Calibrating the SCORE cardiovascular risk chart for use in Spain

Introduction and objectives. The Third Joint European Task Force on cardiovascular prevention recommended the SCORE function for predicting 10-year cardiovascular mortality should be used to guide decision-making on clinical interventions. The objective of the present study was to calibrate the function for use in Spain. Methods. A model was developed to apply the hazard ratios for cardiovascular mortality at 10 years in SCORE study cohorts to the mean age- and sex-specific risk factors found in the third survey of the MONICA-Catalonia study (1994-96) and to 10-year cardiovascular survival function for the Spanish population based on mortality rates for the year 2002. Results. The estimated risks derived using the calibrated SCORE function were 13% higher than those estimated using the low-risk algorithm. However, the differences between the two varied with age, sex, and, in particular, smoking history. The calibrated SCORE risk chart identified 32 high-risk situations that were not registered in the original low-risk SCORE chart. However, 50% of these situations had a low or zero prevalence. The maximum percentage of subjects who were newly identified as being at a high risk using the calibrated chart was 22%. Most differences were observed in men aged over 55 years. Conclusions. While risk estimates based on sufficiently large Spanish population cohorts are still not available, application of the original cardiovascular risk function calibrated for use in Spain should enable the appropriate clinical and public health decisions to be taken.