Development Fund project no.
MOBERA5 (Norface Network project no 462.16.107), by the Green
ICT programme under Norway Grants 2014 – 2021 (grant number
EU53928), by the European Union through Horizon 2020 grant no.
810645 and through the European Regional Development Fund
(Project No. 2014-2020.4.01.16-0125) and by the PRECISE4Q consortium. PRECISE4Q project has received funding from the European
Union’s Horizon 2020 Research and Innovation Programme under
Grant agreement 777107. This work was partly funded through the
CoMorMent project. CoMorMent has received funding from the
European Union’s Horizon 2020 Research and Innovation Programme
under Grant agreement 847776.
The KORA study was initiated and financed by the Helmholtz
Zentrum Mu¨nchen—German Research Center for Environmental Health,
which is funded by the German Federal Ministry of Education and
Research (BMBF) and by the State of Bavaria. The KORA study was supported by a research grant from the Virtual Institute of Diabetes Research
(Helmholtz Zentrum Mu¨nchen), the Clinical Cooperation Group Diabetes
between Ludwig-Maximilians-Universita¨t Mu¨nchen and Helmholtz
Zentrum Mu¨nchen, and by the German Diabetes Center (DDZ).
The HAPIEE project, Institute, was supported by grants from the
Wellcome Trust (064947/Z/01/Z; WT081081) and US National Institute
on Aging (1R01 and AG23522).
The co-ordination of EPIC is financially supported by International
Agency for Research on Cancer (IARC) and also by the Department of
Epidemiology and Biostatistics, School of Public Health, Imperial College
London, which has additional infrastructure support provided by the
NIHR Imperial Biomedical Research Centre (BRC). The national cohorts
are supported by: Danish Cancer Society (Denmark); Ligue Contre le
Cancer, Institut Gustave Roussy, Mutuelle Ge´ne´rale de l’Education
Nationale, Institut National de la Sante´ et de la Recherche Me´dicale
(INSERM) (France); German Cancer Aid, German Cancer Research
Center (DKFZ), German Institute of Human Nutrition Potsdam
Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF)
(Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy,
Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer
Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch
ZON (Zorg Onderzoek Nederland), World Cancer Research Fund
(WCRF), Statistics Netherlands (The Netherlands); Health Research Fund
(FIS)—Instituto de Salud Carlos III (ISCIII), Regional Governments of
Andalucı´a, Asturias, Basque Country, Murcia and Navarra, and the Catalan
Institute of Oncology—ICO (Spain); Swedish Cancer Society, Swedish
Research Council and County Councils of Ska˚ne and Va¨sterbotten
(Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017
to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk;
MR/M012190/1 to EPIC-Oxford) (United Kingdom).
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected].
