Zheng Fanfan, Xie Wuxiang, Li Chenglong, Gao Darui, Liang Jie
School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.
J Gerontol A Biol Sci Med Sci. 2023 Mar 30;78(4):704-710. doi: 10.1093/gerona/glac251.
Whether the updated Systematic COronary Risk Evaluation (SCORE2) risk algorithm is suitable for the prediction of incident dementia and all-cause mortality and whether its discrimination abilities for these outcomes are higher than those of the SCORE and Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) risk algorithms are unclear.
The present study included 429 033 participants (mean age: 57.1 ± 8.1 years; male: 46.2%; White: 94.1%) free of dementia from the UK Biobank at baseline, with a median follow-up of 12.8 years. Cox regression models were adopted to investigate the longitudinal relationships of SCORE2 risk categories with outcomes, and receiver operating characteristic curve analyses were used to compare the discrimination abilities of the 3 algorithms.
During 5 376 778 person-years of follow-up, 6 477 all-cause dementia, 2 726 Alzheimer's disease (AD), 1 439 vascular disease (VD), and 31 981 all-cause deaths were identified. We found that higher SCORE2 risk was associated with higher risks of all-cause dementia, AD, VD, and all-cause mortality. The C-indices of SCORE2 risk for discriminating incident all-cause dementia, AD, VD, and all-cause death were 0.750 (95% confidence interval [CI]: 0.745 to 0.755), 0.750 (95% CI: 0.743 to 0.757), 0.800 (95% CI: 0.791 to 0.809), and 0.721 (95% CI: 0.718 to 0.724), respectively, which were significantly improved in comparison to those of the SCORE and CAIDE risk algorithms.
The SCORE2 risk algorithm is applicable in predicting incident all-cause dementia, AD, VD, and all-cause mortality in European populations, and its discrimination abilities for dementia and death are significantly higher than those of the SCORE and CAIDE risk algorithms. Further validations in other populations are warranted.
更新后的系统性冠状动脉风险评估（SCORE2）风险算法是否适用于预测新发痴呆症和全因死亡率，以及其对这些结局的区分能力是否高于SCORE和心血管危险因素、衰老与痴呆（CAIDE）风险算法，目前尚不清楚。
本研究纳入了英国生物银行中429033名基线时无痴呆症的参与者（平均年龄：57.1±8.1岁；男性：46.2%；白人：94.1%），中位随访时间为12.8年。采用Cox回归模型研究SCORE2风险类别与结局之间的纵向关系，并使用受试者工作特征曲线分析来比较这三种算法的区分能力。
在5376778人年的随访期间，共识别出6477例全因痴呆症、2726例阿尔茨海默病（AD）、1439例血管性疾病（VD）和31981例全因死亡。我们发现，SCORE2风险越高，全因痴呆症、AD、VD和全因死亡率的风险越高。SCORE2风险用于区分新发全因痴呆症、AD、VD和全因死亡的C指数分别为0.750（95%置信区间[CI]：0.745至0.755）、0.750（95%CI：0.743至0.757）、0.800（95%CI：0.791至0.809）和0.721（95%CI：0.718至0.724），与SCORE和CAIDE风险算法相比有显著提高。
SCORE2风险算法适用于预测欧洲人群中的新发全因痴呆症、AD、VD和全因死亡率，其对痴呆症和死亡的区分能力明显高于SCORE和CAIDE风险算法。有必要在其他人群中进行进一步验证。
