Cardiovascular risk estimation in older persons: SCORE O.P
Abstract
AIMS: Estimation of cardiovascular disease risk, using SCORE (Systematic COronary Risk Evaluation) is recommended by European guidelines on cardiovascular disease prevention. Risk estimation is inaccurate in older people. We hypothesized that this may be due to the assumption, inherent in current risk estimation systems, that risk factors function similarly in all age groups. We aimed to derive and validate a risk estimation function, SCORE O.P., solely from data from individuals aged 65 years and older. METHODS AND RESULTS: 20,704 men and 20,121 women, aged 65 and over and without pre-existing coronary disease, from four representative, prospective studies of the general population were included. These were Italian, Belgian and Danish studies (from original SCORE dataset) and the CONOR (Cohort of Norway) study. The variables which remained statistically significant in Cox proportional hazards model and were included in the SCORE O.P. model were: age, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, smoking status and diabetes. SCORE O.P. showed good discrimination; area under receiver operator characteristic curve (AUROC) 0.74 (95% confidence interval: 0.73 to 0.75). Calibration was also reasonable, Hosmer-Lemeshow goodness of fit test: 17.16 (men), 22.70 (women). Compared with the original SCORE function extrapolated to the ≥65 years age group discrimination improved, p = 0.05 (men), p < 0.001 (women). Simple risk charts were constructed. On simulated external validation, performed using 10-fold cross validation, AUROC was 0.74 and predicted/observed ratio was 1.02. CONCLUSION: SCORE O.P. provides improved accuracy in risk estimation in older people and may reduce excessive use of medication in this vulnerable population.
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Risk estimates have been produced as charts for high- and low-risk regions in Europe.
“Risk estimates have been produced as charts for high- and low-risk regions in Europe (Fig. 1 and 2) [11].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [11]
SCORE overestimates risk in older people because beta-coefficients are not constant with ageing.
“Recent work has shown that b -coefficients are not constant with ageing and that SCORE overestimates risk in older people. 54”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [54]
Recent work shows that b-coefficients are not constant with ageing and that SCORE overestimates risk in older people.
“Recent work has shown that b-coefficients are not constant with ageing and that SCORE overestimates risk in older people.54”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [54]
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- Authors
- Cooney, M. T., Selmer, R., Lindman, A., Tverdal, A., Menotti, A., Thomsen, T., DeBacker, G., De Bacquer, D., Tell, G. S., Njolstad, I., & Graham, I. M.
- Affiliations
- Trinity College Dublin (IE)
- Norwegian Institute of Public Health (NO)
- Association of Cardiac Research, Rome, Italy
- Glostrup Hospital (DK)
- Ghent University (BE)
- Department of Public Health, University of Ghent, Belgium
- University of Bergen (NO)
- University of Tromsø, Norway
- Corresponding author
- Graham, Ian M
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-06-03
- Volume
- 23
- Issue
- 10
- Pages
- 1093-1103
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W1930032053
- Cited by
- 172
- References
- 33
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 10 · 2023: 12 · 2022: 21 · 2021: 22 · 2020: 23 · 2019: 30 · 2018: 10 · 2017: 14 · 2016: 14 · 2013: 1
- FWCI
- 13.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- cardiovascular risk prediction, older adults, coronary heart disease risk, risk prediction model, model validation, age-specific risk factors, cholesterol, blood pressure, smoking, diabetes mellitus, risk charts
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Aging, Belgium, Cardiovascular Diseases, Denmark, Female, Follow-Up Studies, Humans, Italy, Male, Prognosis, Prospective Studies, Risk Factors, ROC Curve, Time Factors, Incidence, Risk Assessment
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