Evaluating CMR

The SCORE project

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To date, one of the best-known risk prediction systems is based on the Framingham Heart Study (3). However, the Framingham Study examined a relatively homogenous American population living within a limited geographical area (the city of Framingham, Massachusetts). In view of these limitations, the European Society of Cardiology and the Second Joint Task Force developed a risk estimation system based on a large pool of European studies to capture regional variation in CHD risk (5). Their efforts led to the SCORE project, which assembled a pooled dataset of cohort studies (8-22) from 12 European countries. The consolidated database included 205,178 individuals (117,098 men and 80,080 women) without previous history of heart attack. Among the subjects, there were 7,934 cardiovascular deaths, of which 5,652 were attributed to CHD. Ten-year risk of fatal CVD was calculated using a Weibull model. The risk of cardiovascular death was calculated by combining two separate estimation equations: a model for CHD and a model for non-coronary atherosclerotic CVD.

The endpoint for the SCORE project was fatal atherosclerotic CVD. In interpreting CVD risk estimates, the SCORE project used fatal CVD only, instead of a combination of fatal and non-fatal events. This was because of limited availability of non-fatal endpoint data in several cohort studies and possible variation in endpoint definition. The SCORE project also provides specific European risk charts for countries at high and low cardiovascular risk, using cardiovascular mortality as the endpoint. The baseline survival functions for the cohorts from Denmark, Finland, and Norway were used to develop the high-risk model while baseline survival functions of studies from Belgium, Italy, and Spain were used to develop the low-risk region model. Risk was calculated for two different risk charts. The first chart was based on total cholesterol and the second on the cholesterol/HDL cholesterol ratio. In each chart, the risk factors used were sex, systolic blood pressure, and smoking habits. Age was used as a measure of exposure time to risk rather than as a risk factor. Compared to previous models from the European Society of Cardiology and the Second Joint Task Force (2), SCORE risk charts did not include risk for age 30 because individuals 30 years of age are essentially risk-free for the next 10 years and because there were no events in this age group. The SCORE risk charts therefore provide information for the 35 to 65 age group, which is when risk changes most rapidly.

Reference

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2. Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on coronary prevention. Eur Heart J 1998; 19: 1434-503.

3. Wilson PW, D'Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837-47.

5. Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24: 987-1003.

8. Vartiainen E, Jousilahti P, Alfthan G, et al. Cardiovascular risk factor changes in Finland, 1972-1997. Int J Epidemiol 2000; 29: 49-56.

9. Bjartveit K, Foss OP, Gjervig T, et al. The cardiovascular disease study in Norwegian counties. Background and organization. Acta Med Scand Suppl 1979; 634: 1-70.

10. Njolstad I, Arnesen E and Lund-Larsen PG. Smoking, serum lipids, blood pressure, and sex differences in myocardial infarction. A 12-year follow-up of the Finnmark Study. Circulation 1996; 93: 450-6.

11. Shaper AG, Pocock SJ, Walker M, et al. British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns. Br Med J (Clin Res Ed) 1981; 283: 179-86.

12. Tunstall-Pedoe H, Woodward M, Tavendale R, et al. Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish Heart Health Study: cohort study. BMJ 1997; 315: 722-9.

13. Schroll M, Jorgensen T and Ingerslev J. The Glostrup Population Studies, 1964-1992. Dan Med Bull 1992; 39: 204-7.

14. Wilhelmsen L, Berglund G, Elmfeldt D, et al. The multifactor primary prevention trial in Goteborg, Sweden. Eur Heart J 1986; 7: 279-88.

15. Keil U, Liese AD, Hense HW, et al. Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all-cause mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984-1992. Monitoring Trends and Determinants in Cardiovascular Diseases. Eur Heart J 1998; 19: 1197-207.

16. Ducimetiere P, Richard JL, Cambien F, et al. Coronary heart disease in middle-aged Frenchmen. Comparisons between Paris Prospective Study, Seven Countries Study, and Pooling Project. Lancet 1980; 1: 1346-50.

17. Rodes A, Sans S, Balana LL, et al. Recruitment methods and differences in early, late and non-respondents in the first MONICA-Catalonia population survey. Rev Epidemiol Sante Publique 1990; 38: 447-53.

18. Collaborative US-USSR study on the prevalence of dyslipoproteinemias and ischemic heart disease in American and Soviet populations. Prepared by the US-USSR Steering Committee for Problem Area 1: the pathogenesis of atherosclerosis. Am J Cardiol 1977; 40: 260-8.

19. Regional differences in dietary habits, coronary risk factors and mortality rates in Belgium. 1. Design and methodology. Nutrition and health: an interuniversity study. Acta Cardiol 1984; 39: 285-92.

20. Presentation of the rifle project risk factors and life expectancy. The RIFLE Research Group. Eur J Epidemiol 1993; 9: 459-76.

21. Sans Menendez S, Tomas Abadal L and Domingo Salvany A. Estudio de prevention multifactorial de la cardiopatia isquemica. Intervention sobre factores de riesgo coronario en una poblacion industrial. Resultados de los dos primeros anos. Rev San Hig Publ 1981; 55: 555-70.

22. Sans Menendez S. Ensayo randomizado de prevention multifactorial de la cardiopatia isquemica. PhD doctoral dissertation. Bellaterra: Publications of the Autonomous University of Barcelona. 1994.

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