title: The role of dietary and socioeconomic status assessment on the predictive ability of the HellenicSCORE.
abstract: BACKGROUND
  The optimal performance of cardiovascular disease (CVD) risk models in various populations (such as the Framingham Heart Sheet or the ESC SCORE) is of major interest in risk prediction modeling nowadays. We evaluated whether the inclusion of socioeconomic status (SES) in the HellenicSCORE would increase the accuracy of prediction, irrespectively of dietary information and the classical CVD risk factors.
  
  
  METHODS
  Data from 1514 men and 1528 women (age >18 years), who were free of known CVD on enrolment in 2001-02, were studied (the ATTICA study). Five years later a follow up was performed and the development of CVD was defined (WHO-ICD-10 criteria). As SES indicators, education status and mean annual income were recorded, and a special SES 3-class index was calculated (low, moderate and high). The MedDietScore, which incorporates the inherent characteristics of the Mediterranean diet, was used as a dietary assessment tool, while the HellenicSCORE, which reflects the level of CVD risk factors, was also calculated. Additive logistic regression models were used to test the additive effect of SES and dietary assessment on the predictive ability of the HellenicSCORE.
  
  
  RESULTS
  SES assessment did not improve the predictive ability of the estimated risk model compared to the model that included the HellenicSCORE, physical activity status, waist-to-hip ratio, diabetes and family history of CVD. Additionally, SES did not improve the predictive ability of the estimated risk model even when dietary assessment was added to the above model.
  
  
  CONCLUSIONS
  Socioeconomic status does not improve the predictive ability of a CVD risk model, even when dietary information is also taken into account.
authors.affiliation: Harokopio University, Department of Nutrition Science-Dietetics, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vlismas
authors.forename: Demosthenes B
authors.initials: DB
authors.lastname: Panagiotakos
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsavos
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysohoou
authors.forename: Yannis
authors.initials: Y
authors.lastname: Skoumas
authors.forename: Vassilios
authors.initials: V
authors.lastname: Stavrinos
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011336:Probability; D018570:Risk Assessment; D012923:Social Class