title: SCORE performance in Central and Eastern Europe and former Soviet Union: MONICA and HAPIEE results.
abstract: OBJECTIVE
  The Systematic COronary Risk Evaluation (SCORE) scale assesses 10 year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk SCORE version is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), but its performance has never been systematically assessed in the region. We evaluated SCORE performance in two sets of population-based CEE/FSU cohorts.
  
  
  RESULTS
  The cohorts based on the World Health Organization MONitoring of trends and determinants in CArdiovascular disease (MONICA) surveys in the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s. The Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPIEE) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05. In Cox regression analyses, the high-risk SCORE ≥5% at baseline significantly predicted CVD mortality in both MONICA [n = 15 027; hazard ratios (HR), 1.7-6.3] and HAPIEE (n = 20 517; HR, 2.6-10.5) samples. While SCORE calibration was good in most MONICA samples (predicted and observed mortality were close), the risk was underestimated in Russia. In HAPIEE, the high-risk SCORE overpredicted the estimated 10 year mortality for Czech and Polish samples and adequately predicted it for Russia. SCORE discrimination was satisfactory in both MONICA and HAPIEE.
  
  
  CONCLUSIONS
  The high-risk SCORE underestimated the fatal CVD risk in Russian MONICA but performed well in most MONICA samples and Russian HAPIEE. This SCORE version might overestimate the risk in contemporary Czech and Polish populations.
authors.affiliation: Epidemiology and Public Health Department, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
authors.forename: Olga
authors.initials: O
authors.lastname: Vikhireva
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pajak
authors.forename: Grazyna
authors.initials: G
authors.lastname: Broda
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.forename: Abdonas
authors.initials: A
authors.lastname: Tamosiunas
authors.forename: Ruzena
authors.initials: R
authors.lastname: Kubinova
authors.forename: Galina
authors.initials: G
authors.lastname: Simonova
authors.forename: Zdena
authors.initials: Z
authors.lastname: Skodova
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
authors.forename: Hynek
authors.initials: H
authors.lastname: Pikhart
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D050197:Atherosclerosis / Q000401:mortality*; D015331:Cohort Studies; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D006801:Humans; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D012426:Russia / Q000453:epidemiology; D017678:Sex Distribution
keywords: Cardiovascular mortality; Cardiovascular risk factors; Central and Eastern Europe; Former Soviet Union; Risk prediction; SCORE risk function