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Estimating the performance of three cardiovascular disease risk scores: the Estonian Biobank cohort study
- Source :
- Journal of Epidemiology and Community Health. 73:272-277
- Publication Year :
- 2019
- Publisher :
- BMJ, 2019.
-
Abstract
- BackgroundWe aim to investigate the predictive ability of PCE (Pooled Cohort Equations), QRISK2 and SCORE (Systematic COronary Risk Estimation) scoring systems for atherosclerotic cardiovascular disease (ASCVD) risk prediction in Estonia, a country with one of the highest ASCVD event rates in Europe.MethodsSeven-year risk estimates were calculated in risk score–specific subsets of the Estonian Biobank cohort. Calibration was assessed by standardised incidence ratios (SIRs) and discrimination by Harrell’s C-statistics. In addition, a head-to-head comparison of the scores was performed in the intersection of the three score-specific subcohorts.ResultsPCE, QRISK2 and SCORE risk estimates were calculated for 4356, 7191 and 3987 eligible individuals, respectively. During the 7-year follow-up, 220 hard ASCVD events (PCE outcome), 671 ASCVD events (QRISK2 outcome) and 94 ASCVD deaths (SCORE outcome) occurred among the score-specific subsets of the cohort. While PCE (SIR 1.03, 95% CI 0.90 to 1.18) and SCORE (SIR 0.99, 95% CI 0.81 to 1.21) were calibrated well for the cohort, QRISK2 underestimated the risk by 48% (SIR 0.52, 95% CI 0.48 to 0.56). In terms of discrimination, PCE (C-statistic 0.778) was inferior to QRISK2 (C-statistic 0.812) and SCORE (C-statistic 0.865). All three risk scores performed at similar level in the head-to-head comparison.ConclusionOf three widely used ASCVD risk scores, PCE and SCORE performed at acceptable level, while QRISK2 underestimated ASCVD risk markedly. These results highlight the need for evaluating the accuracy of ASCVD risk scores prior to use in high-risk populations.
- Subjects :
- Adult
Estonia
Male
Epidemiology
030204 cardiovascular system & hematology
Risk Assessment
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Humans
Medicine
030212 general & internal medicine
Aged
business.industry
Atherosclerotic cardiovascular disease
Incidence
Incidence (epidemiology)
Public Health, Environmental and Occupational Health
Middle Aged
Atherosclerosis
Biobank
Cardiovascular Diseases
Predictive value of tests
Cohort
Disease risk
Female
business
Risk assessment
Demography
Cohort study
Subjects
Details
- ISSN :
- 14702738 and 0143005X
- Volume :
- 73
- Database :
- OpenAIRE
- Journal :
- Journal of Epidemiology and Community Health
- Accession number :
- edsair.doi.dedup.....0b8206e3fcb761aed3896b089c054996