title: A competing risk approach for the European Heart SCORE model based on cause-specific and all-cause mortality.
abstract: BACKGROUND
  The European Heart SCORE model constitutes the basis for national guidelines for primary prevention and treatment of cardiovascular disease (CVD) in several European countries. The model estimates individuals' 10-year CVD mortality risks from age, sex, smoking status, systolic blood pressure, and total cholesterol level. The SCORE model, however, is not mathematically consistent and does not estimate all-cause mortality. Our aim is to modify the SCORE model to allow consistent estimation of both CVD-specific and all-cause mortality.
  
  
  METHODS
  Using a competing risk approach, we first re-estimated the cause-specific risk of dying from cardiovascular disease, and secondly we incorporated non-CVD mortality. Finally, non-CVD mortality was allowed to also depend on smoking status, and not only age and sex. From the models, we estimated CVD-specific and all-cause 10-year mortality risk, and the expected residual lifetime together with corresponding expected effects of statin treatment.
  
  
  RESULTS
  The modified model provided CVD-specific 10-year mortality risks similar to those of the European Heart SCORE model. Incorporation of non-CVD mortality increased 10-year mortality risks, in particular for older individuals. When non-CVD mortality was assumed unaffected by smoking status, the absolute risk reduction due to statin treatment ranged from 0.0% to 3.5%, whereas the gain in expected residual lifetime ranged from 3 to 11 months. Statin effectiveness increased for non-smokers and declined for smokers, when smoking was allowed to influence non-CVD mortality.
  
  
  CONCLUSIONS
  The modified model provides mathematically consistent estimates of mortality risk and expected residual lifetime together with expected benefits from statin treatment.
authors.affiliation: Aarhus University, Aarhus, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Støvring
authors.forename: Charlotte G
authors.initials: CG
authors.lastname: Harmsen
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Wisløff
authors.forename: Dorte E
authors.initials: DE
authors.lastname: Jarbøl
authors.forename: Jørgen
authors.initials: J
authors.lastname: Nexøe
authors.forename: Jesper B
authors.initials: JB
authors.lastname: Nielsen
authors.forename: Ivar S
authors.initials: IS
authors.lastname: Kristiansen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D003661:Decision Support Techniques; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol