SCORE2 Latin America and the Caribbean: a region-specific tool to improve cardiovascular risk estimation in clinical practice
S BijkerkAbstract
Background
Guidelines recommend the use of cardiovascular disease (CVD) risk prediction models to identify people at high risk of CVD who may benefit most from preventive action. Most existing CVD prediction models have been developed and validated solely in European or North American populations, despite the substantial CVD burden in Latin America and the Caribbean (LAC) and notable differences in CVD risk factor distributions and CVD incidence patterns.
Purpose
Our aim was to recalibrate and externally validate the SCORE2 model for Latin America and the Caribbean (SCORE2-LAC) to estimate the 10-year risk of fatal and non-fatal CVD events (myocardial infarction and stroke) among adults aged 40–69 years without previous CVD or diabetes in the LAC region.
Methods
We defined four risk regions according to country-specific CVD mortality rates: low risk (<100 CVD deaths per 100,000), moderate risk (100 to <150 CVD deaths per 100,000), high risk (150 to <300 CVD deaths per 100,000), and very high risk (≥300 CVD deaths per 100,000). The sex-specific and competing-risk–adjusted SCORE2 models were systematically recalibrated to reflect contemporary CVD incidence in LAC clinical practice. Models were recalibrated using risk region-representative data on expected incidence and CVD risk factor distributions, applying the methodological framework previously used in the recalibration of SCORE2 for Europe and the Asia-Pacific region. The recalibrated SCORE2-LAC model was externally validated using LAC cohort data, and discrimination was assessed using Harrell’s C-statistic.
Results
Region-specific CVD incidence was estimated using country-specific CVD mortality data and the ratios of fatal to total first CVD events from 40,234,177 individuals (1,281,703 CVD events). External validation was performed on data from 10 additional cohorts across 7 countries, comprising 127,581 individuals and 3,844 CVD events. After applying the recalibrated SCORE2 models to the validation cohorts according to their respective risk region, the cohort-specific overall C-indices ranged from 0.668 (95%CI 0.605-0.731) to 0.789 (95%CI 0.747-0.831).
Conclusion(s)
The SCORE2-LAC model provides region-specific estimates of 10-year CVD risk among apparently healthy individuals in LAC, thereby enhancing the identification of individuals at higher risk of developing CVD across the LAC region.Risk regions based on CVD mortalityOverall and sex-specific discrimination