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SCORE underestimates cardiovascular mortality in hypertension: insight from the OLD-HTA and NEW-HTA Lyon cohorts

Abstract : Abstract Aims Current European guidelines recommend the SCORE to estimate 10-year cardiovascular mortality in patients with moderate/low cardiovascular risk. SCORE was derived from the general population. The objective of this study was to investigate the estimated 10-year cardiovascular mortality according to the SCORE in a historic and a contemporary cohort of hypertensive patients. Methods and results After exclusion of secondary prevention and diabetes, 3086 patients were analysed in the OLD-HTA (1969–90) and 1081 in the NEW-HTA (1997–2014) Lyon cohorts. SCORE was calculated using the low and high cardiovascular risk equations and charts, and patients classified as being at low (0%), moderate (1–4%), high (5–9%), and very high (≥10%) risk. In the OLD-HTA cohort, 10-year cardiovascular mortality was higher (1.2%, 5.5%, 17.7%, and 27.0%) than that predicted by the low-risk equation (0%, 1.7%, 6.4%, and 14.8%). In the NEW-HTA cohort, similar results were observed (1.1%, 4.7%, 15.1%, and 15.2% vs. 0%, 1.9%, 6.2%, and 11.7%, respectively). Using the high-risk equation, mortality was underestimated in both cohorts, but the difference was smaller. The diagnostic performance of the high-risk equation was lower than the low-risk equation in both cohorts, considering the SCORE as a continuous or a categorical variable (Likelihood ratio test P < 0.05 for all comparisons in OLD-HTA). Similar results were obtained using SCORE charts. Conclusion SCORE underestimates the 10-year cardiovascular mortality risk in hypertensive patients in a historic cohort and in a contemporary one. The algorithm to predict cardiovascular mortality in hypertensive patients needs an update given new information since its creation.
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https://hal-cnrs.archives-ouvertes.fr/hal-03538694
Contributor : Damien Garcia Connect in order to contact the contributor
Submitted on : Friday, January 21, 2022 - 11:07:25 AM
Last modification on : Sunday, September 25, 2022 - 3:56:26 AM

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Pierre-Yves Courand, Jerôme Lenoir, Adrien Grandjean, Damien Garcia, Brahim Harbaoui, et al.. SCORE underestimates cardiovascular mortality in hypertension: insight from the OLD-HTA and NEW-HTA Lyon cohorts. European Journal of Preventive Cardiology, Sage Publications, 2021, ⟨10.1093/eurjpc/zwaa163⟩. ⟨hal-03538694⟩

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