| Title: | Including measures of chronic kidney disease to improve cardiovascular risk prediction by SCORE2 and SCORE2-OP |
| Journal: | European Journal of Preventive Cardiology |
| Published: | 16 Aug 2022 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/35972749/ |
| DOI: | https://doi.org/10.1093/eurjpc/zwac176 |
Publication 10438
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Abstract
AIMS: The 2021 European Society of Cardiology (ESC) guideline on cardiovascular disease (CVD) prevention categorizes moderate and severe chronic kidney disease (CKD) as high and very-high CVD risk status regardless of other factors like age and does not include estimated glomerular filtration rate (eGFR) and albuminuria in its algorithms, systemic coronary risk estimation 2 (SCORE2) and systemic coronary risk estimation 2 in older persons (SCORE2-OP), to predict CVD risk. We developed and validated an 'Add-on' to incorporate CKD measures into these algorithms, using a validated approach.</p>
METHODS: In 3,054 840 participants from 34 datasets, we developed three Add-ons [eGFR only, eGFR + urinary albumin-to-creatinine ratio (ACR) (the primary Add-on), and eGFR + dipstick proteinuria] for SCORE2 and SCORE2-OP. We validated C-statistics and net reclassification improvement (NRI), accounting for competing risk of non-CVD death, in 5,997 719 participants from 34 different datasets.</p>
RESULTS: In the target population of SCORE2 and SCORE2-OP without diabetes, the CKD Add-on (eGFR only) and CKD Add-on (eGFR + ACR) improved C-statistic by 0.006 (95%CI 0.004-0.008) and 0.016 (0.010-0.023), respectively, for SCORE2 and 0.012 (0.009-0.015) and 0.024 (0.014-0.035), respectively, for SCORE2-OP. Similar results were seen when we included individuals with diabetes and tested the CKD Add-on (eGFR + dipstick). In 57 485 European participants with CKD, SCORE2 or SCORE2-OP with a CKD Add-on showed a significant NRI [e.g. 0.100 (0.062-0.138) for SCORE2] compared to the qualitative approach in the ESC guideline.</p>
CONCLUSION: Our Add-ons with CKD measures improved CVD risk prediction beyond SCORE2 and SCORE2-OP. This approach will help clinicians and patients with CKD refine risk prediction and further personalize preventive therapies for CVD.</p>
59 Authors
- Kunihiro Matsushita
- Stephen Kaptoge
- Steven H J Hageman
- Yingying Sang
- Shoshana H Ballew
- Morgan E Grams
- Aditya Surapaneni
- Luanluan Sun
- Johan Arnlov
- Milica Bozic
- Hermann Brenner
- Nigel J Brunskill
- Alex R Chang
- Rajkumar Chinnadurai
- Massimo Cirillo
- Adolfo Correa
- Natalie Ebert
- Kai-Uwe Eckardt
- Ron T Gansevoort
- Orlando Gutierrez
- Farzad Hadaegh
- Jiang He
- Shih-Jen Hwang
- Tazeen H Jafar
- Simerjot K Jassal
- Takamasa Kayama
- Csaba P Kovesdy
- Gijs W Landman
- Andrew S Levey
- Donald M Lloyd-Jones
- Rupert W Major
- Katsuyuki Miura
- Paul Muntner
- Girish N Nadkarni
- Christoph Nowak
- Takayoshi Ohkubo
- Michelle J Pena
- Kevan R Polkinghorne
- Toshimi Sairenchi
- Elke Schaeffner
- Markus P Schneider
- Varda Shalev
- Michael G Shlipak
- Marit D Solbu
- Nikita Stempniewicz
- James Tollitt
- José M Valdivielso
- Joep van der Leeuw
- Angela Yee-Moon Wang
- Chi-Pang Wen
- Mark Woodward
- Kazumasa Yamagishi
- Hiroshi Yatsuya
- Luxia Zhang
- Jannick A N Dorresteijn
- Emanuele Di Angelantonio
- Frank L J Visseren
- Lisa Pennells
- Josef Coresh
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