Eur Heart J. 2021 Jul 1;42(25):2455-2467. doi: 10.1093/eurheartj/ehab312.
The aim of this study was to derive and validate the SCORE2-Older Persons (SCORE2-OP) risk model to estimate 5- and 10-year risk of cardiovascular disease (CVD) in individuals aged over 70 years in four geographical risk regions.
Sex-specific competing risk-adjusted models for estimating CVD risk (CVD mortality, myocardial infarction, or stroke) were derived in individuals aged over 65 without pre-existing atherosclerotic CVD from the Cohort of Norway (28 503 individuals, 10 089 CVD events). Models included age, smoking status, diabetes, systolic blood pressure, and total- and high-density lipoprotein cholesterol. Four geographical risk regions were defined based on country-specific CVD mortality rates. Models were recalibrated to each region using region-specific estimated CVD incidence rates and risk factor distributions. For external validation, we analysed data from 6 additional study populations {338 615 individuals, 33 219 CVD validation cohorts, C-indices ranged between 0.63 [95% confidence interval (CI) 0.61-0.65] and 0.67 (0.64-0.69)}. Regional calibration of expected-vs.-observed risks was satisfactory. For given risk factor profiles, there was substantial variation across the four risk regions in the estimated 10-year CVD event risk.
The competing risk-adjusted SCORE2-OP model was derived, recalibrated, and externally validated to estimate 5- and 10-year CVD risk in older adults (aged 70 years or older) in four geographical risk regions. These models can be used for communicating the risk of CVD and potential benefit from risk factor treatment and may facilitate shared decision-making between clinicians and patients in CVD risk management in older persons.
本研究旨在推导和验证 SCORE2-老年人（SCORE2-OP）风险模型，以估计四个地理风险区域中 70 岁以上个体的 5 年和 10 年心血管疾病（CVD）风险。
在没有预先存在的动脉粥样硬化性 CVD 的 65 岁以上个体中，使用挪威队列（28503 名个体，10089 例 CVD 事件），通过竞争风险调整模型来估计 CVD 风险（CVD 死亡率、心肌梗死或中风）。模型包括年龄、吸烟状况、糖尿病、收缩压以及总胆固醇和高密度脂蛋白胆固醇。根据国家特异性 CVD 死亡率定义了四个地理风险区域。使用特定区域的估计 CVD 发病率和风险因素分布，对每个区域的模型进行重新校准。为了外部验证，我们分析了来自 6 个额外研究人群的数据{338615 名个体，33219 例 CVD 验证队列，C 指数在 0.63 [95%置信区间（CI）0.61-0.65]和 0.67（0.64-0.69）之间}。预期与观察到的风险的区域校准令人满意。对于给定的风险因素谱，在四个风险区域中，估计的 10 年 CVD 事件风险存在很大差异。
推导、重新校准并外部验证了竞争风险调整的 SCORE2-OP 模型，以估计四个地理风险区域中 70 岁及以上老年人的 5 年和 10 年 CVD 风险。这些模型可用于交流 CVD 风险以及通过风险因素治疗获得的潜在益处，并可能促进临床医生和患者在老年人 CVD 风险管理方面的共同决策。
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