title: An evaluation of the performance of SCORE Sweden 2015 in estimating cardiovascular risk: The Northern Sweden MONICA Study 1999-2014.
abstract: Risk prediction models for cardiovascular death are important for providing advice on lifestyle and in decision-making regarding primary preventive drug treatment. The latest Swedish version of the Systematic COronary Risk Evaluation (SCORE 2015) has yet not been tested in the population.
  
  
  
  The objective of this study was to estimate the prevalence of high and very high risk of fatal cardiovascular disease (CVD) of the current population according to 2015 SCORE Sweden and to evaluate the predictive accuracy of the 2003 Swedish version of SCORE (2003 SCORE Sweden) and 2015 SCORE Sweden in a population with declining CVD mortality.
  
  
  
  We estimated the high and very high risk group for cardiovascular death for individuals 40-65 years of age in the 2014 Northern Sweden MONICA population survey excluding subjects with known diabetes or previous CVD (n = 813). Using the 1999 MONICA survey (n = 3347) followed up for 10 years for CVD mortality, we assessed the calibration of both 2003 and 2015 SCORE Sweden.
  
  
  
  In 2014 2.6% of the population was considered at high or very high risk for fatal CVD, 95% were men and 76% were in the age group 60-65 years. Including subjects with a single markedly elevated risk factor, known diabetes or CVD, 12% of the population was at high or very high risk. During 10 years of follow-up of the 1999 cohort, 34 CVD deaths (24 men and 10 women) occurred. The 2003 SCORE overestimated the risk of death from CVD (ratio predicted/observed 2.3, P < 0.001) whereas the 2015 SCORE slightly overestimated the number of deaths (predicted/observed 1.3, P = 0.12). The 2015 SCORE predicted more accurately than the 2003 SCORE the number of deaths in the different risk and age categories.
  
  
  
  The 2015 SCORE Sweden more adequately than 2003 SCORE Sweden predicts the number of deaths. In 2014, the proportion of high-risk individuals is small in northern Sweden. The main use of 2015 SCORE Sweden would therefore be as an educational tool between the physician and people without diabetes or CVD in a consultation regarding cardiovascular risk.
authors.affiliation: Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeu University, Sweden.
authors.forename: Tina
authors.initials: T
authors.lastname: Karjalainen
authors.affiliation: Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden.|Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Adiels
authors.affiliation: Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden.|Institute of Health and Care Sciences, University of Gothenburg, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Björck
authors.affiliation: Department of Medicine, St Vincent's Hospital, Ireland.
authors.forename: Marie-Therèse
authors.initials: MT
authors.lastname: Cooney
authors.affiliation: Trinity College Dublin, Ireland.
authors.forename: Ian
authors.initials: I
authors.lastname: Graham
authors.affiliation: Department of Health and Life Sciences, Linnaeus University, Sweden.
authors.forename: Joep
authors.initials: J
authors.lastname: Perk
authors.affiliation: Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeu University, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Söderberg
authors.affiliation: Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeu University, Sweden mats.eliasson@nll.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Eliasson
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
keywords: Cardiovascular disease; SCORE; cohort study; mortality; prediction