title: Inclusion of hazardous drinking does not improve the SCORE performance in men from Central and Eastern Europe: the findings from the HAPIEE cohorts.
abstract: BACKGROUND
  The SCORE (Systematic COronary Risk Evaluation) scale uses conventional risk factors for the prediction of the 10-year risk of fatal atherosclerotic cardiovascular disease (CVD). The high-risk version of SCORE is recommended by the European Society of Cardiology for use in the populations of Central and Eastern Europe and former Soviet Union (CEE/FSU). Given the role of hazardous alcohol consumption as an important determinant of CVD mortality in CEE/FSU men, this study investigated whether adding hazardous drinking characteristics to the high-risk SCORE improves its prognostic performance in contemporary population-based male CEE/FSU cohorts.
  
  
  METHODS
  The HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study follows Czech (seven towns), Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-2005. In HAPIEE men (n = 8,927), 264 atherosclerotic cardiovascular deaths were registered over the median follow-up time of 6.2-8.1 years.
  
  
  RESULTS
  In HAPIEE men, the baseline levels of the high-risk SCORE ≥5% significantly predicted fatal CVD. After controlling for the high-risk SCORE, binge drinking (drinking ≥100 g of ethanol at least once a month) and problem drinking (≥2 positive answers to CAGE questionnaire) were inconsistently associated with fatal CVD. No marked improvement in calibration and discrimination was observed for the high-risk SCORE extended by these hazardous drinking indicators, and all values of integrated discrimination improvement were <0.5%.
  
  
  CONCLUSIONS
  Extending the high-risk SCORE by hazardous drinking parameters failed to improve its prognostic performance across male CEE/FSU population samples. Our findings tentatively support the use of the original high-risk SCORE in male CEE/FSU populations. More research is needed on the potential use of hazardous drinking in cardiovascular risk prediction.
authors.affiliation: Epidemiology and Public Health Department, University College London, London, UK. o.vikhireva@ucl.ac.uk.
authors.forename: Olga
authors.initials: O
authors.lastname: Vikhireva
authors.forename: Ruzena
authors.initials: R
authors.lastname: Kubinova
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pająk
authors.forename: Galina
authors.initials: G
authors.lastname: Simonova
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
authors.forename: Hynek
authors.initials: H
authors.lastname: Pikhart
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D044465:White People