title: Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines.
abstract: OBJECTIVE
  The European HeartScore has traditionally differentiated between low and high-risk countries. Until 2012 Germany and Denmark were considered to be high-risk countries but have now been defined as low-risk countries. In this survey we aim to address the consequences of this downgrading.
  
  
  METHODS
  A screening of 3932 randomly selected (mean age 56 years, 46% male) individuals from Germany and Denmark free of cardiovascular disease was performed. Traditional risk factors were determined, and the HeartScore was measured using both the low-risk and the high-risk country models. A non-contrast Cardiac-CT scan was performed to detect coronary artery calcification (CAC).
  
  
  RESULTS
  Agreement of HeartScore risk groups with CAC groups was poor, but higher when applying the algorithm for the low-risk compared to the high-risk country model (agreement rate: 77% versus 63%, and weighted Kappa: 0.22 versus 0.15). However, the number of subjects with severe coronary calcification (CAC score ≥400) increased in the low and intermediate HeartScore risk group from 78 to 147 participants (from 2.7 % to 4.2 %, p = 0.001), when estimating the risk based on the algorithm for low-risk countries.
  
  
  CONCLUSIONS
  As a consequence of the reclassification of Germany and Denmark as low-risk countries more people with severe atherosclerosis will be classified as having a low or intermediate risk of fatal cardiovascular disease.
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark. Electronic address: axel.diederichsen@rsyd.dk.
authors.forename: Axel C P
authors.initials: AC
authors.lastname: Diederichsen
authors.affiliation: Department of Cardiology, West-German Heart Centre, University Hospital of Essen, Germany.
authors.forename: Amir-Abbas
authors.initials: AA
authors.lastname: Mahabadi
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Denmark; Centre of Health Economics Research, University of Southern Denmark, Denmark.
authors.forename: Oke
authors.initials: O
authors.lastname: Gerke
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.affiliation: Department of Cardiology, Sydvestjysk Hospital, Denmark.
authors.forename: Niels P
authors.initials: NP
authors.lastname: Sand
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Department of Cardiology, Svendborg Hospital, Denmark.
authors.forename: Jess
authors.initials: J
authors.lastname: Lambrechtsen
authors.affiliation: Department of Cardiology, West-German Heart Centre, University Hospital of Essen, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Kälsch
authors.affiliation: Department of Cardiology, Aarhus University Hospital-Skejby, Denmark.
authors.forename: Jesper M
authors.initials: JM
authors.lastname: Jensen
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Mickley
authors.affiliation: Department of Cardiology, West-German Heart Centre, University Hospital of Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
mesh_terms: D000368:Aged; D000465:Algorithms; D050197:Atherosclerosis / Q000175:diagnosis / Q000517:prevention & control; D002114:Calcinosis / Q000175:diagnosis* / Q000517:prevention & control; D002309:Cardiology / Q000592:standards*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000517:prevention & control; D003331:Coronary Vessels / Q000503:physiopathology; D003718:Denmark; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index
keywords: Atherosclerosis; Cardiovascular disease; Coronary artery calcium; Epidemiology; Risk factors; Risk prevention