Cholesterol treatment for the primary prevention of cardiovascular disease is based on cardiovascular risk, as assessed by the SCORE (Systematic COronary Risk Evaluation) scale. This study aimed to ...assess the predictive value and clinical utility of the SCORE scale for preventing cardiovascular events and all-cause mortality in people with dyslipidemia and no lipid-lowering treatment.
Patients with dyslipidemia and no lipid-lowering treatment were included from the ESCARVAL-RISK cohort. Cardiovascular risk was calculated by means of the SCORE scale. All deaths and cardiovascular events were recorded for up to five years of follow-up. We calculated sensitivity, specificity and other predictive values for different cut-off points and assessed the effect of different risk factors on the diagnostic accuracy of the SCORE charts.
In the final cohort of 18,853 patients, there were 1565 cardiovascular events and 268 deaths. The risk value recommended to initiate pharmacological treatment (5%) presented a specificity of 86% for death and 90% for cardiovascular events, and a sensitivity of 53% for death and 32% for cardiovascular events. In addition, the scale classified as low risk 62.8% of the patients who suffered a cardiovascular event and 46.6% of those who died. Antithrombotic treatment, diabetes, hypertension, heart failure, peripheral artery disease and chronic kidney disease were associated with a reduction in the predictive capability of the SCORE scale, whereas metabolic syndrome was related to better risk prediction.
The predictive capability of the SCORE scale for cardiovascular disease and total mortality in patients with dyslipidemia is limited.
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•Hypercholesterolemia is one of the main cardiovascular risk factors.•Recommendations on the initiation of lipid-lowering treatment depend on the level of cardiovascular risk, as calculated using SCORE.•SCORE does not accurately predict the appearance of cardiovascular events in patients with hypercholesterolemia and no lipid-lowering treatment.•Using SCORE in clinical practice can derive in the undertreatment of patients with hypercholesterolemia.
•A eGFR<90mL/min/1.73m2 was associated with increased mortality risk (p<0.001).•A eGFR<90mL/min/1.73m2 was associated with increased hospitalizations (p<0.001).•Mortality estimated PAR associated ...with eGFR levels<60 was significant in DM.•Mortality estimated PAR associated with eGFR levels<60 was significant in CVD.
To estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes.
A prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008–2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated.
Mean follow-up was 3.2 years and 506 deaths and 1720 hospitalizations were recorded. The cumulative risk for the individual events increased as eGFR levels decreased. The PAR associated with having an eGFR of 60mL/min/1.73m2 or less was 11.4% (95% CI 4.8–18.3) for all-cause mortality, 9.2% (95% CI 5.3–13.4) for coronary heart disease, and 2.6% (95% CI −1.8 to 7.4) for stroke.
Reduced eGFR levels were associated with a larger proportion of avoidable deaths and cardiovascular hospitalizations in people with diabetes compared to previously reported results in people with other cardiovascular risk factors.
