Research Article| Volume 290, P80-86, November 2019

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Predictive validity of the risk SCORE model in a Mediterranean population with dyslipidemia


      • 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.


      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.


      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.

      Graphical abstract


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