title: Traditional SCORE-based health check fails to identify individuals who develop acute myocardial infarction.
abstract: BACKGROUND
  Atherosclerotic cardiovascular disease (CVD), including acute myocardial infarction (AMI), is caused by well-known risk factors. They constitute important therapeutic targets, but their predictive value is disputed. We evaluated the effectiveness of the risk scoring system (SCORE) and thresholds for pharmacotherapy re-commended in the European guidelines on CVD prevention.
  
  
  METHODS
  The medical records of 605 consecutive patients hospitalized for a first AMI were reviewed. Patients with pre-existing CVD, diabetes, or incomplete information on risk factors were excluded. Those not treated with statin before AMI were risk stratified based on risk factors. A SCORE ≥ 5% or ≥ 10% was considered to qualify for preventive medication in young adults (age ≤ 60 years) or elderly (age > 60 years), respectively.
  
  
  RESULTS
  Before AMI, 40 (9%) used statin. Among non-statin users, only five of the 109 young adults had a SCORE ≥ 5%, and 23 of the 284 elderly had a SCORE ≥ 10%. Among women, only three elderly qualified for treatment. More than four times more patients would have qualified for treatment with the high-risk country chart used in 2011. The incremental value of the novel high-density lipoprotein adjusted SCORE charts was limited.
  
  
  CONCLUSIONS
  Few patients admitted with a first AMI used statin. Among non-statin users, SCORE and the recommended thresholds for pharmacotherapy identified no women and less than one out of ten men who untreated were destined for an AMI before 61 years of age. The preventive potential of a traditional risk factor-based health check is limited.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Kardiologisk Afdeling, Aarhus Universitetshospital, 8200 Aarhus N, Denmark. martin.bodtker.mortensen@ki.au.dk
authors.forename: Martin B
authors.initials: MB
authors.lastname: Mortensen
authors.forename: Kim
authors.initials: K
authors.lastname: Sivesgaard
authors.forename: Helle K
authors.initials: HK
authors.lastname: Jensen
authors.forename: Willemijn
authors.initials: W
authors.lastname: Comuth
authors.forename: Helle
authors.initials: H
authors.lastname: Kanstrup
authors.forename: Ole
authors.initials: O
authors.lastname: Gotzsche
authors.forename: Ole
authors.initials: O
authors.lastname: May
authors.forename: Jette
authors.initials: J
authors.lastname: Bertelsen
authors.forename: Erling
authors.initials: E
authors.lastname: Falk
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol