From SCORE2 to SCORE2-RF: development of a Russian model for cardiovascular risk stratification

Aim. To validate the European SCORE2 scale for assessing the 10-year risk of fatal and non-fatal cardiovascular events in the Russian population and to develop an adapted local version of the scale (SCORE2-RF) with defined thresholds for risk stratification.

Material and methods. The analysis was performed on data from the prospective follow-up of the Russian cohort of the ESSE-RF study (2012-2014, 10 regions). The final sample included participants aged 40-64 years without a history of cardiovascular disease (CVD) or diabetes mellitus. The median follow-up was 11.5 years. The combined endpoint included death from cardiovascular causes, non-fatal myocardial infarction, and/or stroke. Data collection involved questionnaires, anthropometry, and laboratory tests. Тo assess the associations of risk factors with the combined cardiovascular endpoint, a Fine–Gray competing risks model with stratification by region and type of settlement was used. The calculated hazard ratios were converted into absolute probabilities. The prediction accuracy of the original and adapted scales was assessed using Bland–Altman plots and calibration coefficients.

Results. The Fine–Gray model confirmed a statistically significant association with the combined endpoint for most SCORE2 components (age, systolic blood pressure, total cholesterol, smoking) in men. In women, smoking did not show a significant association (HR 1.18; 95% CI: 0.73-1.91). Validation showed that the original SCORE2 scale satisfactorily predicted risk for Russian men, slightly overestimating it (by 0.96 percentage points or by a factor of 1.11), but the prognosis for women was significantly overestimated – on average by 3.12 percentage points or by a factor of 1.72. Based on the constructed Fine–Gray model, an adapted SCORE2-RF scale was developed. To avoid shifting most of the population into the high-risk category when using the original SCORE2 thresholds, new stratification criteria were proposed, based on the percentile distribution of risk within each age-sex group (low/moderate, high, very high risk).

Conclusion. The adapted SCORE2-RF scale, developed based on Russian population data and using new threshold values, is a more accurate and practical tool for risk stratification and clinical decision-making in the Russian healthcare setting.

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