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, Maneesh Sud Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto , 2075 Bayview Ave, Toronto, M4N 3M5 , Institute of Health Policy, Management, and Evaluation, University of Toronto , 155 College St, Toronto, M5T 3M6 , Canada ICES , 2075 Bayview Ave, D-410, Toronto, M4N 3M5 , Canada Department of Medicine, University of Toronto , 27 King's College Circle, Toronto, M5S 1A1 , Canada Corresponding author. Tel: +416 480 6100, Email: maneesh.sud@sunnybrook.ca Search for other works by this author on: Oxford Academic Atul Sivaswamy ICES , 2075 Bayview Ave, D-410, Toronto, M4N 3M5 , Canada Search for other works by this author on: Oxford Academic Peter C Austin Institute of Health Policy, Management, and Evaluation, University of Toronto , 155 College St, Toronto, M5T 3M6 , Canada ICES , 2075 Bayview Ave, D-410, Toronto, M4N 3M5 , Canada Search for other works by this author on: Oxford Academic Husam Abdel-Qadir Institute of Health Policy, Management, and Evaluation, University of Toronto , 155 College St, Toronto, M5T 3M6 , Canada ICES , 2075 Bayview Ave, D-410, Toronto, M4N 3M5 , Canada Department of Medicine, University of Toronto , 27 King's College Circle, Toronto, M5S 1A1 , Canada Women’s College Hospital, University of Toronto , 76 Grenville St, Toronto, M5S 1B2 , Canada Search for other works by this author on: Oxford Academic Todd J Anderson Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta , 3310 Hospital Drive NW, Calgary, T2N 4N1 , Canada Cumming School of Medicine, University of Calgary , 3330 Hospital Drive NW, Calgary, T2N 4N1 , Canada Search for other works by this author on: Oxford Academic Rohan Khera Section of Cardiovascular Medicine, Departmentof Internal Medicine, Yale School of Medicine , 333 Cedar Street, New Haven, CT 06510 , USA Center for Outcomes Research and Evaluation, Yale-New Haven Health Hospital , 20 York St, New Haven, CT 06510 , USA Section of Health Informatics, Department of Biostatistics, Yale School of Public Health , 60 College St, New Haven, CT 06510 , USA Search for other works by this author on: Oxford Academic David M J Naimark Institute of Health Policy, Management, and Evaluation, University of Toronto , 155 College St, Toronto, M5T 3M6 , Canada ICES , 2075 Bayview Ave, D-410, Toronto, M4N 3M5 , Canada Department of Medicine, University of Toronto , 27 King's College Circle, Toronto, M5S 1A1 , Canada Search for other works by this author on: Oxford Academic Douglas S Lee Institute of Health Policy, Management, and Evaluation, University of Toronto , 155 College St, Toronto, M5T 3M6 , Canada ICES , 2075 Bayview Ave, D-410, Toronto, M4N 3M5 , Canada Department of Medicine, University of Toronto , 27 King's College Circle, Toronto, M5S 1A1 , Canada Peter Munk Cardiac Centre, University Health Network, University of Toronto , 585 University Ave, Toronto, M5G 2N2 , Canada Ted Rogers Centre for Heart Research, University of Toronto, Toronto, 661 University Ave, Toronto, M5G 1M1 , Canada Search for other works by this author on: Oxford Academic Idan Roifman Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto , 2075 Bayview Ave, Toronto, M4N 3M5 , Canada Institute of Health Policy, Management, and Evaluation, University of Toronto , 155 College St, Toronto, M5T 3M6 , Canada ICES , 2075 Bayview Ave, D-410, Toronto, M4N 3M5 , Canada Department of Medicine, University of Toronto , 27 King's College Circle, Toronto, M5S 1A1 , Canada Search for other works by this author on: Oxford Academic George Thanassoulis Department of Medicine, McGill University , 3605 Rue de la Montagne, Montréal, H3G 2M1 , Canada Preventive and Genomic Cardiology, McGill University Health Centre , 1001 boul. Décarie, Montréal, H4A 3J1 , Canada Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0003-1936-5133 , Karen Tu Institute of Health Policy, Management, and Evaluation, University of Toronto , 155 College St, Toronto, M5T 3M6 , Canada Toronto Western Family Health Team, North York General Hospital, University Health Network, University of Toronto , 440 Bathurst Street, Toronto, M5T 2S6 , Canada Department of Family and Community Medicine, University of Toronto , 500 University Ave, Toronto, M5G 1V7 , Canada Search for