Highlight
- •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.
Abstract
Background and aims
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.
Methods
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.
Results
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.
Conclusions
The predictive capability of the SCORE scale for cardiovascular disease and total
mortality in patients with dyslipidemia is limited.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: September 23, 2019
Accepted:
September 19,
2019
Received in revised form:
September 15,
2019
Received:
July 16,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
