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European Heart Journal 2003 24(11):987-1003; doi:10.1016/S0195-668X(03)00114-3
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Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project

R.M. Conroya, K. Pyöräläb, A.P. Fitzgeralda, S. Sansc, A. Menottid, G. De Backere, D. De Bacquere, P. Ducimetièref, P. Jousilahtig, U. Keilh, I. Njølstadi, R.G. Oganovj, T. Thomsenk, H. Tunstall-Pedoel, A. Tverdalm, H. Wedeln, P. Whincupo, L. Wilhelmsenn and I.M. Grahama,* on behalf of the SCORE project group1

a Department of Epidemiology & Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
b University of Kuopio, Kuopio, Finland
c Institute of Health Studies, The Catalan Department of Health and Social Security, Barcelona, Spain
d Association for Cardiac Research, Rome, Italy
e Department of Public Health, Ghent University, Ghent, Belgium
f National Institute for Health and Medical Research (INSERM), Unit 258, Villejuif, France
g Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
h Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
i Institute of Community Medicine, University of Tromsø, Tromsø, Norway
j National Research Centre for Preventive Medicine, Russian Ministry of Health, Moscow, Russia
k Centre for Preventive Medicine, Medical Department M, Glostrup University Hospital, Glostrup, Denmark
l Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee,Scotland, UK
m Norwegian Institute of Public Health, Oslo, Norway
n Section of Preventive Cardiology, Göteborg University, Göteborg, Sweden
o Department of Public Health Sciences, St. George's Hospital Medical School, London, UK

* Corresponding author: Ian M. Graham (project leader), SCORE, Department of Epidemiology & Public Health Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland. Tel.: +353-1-402-2434; fax: +353-1-402-2329
E-mail address: igraham{at}amnch.ie

Aims The SCORE project was initiated to develop a risk scoring system for use in the clinical management of cardiovascular risk in European clinical practice.

Methods and results The project assembled a pool of datasets from 12 European cohort studies, mainly carried out in general population settings. There were 205 178 persons (88 080 women and 117 098 men) representing 2.7 million person years of follow-up. There were 7934 cardiovascular deaths, of which 5652 were deaths from coronary heart disease. Ten-year risk of fatal cardiovascular disease was calculated using a Weibull model in which age was used as a measure of exposure time to risk rather than as a risk factor. Separate estimation equations were calculated for coronary heart disease and for non-coronary cardiovascular disease. These were calculated for high-risk and low-risk regions of Europe. Two parallel estimation models were developed, one based on total cholesterol and the other on total cholesterol/HDL cholesterol ratio. The risk estimations are displayed graphically in simple risk charts. Predictive value of the risk charts was examined by applying them to persons aged 45–64; areas under ROC curves ranged from 0.71 to 0.84.

Conclusions The SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.

Key Words: Cardiovascular disease • Risk factors • Risk estimation • Europe


 


