BACKGROUND AND OBJECTIVE: The SCORE scale predicts the 10-year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk version of SCORE is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), due to high CVD mortality rates in these countries. Given the pronounced social gradient in cardiovascular mortality in the region, it is important to consider social factors in the CVD risk prediction. We investigated whether adding education and marital status to SCORE benefits its prognostic performance in two sets of population-based CEE/FSU cohorts. METHODS: The WHO MONICA (MONItoring of trends and determinants in CArdiovascular disease) cohorts from the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s (577 atherosclerotic CVD deaths among 14,969 participants with non-missing data). The HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05 (395 atherosclerotic CVD deaths in 19,900 individuals with non-missing data). RESULTS: In MONICA and HAPIEE, the high-risk SCORE ≥5% at baseline strongly and significantly predicted fatal CVD both before and after adjustment for education and marital status. After controlling for SCORE, lower education and non-married status were significantly associated with CVD mortality in some samples. SCORE extension by these additional risk factors only slightly improved indices of calibration and discrimination (integrated discrimination improvement <5% in men and ≤1% in women). CONCLUSION: Extending SCORE by education and marital status failed to substantially improve its prognostic performance in population-based CEE/FSU cohorts.

Department of CVD Epidemiology Prevention and Health Promotion the Cardinal Stefan Wyszynski Institute of Cardiology Warsaw Poland

Department of Epidemiology and Population Sciences Institute of Public Health Faculty of Health Sciences Jagiellonian University Medical College Krakow Poland

Environmental Health Monitoring System National Institute of Public Health Prague Czech Republic

Epidemiology and Public Health Department University College London London United Kingdom

Institute of Internal and Preventive Medicine Siberian Branch of the Russian Academy of Medical Sciences Novosibirsk Russia

Institute of Internal and Preventive Medicine Siberian Branch of the Russian Academy of Medical Sciences Novosibirsk Russia; State Novosibirsk Medical University Novosibirsk Russia

Laboratory of Population Research Institute of Cardiology Lithuanian University of Health Sciences Kaunas Lithuania

Preventive Cardiology Department Institute of Clinical and Experimental Medicine Prague Czech Republic

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Development and validation of two SCORE-based cardiovascular risk prediction models for Eastern Europe: a multicohort study