Risk prediction is improved by adding markers of subclinical organ damage to SCORE.
OBJECTIVE
It is unclear whether subclinical vascular damage adds significantly to Systemic Coronary Risk Evaluation (SCORE) risk stratification in healthy subjects.


RESULTS
In a population-based sample of 1968 subjects without cardiovascular disease or diabetes not receiving any cardiovascular, anti-diabetic, or lipid-lowering treatment, aged 41, 51, 61, or 71 years, we measured traditional cardiovascular risk factors, left ventricular (LV) mass index, atherosclerotic plaques in the carotid arteries, carotid/femoral pulse wave velocity (PWV), and urine albumin/creatinine ratio (UACR) and followed them for a median of 12.8 years. Eighty-one subjects died because of cardiovascular causes. Risk of cardiovascular death was independently of SCORE associated with LV hypertrophy [hazard ratio (HR) 2.2 (95% CI 1.2-4.0)], plaques [HR 2.5 (1.6-4.0)], UACR > or = 90th percentile [HR 3.3 (1.8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE > or = 5% and 7.3 (3.2-16.1) for SCORE < 5%]. Restricting primary prevention to subjects with SCORE > or = 5% as well as subclinical organ damage, increased specificity of risk prediction from 75 to 81% (P < 0.002), but reduced sensitivity from 72 to 65% (P = 0.4). Broaden primary prevention from subjects with SCORE > or = 5% to include subjects with 1% < or = SCORE < 5% together with subclinical organ damage increased sensitivity from 72 to 89% (P = 0.006), but reduced specificity from 75 to 57% (P < 0.002) and positive predictive value from 11 to 8% (P = 0.07).


CONCLUSIONS
Subclinical organ damage predicted cardiovascular death independently of SCORE and the combination may improve risk prediction.
Sehestedt
Thomas
T
Department of Internal Medicine, The Cardiovascular Research Unit, Glostrup University Hospital, Nordre Ringvej, Glostrup, Denmark. ts@heart.dk
Jeppesen
Jørgen
J
Hansen
Tine W
TW
Wachtell
Kristian
K
Ibsen
Hans
H
Torp-Pedersen
Christian
C
Torp-Petersen
Christian
C
Hildebrandt
Per
P
Olsen
Michael H
MH
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000401:mortality; D050197:Atherosclerosis / Q000401:mortality / Q000473:pathology; D015415:Biomarkers / Q000032:analysis; D001783:Blood Flow Velocity / Q000502:physiology; D002318:Cardiovascular Diseases / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D003404:Creatinine / Q000652:urine; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011673:Pulsatile Flow; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
D015415:Biomarkers; D003404:Creatinine