title: The Systematic COronary Risk Evaluation (SCORE) in a large UK population: 10-year follow-up in the EPIC-Norfolk prospective population study.
abstract: BACKGROUND
  The European Society of Cardiology endorses cardiovascular disease (CVD) risk stratification using the Systematic COronary Risk Evaluation (SCORE) algorithm, with separate algorithms for high-risk and low-risk countries. In the 2012 European Guidelines on CVD Prevention in Clinical Practice, the UK has been reclassified as a low-risk country. However, the performance of the SCORE algorithm has not been validated in the UK.
  
  
  METHODS
  We compared CVD mortality as predicted by SCORE with the observed CVD mortality in the European Prospective Investigation of Cancer-Norfolk (EPIC-Norfolk) prospective population study, a cohort representative of the general population.
  
  
  METHODS
  Individuals without known CVD or diabetes mellitus, aged 39-65 years at baseline, were included in our analysis. CVD mortality was defined as death due to ischaemic heart disease, cardiac failure, cerebrovascular disease, peripheral artery disease and aortic aneurysm. Predicted CVD mortality was calculated at baseline using the SCORE high-risk and low-risk algorithms.
  
  
  RESULTS
  A total of 15,171 individuals (57.1% female) with a mean age of 53.9 (SD 6.2) years were included. Predicted CVD mortality was 2.85% (95% confidence interval (CI) 2.80-2.90) with the SCORE high-risk algorithm and 1.55% (95% CI 1.52-1.58) with the low-risk algorithm. The observed 10-year CVD mortality was 1.25% (95% CI 1.08-1.44). Similar results were observed across sex and age subgroups.
  
  
  CONCLUSIONS
  In the large EPIC-Norfolk cohort representative of the UK population, the SCORE low-risk algorithm performed better than the high-risk algorithm in predicting 10-year CVD mortality. Our findings indicate that the UK has been correctly reclassified as a low-risk country.
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands h.t.jorstad@amc.uva.nl.
authors.forename: Harald T
authors.initials: HT
authors.lastname: Jørstad
authors.affiliation: Department of Cardiology, Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Ersen B
authors.initials: EB
authors.lastname: Colkesen
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Madelon
authors.initials: M
authors.lastname: Minneboo
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Ron J G
authors.initials: RJ
authors.lastname: Peters
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: S Matthijs
authors.initials: SM
authors.lastname: Boekholdt
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Medical Research Council Epidemiology Unit, Cambridge, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, UK.
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002423:Cause of Death; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality*; D004739:England; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Cardiovascular diseases; algorithms; risk factors