Use of Mediterranean Diet Adherence and Physical Activity for Refining Cardiovascular Risk Prediction in the General Population - Insights from the CoLaus/PsyCoLaus Study

AIM: The SCORE2/SCORE2-OP, recommended for estimating 10-year risk of first atherosclerotic cardiovascular disease (ASCVD), does not include lifestyle factors. We investigated whether adding self-reported physical activity and Mediterranean diet adherence improves prediction beyond SCORE2/SCORE2-OP. METHODS: We included participants from the population-based CoLaus|PsyCoLaus cohort with data for the Physical Activity Frequency Questionnaire (PAFQ) and Mediterranean Diet Score (MedDietScore). We fitted Cox-regression models including SCORE2 or SCORE2-OP as covariates, depending on the participants' age, alone or in addition to PAFQ, MedDietScore or both. We assessed discrimination (Harrell's C), calibration slope, and net reclassification improvement (NRI) for all models. RESULTS: A total of 2,587 participants (59% women) were followed for a median duration of 9.0 years (IQR: 8.13-11.6), during which 145 ASCVD events occurred. 2,348 were younger than 70 years and evaluated using SCORE2, with 106 ASCVD events. The remaining 239 were aged 70 years or older and assessed with SCORE2-OP, with 39 ASCVD events. Adding physical activity or diet or both to SCORE2 did not improve discrimination (Harrell's C: 0.74 for all models), calibration (slope: 1.06 for all), or reclassification (continuous total NRI: -8.8 to 2.5%). Adding both lifestyle factors to SCORE2-OP improved discrimination (Harrell's C: 0.63 to 0.66), calibration (slope: 1.34 for SCORE2-OP to 1.16 for full model) and reclassification (continuous total NRI: 41% (95%CI 7-74%) with event NRI of 28% and non-event NRI of 13%). CONCLUSION: The addition of self-reported physical activity and Mediterranean diet may provide modest incremental value to improve ASCVD risk prediction in older adults beyond the traditional SCORE2-OP.