Should non-cardiovascular mortality be considered in the SCORE model? Findings from the Prevention of Renal and Vascular End-stage Disease (PREVEND) cohort

Demissei, B. G., Postmus, D., Valente, M. A., van der Harst, P., van Gilst, W. H., Van den Heuvel, E. R. & Hillege, H. L., Jan-2015, In : European Journal of Epidemiology. 30, 1, p. 47-56 10 p.

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  • Should non-cardiovascular mortality be considered in the SCORE model

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Competing non-cardiovascular related deaths were not accounted for in the Systematic COronary Risk Evaluation (SCORE) model. In this study we assessed the impact of non-cardiovascular related deaths on the prognostic performance and yield of the SCORE model. 5,752 participants from the Prevention of Renal and Vascular End stage Disease cohort aged 40 years and older who were free of atherosclerotic cardiovascular disease (CVD) at baseline were included. A cause-specific hazards (CSH) CVD-related mortality prediction model that accounted for non-CVD-related deaths was developed. The prognostic performance of this model was then compared with a refitted SCORE model. During a median follow-up period of 12.5 years, 139 CVD and 495 non-CVD-related deaths were reported. Discriminatory performance was comparable between the models (C-index = 0.64). The models showed good calibration although the CSH model underestimated risk in the highest decile while the refitted SCORE model showed overestimation. The CSH model classified more non-events into the low risk group compared to the refitted SCORE model (n = 51), yet it was accompanied by a misclassification of six events into the low risk group. The refitted SCORE model classified more individuals as high risk. However, the potential overtreatment that may result from utilizing the refitted SCORE model, when compared with the CSH model, still falls within acceptable limits. Our findings do not support the incorporation of non-cardiovascular mortality into the estimation of total cardiovascular risk in the SCORE model.

Original languageEnglish
Pages (from-to)47-56
Number of pages10
JournalEuropean Journal of Epidemiology
Issue number1
Publication statusPublished - Jan-2015


  • Competing risks, Total cardiovascular risk, SCORE, Primary prevention, Risk misclassification, Overtreatment, URINARY ALBUMIN EXCRETION, COMPETING RISKS, GENERAL-POPULATION, CHOLESTEROL, VALIDATION, STATINS

ID: 20251995