Comparisons of cardiovascular risk scores in patients with obstructive sleep apnea - the European Sleep Apnea Database (ESADA)

<bold>Introduction:</bold> The Systemic Coronary Risk Evaluation 2 (SCORE2), which evaluates 10-year risk of a cardiovascular (CV) event, was proposed as a decision-aid tool for obstructive sleep apnea (OSA) management (Hrubos-Strøm, Bergqvist, & Zou, 2023). We compared SCORE2 with the Framingham Risk Score (FRS) and the Pooled Cohort Equation (PCE) in a Pan-European OSA cohort. <bold>Methods:</bold> 7501 patients with no history of cardiac disease nor diabetes (69.4% males, age 55±10 yrs, BMI 32±6 kg/m², apnea hypopnea index [AHI] 35±26/h) were included in the retrospective analysis. OSA severity was graded as non-OSA, mild, moderate, and severe (AHI <5, 5-14.9, 15-29.9, and ≥30/h, respectively). CV risk were calculated and designated as low, moderate or high risk class according to each of the three algorithms. <bold>Results:</bold> OSA severity was associated with increased CV risk in all risk scores (all <bold>P <0.001</bold>). Compared to SCORE2, FRS and PCE classified fewer patients as moderate/high CV risk (<bold>Table</bold>). The discrepancy was similar across OSA severities. <table-wrap><object-id>erj;64/suppl_68/PA5349/T1</object-id><object-id>T1</object-id><object-id>t1</object-id><table><colgroup><col></col><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td></td><td> <bold>All patients</bold> (n=7501) </td><td> <bold>SCORE2</bold> <bold>Low risk</bold> (n=2353, 31%) </td><td> <bold>SCORE2</bold> <bold>Moderate risk</bold> (n=3436, 46%) </td><td> <bold>SCORE2</bold> <bold>High risk</bold> (n=1712, 23%) </td></tr><tr><td><bold>FRS</bold></td><td><bold>Low</bold></td><td> 4898 (65%) </td><td>2326 (99%)</td><td>2246 (65%)</td><td>326 (19%)</td></tr><tr><td><bold>Moderate</bold></td><td> 2009 (27%) </td><td> 27 (1%) </td><td> 1115 (33%) </td><td>867 (51%)</td></tr><tr><td><bold>High</bold></td><td> 594 (8%) </td><td> 0 (0) </td><td> 75 (2%) </td><td>519 (30%)</td></tr><tr><td><bold>PCE</bold></td><td><bold>Low</bold></td><td> 4197 (56%) </td><td> 2290 (97%) </td><td> 1798 (52%) </td><td> 109 (6%) </td></tr><tr><td><bold>Moderate</bold></td><td> 2576 (34%) </td><td> 63 (3%) </td><td> 1593 (46%) </td><td>920 (54%)</td></tr><tr><td><bold>High</bold></td><td>728 (10%)</td><td>0 (0)</td><td> 45 (1%) </td><td>683 (40%)</td></tr></tbody></table></table-wrap> <bold>Conclusions:</bold> Geographic risk region based SCORE2 algorithm identified low CV risk patients with high specificity in ESADA. SCORE2 provides novel insights of CV risk profile and is useful for treatment stratification in OSA patients.