Vikhireva Olga, Broda Grazyna, Kubinova Ruzena, Malyutina Sofia, Pająk Andrzej, Tamosiunas Abdonas, Skodova Zdena, Simonova Galina, Bobak Martin, Pikhart Hynek
Epidemiology and Public Health Department, University College London, London, United Kingdom.
Department of CVD Epidemiology, Prevention, and Health Promotion, the Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland.
PLoS One. 2014 Apr 8;9(4):e94344. doi: 10.1371/journal.pone.0094344. eCollection 2014.
The SCORE scale predicts the 10-year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk version of SCORE is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), due to high CVD mortality rates in these countries. Given the pronounced social gradient in cardiovascular mortality in the region, it is important to consider social factors in the CVD risk prediction. We investigated whether adding education and marital status to SCORE benefits its prognostic performance in two sets of population-based CEE/FSU cohorts.
The WHO MONICA (MONItoring of trends and determinants in CArdiovascular disease) cohorts from the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s (577 atherosclerotic CVD deaths among 14,969 participants with non-missing data). The HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05 (395 atherosclerotic CVD deaths in 19,900 individuals with non-missing data).
In MONICA and HAPIEE, the high-risk SCORE ≥5% at baseline strongly and significantly predicted fatal CVD both before and after adjustment for education and marital status. After controlling for SCORE, lower education and non-married status were significantly associated with CVD mortality in some samples. SCORE extension by these additional risk factors only slightly improved indices of calibration and discrimination (integrated discrimination improvement <5% in men and ≤1% in women).
Extending SCORE by education and marital status failed to substantially improve its prognostic performance in population-based CEE/FSU cohorts.
SCORE量表基于传统风险因素预测致死性动脉粥样硬化性心血管疾病（CVD）的10年风险。由于中东欧和前苏联（CEE/FSU）国家的CVD死亡率较高，因此推荐在这些地区使用SCORE高危版本。鉴于该地区心血管疾病死亡率存在明显的社会梯度差异，在CVD风险预测中考虑社会因素非常重要。我们研究了在两组基于人群的CEE/FSU队列中，将教育程度和婚姻状况纳入SCORE量表是否能改善其预后性能。
对来自捷克共和国、波兰（华沙和塔尔诺布热格）、立陶宛（考纳斯）和俄罗斯（新西伯利亚）的世界卫生组织MONICA（心血管疾病趋势和决定因素监测）队列进行了随访，随访时间从20世纪80年代中期开始（14969名无缺失数据的参与者中有577例动脉粥样硬化性CVD死亡）。HAPIEE（东欧的健康、酒精和社会心理因素）研究对2002年至2005年期间的捷克、波兰（克拉科夫）和俄罗斯（新西伯利亚）队列进行了随访（19900名无缺失数据的个体中有395例动脉粥样硬化性CVD死亡）。
在MONICA和HAPIEE队列中，基线时高危SCORE≥5%在调整教育程度和婚姻状况前后均能强烈且显著地预测致死性CVD。在控制SCORE后，较低的教育程度和未婚状态在一些样本中与CVD死亡率显著相关。通过这些额外风险因素扩展SCORE仅略微改善了校准和区分指数（男性的综合区分改善<5%，女性≤1%）。
在基于人群的CEE/FSU队列中，通过教育程度和婚姻状况扩展SCORE未能显著改善其预后性能。