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Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al.
2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Eur. Heart J., June 11, 2007; (2007) ehm236v1.
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Eur Heart JHome page
M. H. Olsen, T. W. Hansen, M. K. Christensen, F. Gustafsson, S. Rasmussen, K. Wachtell, H. Ibsen, C. Torp-Pedersen, and P. R. Hildebrandt
N-terminal pro-brain natriuretic peptide, but not high sensitivity C-reactive protein, improves cardiovascular risk prediction in the general population
Eur. Heart J., June 1, 2007; 28(11): 1374 - 1381.
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Eur Heart J SupplHome page
Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. V. d. Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al.
Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)
Eur. Heart J. Suppl., June 1, 2007; 9(suppl_C): C3 - C74.
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Diabetes CareHome page
R. L. Coleman, R. J. Stevens, R. Retnakaran, and R. R. Holman
Framingham, SCORE, and DECODE Risk Equations Do Not Provide Reliable Cardiovascular Risk Estimates in Type 2 Diabetes
Diabetes Care, May 1, 2007; 30(5): 1292 - 1293.
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Eur Heart J SupplHome page
D. Wood
The concept of doctor targets based on quality guidelines: focus on blood pressure
Eur. Heart J. Suppl., May 1, 2007; 9(suppl_B): B29 - B36.
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Eur Heart JHome page
M. J. Holzmann, N. Hammar, S. Ahnve, T. Nordqvist, K. Pehrsson, and T. Ivert
Renal insufficiency and long-term mortality and incidence of myocardial infarction in patients undergoing coronary artery bypass grafting
Eur. Heart J., April 1, 2007; 28(7): 865 - 871.
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Pharmacol. Rev.Home page
J. H. Revkin, C. L. Shear, H. G. Pouleur, S. W. Ryder, and D. G. Orloff
Biomarkers in the Prevention and Treatment of Atherosclerosis: Need, Validation, and Future
Pharmacol. Rev., March 1, 2007; 59(1): 40 - 53.
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J. Epidemiol. Community HealthHome page
Asia Pacific Cohort Studies Collaboration
Cardiovascular risk prediction tools for populations in Asia
J Epidemiol Community Health, February 1, 2007; 61(2): 115 - 121.
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J Am Coll CardiolHome page
P. Greenland, R. O. Bonow, B. H. Brundage, M. J. Budoff, M. J. Eisenberg, S. M. Grundy, M. S. Lauer, W. S. Post, P. Raggi, R. F. Redberg, et al.
ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain: A Report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) Developed in Collaboration With the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography
J. Am. Coll. Cardiol., January 23, 2007; 49(3): 378 - 402.
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Eur Heart JHome page
Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al.
Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)
Eur. Heart J., January 1, 2007; 28(1): 88 - 136.
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Nephrol Dial TransplantHome page
S. J. L. Bakker, R. T. Gansevoort, and D. de Zeeuw
Metabolic syndrome: a fata morgana?
Nephrol. Dial. Transplant., January 1, 2007; 22(1): 15 - 20.
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HeartHome page
P Brindle, A Beswick, T Fahey, and S Ebrahim
Accuracy and impact of risk assessment in the primary prevention of cardiovascular disease: a systematic review
Heart, December 1, 2006; 92(12): 1752 - 1759.
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HeartHome page
J S Jurgensen
The value of risk scores
Heart, December 1, 2006; 92(12): 1713 - 1714.
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CirculationHome page
Y. Wu, X. Liu, X. Li, Y. Li, L. Zhao, Z. Chen, Y. Li, X. Rao, B. Zhou, R. Detrano, et al.
Estimation of 10-Year Risk of Fatal and Nonfatal Ischemic Cardiovascular Diseases in Chinese Adults
Circulation, November 21, 2006; 114(21): 2217 - 2225.
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LupusHome page
K De Leeuw, B Freire, A J Smit, H Bootsma, C G Kallenberg, and M Bijl
Traditional and non-traditional risk factors contribute to the development of accelerated atherosclerosis in patients with systemic lupus erythematosus
Lupus, October 1, 2006; 15(10): 675 - 682.
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HeartHome page
P. Paramsothy and R. Knopp
Management of dyslipidaemias.
Heart, October 1, 2006; 92(10): 1529 - 1534.
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Eur Heart JHome page
D.-H. Lee, K. Silventoinen, G. Hu, D. R. Jacobs Jr, P. Jousilahti, J. Sundvall, and J. Tuomilehto
Serum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28 838 middle-aged men and women
Eur. Heart J., September 2, 2006; 27(18): 2170 - 2176.
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ANN INTERN MEDHome page
D. M. Lloyd-Jones, K. Liu, L. Tian, and P. Greenland
Narrative Review: Assessment of C-Reactive Protein in Risk Prediction for Cardiovascular Disease
Ann Intern Med, July 4, 2006; 145(1): 35 - 42.
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