METHODS FOR ASSESSING TOTAL CARDIOVASCULAR RISK AND PREDICTING CAROTID ATHEROSCLEROSIS IN PRIMARY PREVENTION

Objective: The estimation of total cardiovascular risk (CVR) in primary prevention, using risk assessment tools, is essential for optimal clinical decision making. The aim of this study was to determine the predictive value of the available risk assessment tools [Systematic Coronary Risk Evaluation 2 (SCORE2), Pooled Cohort Equations (PCE), Predicting Risk of cardiovascular disease EVENTs (PREVENT)] with regard to carotid atherosclerosis. Design and method: The study was conducted in a general population sample (age 40-69 years without established cardiovascular disease) recruited in the context of screening programs of 2 municipalities in Attica, Greece during the period 2023-2024. Individuals were classified as (i) low-moderate CVR (SCORE2 <2.5/5% for 40-49/50-69 age group, PCE and PREVENT scores <7.5%) and (ii) high/very high CVR for the other values. Individuals with carotid plaque were categorized as high/very high CVR. Results: A total of 767 participants were analyzed (age 57.6±7.8 years, men 44.1%, smokers 29.5%, antihypertensive/lipid lowering drug treatment 43.3/51.2% respectively, systolic/diastolic blood pressure 123.7±14.4/76.5±9.5 mmHg, SCORE2 5.4±3.5%, PCE 7.1±6.3%, PREVENT 3.8±2.6%). The percentage of participants who were classified as high/very high CVR was 51.2%/34.2%/8.5% with SCORE2/PCE/PREVENT respectively and 55.7% were categorized as high/very high CVR due to the presence of carotid atherosclerosis. The ROC curve was comparable for all assessment risk tools in terms of carotid atherosclerosis (AUC 0.754/0.756/0.749 for SCORE2/PCE/PREVENT respectively). After applying the CVR classification thresholds, the agreement with carotid atherosclerosis was 65.6% (kappa 0.31, p<0.05)/62.6% (0.28, p<0.05)/50.5% (0.09, p<0.05) for SCORE2/PCE/PREVENT respectively. 39.8% of the individuals were identified as low-moderate CVR based on SCORE2 were reclassified as high/very high CVR based on carotid ultrasonography. Among individuals who were identified as high/very high CVR based on SCORE2 (i) 11.6% had LDL <70 mg/dl and (ii) 49.9% had blood pressure <130/80 mmHg. Conclusions: In this European middle-aged population, the predictive value of CVR assessment tools appears to be moderate for identifying carotid atherosclerosis; yet, SCORE2 outperformed PCE/PREVENT scores. Moreover, the control rates of modifiable CVR factors were unsatisfactory predicting increased risk.