Prediction of 10-Year Cardiovascular Disease Risk, by Diabetes status and Lipoprotein-a levels; the HellenicSCORE II

Demosthenes Panagiotakos; Christina Chrysohoou; Christos Pitsavos; Konstantinos Tsioufis

doi:10.1016/j.hjc.2023.10.001

Prediction of 10-Year Cardiovascular Disease Risk, by Diabetes status and Lipoprotein-a levels; the HellenicSCORE II

Hellenic J Cardiol. 2023 Oct 30:S1109-9666(23)00192-6. doi: 10.1016/j.hjc.2023.10.001. Online ahead of print.

Authors

Demosthenes Panagiotakos¹, Christina Chrysohoou², Christos Pitsavos², Konstantinos Tsioufis²

Affiliations

¹ Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece. Electronic address: dbpanag@hua.gr.
² First Cardiology Clinic, Hippokration Hospital, School of Medicine, University of Athens, Athens, Greece.

PMID: 37913991
DOI: 10.1016/j.hjc.2023.10.001

Abstract

Background: The aim of this study was to develop an updated model to predict10-year cardiovascular disease (CVD) risk for Greek adults, i.e., the HellenicSCORE II+, based on smoking, systolic blood pressure (SBP), total and High-Density-Lipoprotein-(HDL) cholesterol levels, and stratified by age group, sex, history of diabetes, and Lipoprotein (Lp)-a levels.

Methods: Individual CVD risk scores were calculated through logit-function models, using the beta-coefficients derived from SCORE2. The Attica Study data were used for the calibration (3,042 participants, aged 45(14) years; 49.1% men). Discrimination ability of the HellenicSCORE II+ was assessed using C-index (range 0-1), adjusted for competing risks.

Results: The mean HellenicSCORE II+ score was 6.3% (95% Confidence Interval (CI) 5.9% to 6.6%) for men and 3.7% (95% CI 3.5% to 4.0%) for women (p<0.001), and were higher compared to the relevant SCORE2; 23.5% of men were classified as low risk, 40.2% as moderate and 36.3% as high risk, whereas the corresponding percentages for women were 56.2%, 18.6% and 25.2%. C-statistic index was 0.88 for women and 0.79 for men, when the HellenicSCORE II+ was applied to the ATTICA Study data, suggesting very good accuracy. Stratified analysis by Lp(a) levels led to a 4% improvement in correct classification among participants with high Lp(a).

Conclusion: HellenicSCORE II+ values were higher than SCORE2, confirming that the Greek population is at moderate-to-high CVD risk. Stratification by Lp(a) levels may assist to better identify individuals at high CVD risk.

Keywords: cardiovascular disease; lipoprotein-a; non-HDL; renal function; risk; score.