SCORE2 and derived model based on traditional risk factors in predicting cardiovascular disease mortality. 18 years follow-up of the Polish cohort participating in the HAPIEE Study

INTRODUCTION: Accurate risk prediction in cardiovascular disease (CVD) is crucial for personalized preventive medicine. OBJECTIVES: The study aimed to evaluate the effect of traditional risk factors on CVD mortality, and to validate the prognostic performance of the Systematic Coronary Risk Evaluation 2 (SCORE2) model for the prediction of 18‑year risk of CVD death. PATIENTS AND METHODS: Our cohort study included 6780 residents of Kraków (54% women), free of CVD and diabetes at baseline, recruited between 2002 and 2005. Mean (SD) baseline age was 57.2 (6.9) years for men and 56.6 (6.8) years for women. RESULTS: In 50 246 and 62 906 person‑years of follow‑up in men and women, respectively, cumulative CVD mortality was 9% in men and 5.2% in women, with competing (non‑CVD) mortality of 19.2% and 12%, respectively. Smoking and hypertension were strongly associated with CVD mortality, whereas associations with total cholesterol (TC) and high‑density lipoprotein cholesterol (HDL‑C) levels were weaker. A newly‑derived model including age, smoking, systolic blood pressure, TC, and HDL‑C achieved Harrell C index of 0.693 in men and 0.757 in women. The model including SCORE2 as a continuous variable showed similar discrimination (Harrell C index of 0.718 in men and 0.754 in women), while SCORE2 categories demonstrated poorer predictive performance (Harrell C index of 0.589 and 0.676, respectively). CONCLUSIONS: Smoking and elevated blood pressure were confirmed as major long‑term predictors of CVD mortality. The prognostic performance of SCORE2 as a continuous measure was good and comparable to the derived prediction model including age and traditional risk factors. However, the predictive accuracy of SCORE2 categories was lower, particularly in men.