other works by this author on: Oxford Academic Harindra C Wijeysundera Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto , 2075 Bayview Ave, Toronto, M4N 3M5 , Canada Institute of Health Policy, Management, and Evaluation, University of Toronto , 155 College St, Toronto, M5T 3M6 , Canada ICES , 2075 Bayview Ave, D-410, Toronto, M4N 3M5 , Canada Department of Medicine, University of Toronto , 27 King's College Circle, Toronto, M5S 1A1 , Canada Search for other works by this author on: Oxford Academic Dennis T Ko Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto , 2075 Bayview Ave, Toronto, M4N 3M5 , Canada Institute of Health Policy, Management, and Evaluation, University of Toronto , 155 College St, Toronto, M5T 3M6 , Canada ICES , 2075 Bayview Ave, D-410, Toronto, M4N 3M5 , Canada Department of Medicine, University of Toronto , 27 King's College Circle, Toronto, M5S 1A1 , Canada Search for other works by this author on: Oxford Academic
European Journal of Preventive Cardiology, Volume 31, Issue 6, April 2024, Pages 668–676, https://doi.org/10.1093/eurjpc/zwad352
Published:
08 November 2023
Article history
Received:
18 August 2023
Revision received:
13 October 2023
Accepted:
06 November 2023
Published:
08 November 2023
Corrected and typeset:
28 November 2023
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Maneesh Sud, Atul Sivaswamy, Peter C Austin, Husam Abdel-Qadir, Todd J Anderson, Rohan Khera, David M J Naimark, Douglas S Lee, Idan Roifman, George Thanassoulis, Karen Tu, Harindra C Wijeysundera, Dennis T Ko, Validation of the European SCORE2 models in a Canadian primary care cohort, European Journal of Preventive Cardiology, Volume 31, Issue 6, April 2024, Pages 668–676, https://doi.org/10.1093/eurjpc/zwad352
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Abstract
Aims
Systematic Coronary Risk Evaluation Model 2 (SCORE2) was recently developed to predict atherosclerotic cardiovascular disease (ASCVD) in Europe. Whether these models could be used outside of Europe is not known. The objective of this study was to test the validity of SCORE2 in a large Canadian cohort.
Methods and results
A primary care cohort of persons with routinely collected electronic medical record data from 1 January 2010 to 31 December 2014, in Ontario, Canada, was used for validation. The SCORE2 models for younger persons (YP) were applied to 57 409 individuals aged 40–69 while the models for older persons (OPs) were applied to 9885 individuals 70–89 years of age. Five-year ASCVD predictions from both the uncalibrated and low-risk region recalibrated SCORE2 models were evaluated. The C-statistic for SCORE2-YP was 0.74 in women and 0.69 in men. The uncalibrated SCORE2-YP overestimated risk by 17% in women and underestimated by 2% in men. In contrast, the low-risk region recalibrated model demonstrated worse calibration, overestimating risk by 100% in women and 36% in men. The C-statistic for SCORE2-OP was 0.64 and 0.62 in older women and men, respectively. The uncalibrated SCORE2-OP overestimated risk by more than 100% in both sexes. The low-risk region recalibrated model demonstrated improved calibration but still overestimated risk by 60% in women and 13% in men.
Conclusion
The performance of SCORE2 to predict ASCVD risk in Canada varied by age group and depended on whether regional calibration was applied. This underscores the necessity for validation assessment of SCORE2 prior to implementation in new jurisdictions.
Lay Summary
In this study, new tools [Systematic Coronary Risk Evaluation Model 2 (SCORE2)] that were developed across Europe to predict heart attack and stroke risk in healthy individuals were tested independently for the first time in a Canadian setting. Key findings are as follows:
The accuracy of predictions from SCORE2 in Canadians depends on the age group considered and whether uncalibrated or recalibrated equations are being used.
Independent assessment of tools such as SCORE2 remains useful prior to widespread implementation in new jurisdictions.
Risk prediction, Atherosclerotic cardiovascular disease, Statins, SCORE2, Myocardial infarction, Stroke, Primary prevention
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)
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