Does inclusion of education and marital status improve SCORE performance in central and eastern europe and former soviet union? findings from MONICA and HAPIEE cohorts.
OBJECTIVE
The SCORE scale predicts the 10-year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk version of SCORE is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), due to high CVD mortality rates in these countries. Given the pronounced social gradient in cardiovascular mortality in the region, it is important to consider social factors in the CVD risk prediction. We investigated whether adding education and marital status to SCORE benefits its prognostic performance in two sets of population-based CEE/FSU cohorts.


METHODS
The WHO MONICA (MONItoring of trends and determinants in CArdiovascular disease) cohorts from the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s (577 atherosclerotic CVD deaths among 14,969 participants with non-missing data). The HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05 (395 atherosclerotic CVD deaths in 19,900 individuals with non-missing data).


RESULTS
In MONICA and HAPIEE, the high-risk SCORE ≥5% at baseline strongly and significantly predicted fatal CVD both before and after adjustment for education and marital status. After controlling for SCORE, lower education and non-married status were significantly associated with CVD mortality in some samples. SCORE extension by these additional risk factors only slightly improved indices of calibration and discrimination (integrated discrimination improvement <5% in men and ≤1% in women).


CONCLUSIONS
Extending SCORE by education and marital status failed to substantially improve its prognostic performance in population-based CEE/FSU cohorts.
Epidemiology and Public Health Department, University College London, London, United Kingdom.
Olga
O
Vikhireva
Department of CVD Epidemiology, Prevention, and Health Promotion, the Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland.
Grazyna
G
Broda
Environmental Health Monitoring System, National Institute of Public Health, Prague, Czech Republic.
Ruzena
R
Kubinova
Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia; State Novosibirsk Medical University, Novosibirsk, Russia.
Sofia
S
Malyutina
Department of Epidemiology and Population Sciences, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
Andrzej
A
Pająk
Laboratory of Population Research, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Abdonas
A
Tamosiunas
Preventive Cardiology Department, Institute of Clinical and Experimental Medicine, Prague, Czech Republic.
Zdena
Z
Skodova
Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia.
Galina
G
Simonova
Epidemiology and Public Health Department, University College London, London, United Kingdom.
Martin
M
Bobak
Epidemiology and Public Health Department, University College London, London, United Kingdom.
Hynek
H
Pikhart
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D005061:Europe, Eastern; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012426:Russia; D012959:Socioeconomic Factors