Highlights
- •SCORE periodical calibration is needed in countries with changing CVD epidemiology.
- •SCORE charts can also identify individuals at increased risk of cancer.
- •Rigorous cancer screening may be considered in individuals with SCORE ≥5%.
Abstract
Background
Cardiovascular disease (CVD) followed by cancer are the two leading causes of death
worldwide. SCORE charts have been recommended in Europe to identify individuals at
increased CVD risk. However, the SCORE ability to identify individuals at increased
risk of cancer has not yet been evaluated. The aim of this study was to determine
the SCORE chart calibration in a country with changing CVD epidemiology, and its discrimination
ability to identify individuals at increased risk of cancer over 20-years.
Methods
The present analysis includes data from two cross-sectional independent surveys within
the Czech post-MONICA study (randomly selected representative population samples of
the Czech Republic, aged 25–64 years); 3209 individuals in 1997/98 and 3612 in 2006–2009.
Results
The SCORE had reasonable discrimination to predict 10-year CVD mortality, but significantly
overestimated the risk across all risk categories. During the 20-year follow up, high
and very high-risk categories were associated with an increased risk of cancer morbidity
(in particular colorectal, other gastrointestinal, lung and malignant skin) and cancer
mortality, as compared to low risk category.
Conclusions
The present study shows that periodical calibration testing of SCORE charts is needed
in countries with changing CVD epidemiology. Furthermore, we show that in middle-aged
individuals, identified by SCORE charts as being at high or very high risk for CVD,
cancer morbidity and cancer mortality is increased. Rigorous cancer screening may
be appropriate in this group, especially in countries with falling CVD mortality,
where relative proportion of cancer mortality is increasing.
Keywords
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Article info
Publication history
Published online: June 10, 2020
Accepted:
May 22,
2020
Received in revised form:
May 17,
2020
Received:
February 10,
2020
Identification
Copyright
Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
