Refinement of Atherosclerotic Cardiovascular Disease Risk Assessment by Body Mass Index Categories: A Recalibration of the HellenicSCORE II+
Konstantinos Kassanis, Demosthenes PanagiotakosAbstract
Introduction:
Body mass index (BMI) is a major, modifiable cardiovascular risk factor, yet it is not directly incorporated into most contemporary cardiovascular disease risk prediction scores. The aim of this study was to refine the HellenicSCORE II+ by deriving sex-specific BMI conversion factors for Greek adults aged 40–69 years.
Methods:
Data from the ATTICA study, a population-based prospective cohort with a 10-year follow-up, were used. The analysis included 1006 participants aged 40–69 years (52% of men). BMI was classified according to the World Health Organization thresholds as normal weight (18.5–24.9 kg/m 2 ), overweight (25–29.9 kg/m 2 ) and obese (≥30 kg/m 2 ). For each sex and BMI category, a conversion factor was derived as the ratio of observed to expected 10-year cardiovascular events, relative to the normal-weight reference, and applied to the HellenicSCORE II+ value. Calibration was assessed with a Poisson model before and after application of the factors.
Results:
Overweight and obesity were associated with a higher 10-year cardiovascular incidence in both sexes. The conversion factors were 1.28 (95% confidence interval: 0.79–2.07) for overweight and 2.01 (1.21–3.34) for obesity in men and 1.45 (0.82–2.58) and 1.94 (1.11–3.38), respectively, in women; the obesity factors were statistically significant in both sexes. Before adjustment, the observed-to-expected ratio differed across BMI categories; afterward, it no longer differed (all
Conclusions:
Simple, sex-specific BMI conversion factors are proposed for the HellenicSCORE II+, bringing predicted risk closer to observed incidence in overweight and obese Greek adults. These factors are exploratory and require external validation before clinical use.