SCORE and SCORE2 in East Asian Population: A Performance Comparison

JungMin Choi; Soseul Sung; Sue K Park; Seyong Park; Hyoyeong Kim; Myeong-Chan Cho; Bryan Williams; Hae-Young Lee

doi:10.1016/j.jacasi.2023.10.013

SCORE and SCORE2 in East Asian Population: A Performance Comparison

JACC Asia. 2023 Dec 26;4(4):265-274. doi: 10.1016/j.jacasi.2023.10.013. eCollection 2024 Apr.

Authors

JungMin Choi¹, Soseul Sung^{2

3

4}, Sue K Park^{3

4

5}, Seyong Park⁶, Hyoyeong Kim⁶, Myeong-Chan Cho⁷, Bryan Williams⁸, Hae-Young Lee^{1

9}

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
² Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea.
³ Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
⁴ Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
⁵ Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Republic of Korea.
⁶ Seoul National University College of Medicine, Seoul, Republic of Korea.
⁷ Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
⁸ UCL Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
⁹ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

Abstract

Background: Systematic COronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons (OP) models have been proposed as new cardiovascular risk evaluation tools.

Objectives: This study evaluated the performance of SCORE/SCORE-OP and SCORE2/SCORE2-OP in the East Asian population by using population-based cohort data from the National Health Insurance Service (NHIS) Health Screening Cohort of Korea.

Methods: A total of 324,384 NHIS examinees from 2004 to 2005 were divided into 5 age groups: 40-49 years, 50-59 years, 60-69 years,70-79 years, and more than 80 years. The examinees had their predicted cardiovascular disease risks calculated by using SCORE, SCORE2, SCORE-OP, and SCORE2-OP models. The low-risk model was applied on the basis of the cohort's observed event rates. The observed and predicted cardiovascular risks were compared.

Results: A total of 324,384 subjects were included (mean age 51.4 ± 7.3 years; women, 37.9% for the SCORE/SCORE2 group and mean age 73.0 ± 2.8 years; women, 47.5% for the SCORE/SCORE2-OP group). Over a median follow-up of 9 years, cardiovascular events occurred in 15.0% and 28.9% in SCORE/SCORE2 and SCORE/SCORE2-OP groups, respectively. The SCORE/SCORE-OP model underestimated cardiovascular disease risk in young men (aged 40-49 years) and women (aged 40-59 years) and overestimated it in older age groups. In contrast, SCORE2/SCORE2-OP invariably overestimated the risk in all age groups and sexes. SCORE2/SCORE2-OP showed no improvement in Harrell's concordance index (C-index) compared with SCORE/SCORE-OP. Calibration plots favored SCORE2 over SCORE but not SCORE2-OP over SCORE-OP.

Conclusions: Both SCORE2/SCORE2-OP and SCORE/SCORE-OP overestimated cardiovascular disease risk with low performance. SCORE2/SCORE2-OP showed slight improvement over older versions, but modifications are necessary for the East Asian population.

Keywords: Asian population; Systematic COronary Risk Evaluation; cardiovascular disease; validity.