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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


   Abstract
Top
 Abstract
1. Introduction
 2. Subjects and methods
 3. Results
 4. Discussion
 5. Limitations
 Appendix A
 Appendix B: Project Structure...
 Footnotes 
 References
 
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

 


   Acknowledgments
 
The funding of the SCORE project by the European Union Biomed-2 programme (contract BMH4-98-3186) and the additional support from the Royal College of Surgeons of Ireland are gratefully acknowledged. We also gratefully acknowledge the funding of the original participating studies and the SCORE project by participating institutions anddifferent national funding organisations.

We would like to acknowledge the professional advice of Dr Robert Clarke (Oxford, UK), Prof Alun Evans (Belfast, UK), Dr Ed Korn (Bethesda, MD, US), Prof Daan Kromhout (Bilthoven, The Netherlands), Dr Sarah Lewington (Oxford, UK), Prof Dan McGee (Charleston, SC, US), and Dr Qing Qiao (Helsinki, Finland), and the energetic advocacy of Prof Philip Poole-Wilson (London, UK), the former President of the ESC, in the planning phase of the project.

The SCORE Project Steering Committee gratefully acknowledges the efficient work of the Administrative Secretary of the project, Ms Jane Ingham (London, UK) in organising the Steering Committee meetings and SCORE Project workshops.


   Footnotes 
Top
 Abstract
 1. Introduction
 2. Subjects and methods
 3. Results
 4. Discussion
 5. Limitations
 Appendix A
 Appendix B: Project Structure...
 Footnotes 
References
 
* The Weibull model is traditionally expressed in terms of {lambda}=exp({alpha}) Back


   References
Top
 Abstract
 1. Introduction
 2. Subjects and methods
 3. Results
 4. Discussion
 5. Limitations
 Appendix A
 Appendix B: Project Structure...
 Footnotes 
 References
 

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P. Collins, G. Rosano, C. Casey, C. Daly, M. Gambacciani, P. Hadji, R. Kaaja, T. Mikkola, S. Palacios, R. Preston, et al.
Management of cardiovascular risk in the peri-menopausal woman: a consensus statement of European cardiologists and gynaecologists
Eur. Heart J., August 2, 2007; 28(16): 2028 - 2040.
[Abstract] [Full Text] [PDF]

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B. Norrving, P. Wester, K. S. Sunnerhagen, A. Terent, A. Sohlberg, F. Berggren, P.-O. Wester, K. Asplund, for the Stroke Guidelines Working Group,, and National Board of Health and Welfare, Stockholm, S
Beyond Conventional Stroke Guidelines: Setting Priorities
Stroke, July 1, 2007; 38(7): 2185 - 2190.
[Abstract] [Full Text] [PDF]

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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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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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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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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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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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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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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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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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