Cardiovascular risk according to the SCORE, SCORE2, and SCORE2-RF scales in the nationwide study ESSE-RF of 2012-2022 and its dependence on regional living conditions

Aim. To conduct a comparative analysis of individual cardiovascular risk (CVR) assessment using three versions of the SCORE scale and to evaluate the associations of risk with regional living conditions.

Material and methods. Individual data from the cross-sectional phase of the ESSE-RF study in 2012-2014, 2017-2018, and 2020-2022 were used for the analysis. The analytical sample included 15,298 women and 10,861 men aged 40-64 years without a history of stroke, coronary heart disease, myocardial infarction, or diabetes, and without missing data. Individual CVR was assessed using the SCORE, SCORE2, and SCORE2-RF scales. The annual Economic, Demographic, Industrial, and Social Indexes of the National Medical Research Center for Therapy and Preventive Medicine were used as regional characteristics. Linear regression was used for quantitative outcomes, and logistic regression for binary outcomes. Logistic regression associations are expressed as odds ratios (ORs) and 95% confidence intervals.

Results. According to the SCORE scale, the proportion of individuals with high/very high cardiovascular risk (CVR) is 2.2% among women and 28.8% among men; according to SCORE2, the proportions are 25.7% and 54.7%; and according to SCORE2-RF, the proportions are 6.8% and 12.9%, respectively. Improvements in demographics (only for women) and social conditions in a region are associated with a reduced likelihood of high/very high CVR. Thus, an increase in the quintile of the Demographic Index is associated in women with a decrease in the likelihood of high/very high CVR: according to SCORE OR=0.81 (0.73-0.90), according to SCORE2 OR=0.94 (0.90-0.97), according to SCORE2-RF OR=0.88 (0.83-0.94). An increase in the quintile of the Social Index in women is associated with a decrease in the likelihood of high / very high CVR: according to SCORE OR=0.85 (0.77-0.94), according to SCORE2 OR=0.95 (0.92-0.99), according to SCORE2-RF OR=0.93 (0.88-0.98). In men, an increasing Social Index quintile is associated with a decreased likelihood of high/very high cardiovascular risk: according to SCORE, OR =0.91 (0.87-0.96), according to SCORE2-RF, OR=0.92 (0.87-0.96).

Conclusion. The study results suggest that the calibrated version of the SCORE2-RF scale is the most acceptable for practical use in preventive cardiology. Regional demographic and social conditions are associated with the profile of cardiovascular risk factors and can potentially be considered as population health factors. For Russia, a geographically diverse country, taking into account regional characteristics of the population allows for differentiation of prevention, as well as its focus and assessment of effectiveness.

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