Original article| Volume 79, P63-69, September 2020

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Systematic COronary Risk Evaluation (SCORE) and 20-year risk of cardiovascular mortality and cancer


      • 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%.



      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.


      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.


      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.


      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.


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        • Roth G.A.
        • Abate D.
        • Abate K.H.
        • et al.
        Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017.
        The Lancet. 2018; 392: 1736-1788
        • Mach F.
        • Baigent C.
        • Catapano A.L.
        • et al.
        2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.
        Atherosclerosis. 2019; 290: 140-205
        • Piepoli M.F.
        • Hoes A.W.
        • Agewall S.
        • et al.
        2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).
        European Heart J. 2016; 37: 2315-2381
        • Conroy R.M.
        • Pyorala K.
        • Fitzgerald A.P.
        • et al.
        Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.
        Eur Heart J. 2003; 24: 987-1003
        • Cifkova R.
        • Skodova Z.
        • Bruthans J.
        • et al.
        Longitudinal trends in cardiovascular mortality and blood pressure levels, prevalence, awareness, treatment, and control of hypertension in the Czech population from 1985 to 2007/2008.
        J Hypertens. 2010; 28: 2196-2203
        • Bruthans J.
        • Cífková R.
        • Lánská V.
        • et al.
        Explaining the decline in coronary heart disease mortality in the Czech Republic between 1985 and 2007.
        Eur J Prev Cardiol. 2012; 21: 829-839
        • Johnson C.B.
        • Davis M.K.
        • Law A.
        • Sulpher J
        Shared Risk Factors for Cardiovascular Disease and Cancer: implications for Preventive Health and Clinical Care in Oncology Patients.
        Can J Cardiol. 2016; 32: 900-907
        • Handy C.E.
        • Quispe R.
        • Pinto X.
        • et al.
        Synergistic Opportunities in the Interplay Between Cancer Screening and Cardiovascular Disease Risk Assessment.
        Circulation. 2018; 138: 727-734
        • Cifkova R.
        • Skodova Z.
        • Bruthans J.
        • et al.
        Longitudinal trends in major cardiovascular risk factors in the Czech population between 1985 and 2007/8.
        Czech MONICA and Czech post-MONICA. Atherosclerosis. 2010; 211: 676-681
        • Steyerberg E.W.
        • Vickers A.J.
        • Cook N.R.
        • et al.
        Assessing the performance of prediction models: a framework for traditional and novel measures.
        Epidemiology. 2010; 21: 128-138
        • Finazzi S.
        • Poole D.
        • Luciani D.
        • Cogo P.E.
        • Bertolini G
        Calibration Belt for Quality-of-Care Assessment Based on Dichotomous Outcomes.
        PLoS ONE. 2011; 6: e16110
        • Pennells L.
        • Kaptoge S.
        • Wood A.
        • et al.
        Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.
        Eur Heart J. 2019; 40: 621-631
      1. SinghJ.B.A. Expert Review: shared modifiable risk factors between cancer and CVD Am Coll Cardiol. 2017;

        • Masoudkabir F.
        • Sarrafzadegan N.
        • Gotay C.
        • et al.
        Cardiovascular disease and cancer: evidence for shared disease pathways and pharmacologic prevention.
        Atherosclerosis. 2017; 263: 343-351
      2. KreatsoulasC., AnandS.S., SubramanianS.V. An emerging double burden of disease: the prevalence of individuals with cardiovascular disease and cancer. 2014;275(5):494–505.

        • Sotos-Prieto M.
        • Mattei J.
        • Cook N.R.
        • et al.
        Association Between a 20-Year Cardiovascular Disease Risk Score Based on Modifiable Lifestyles and Total and Cause-Specific Mortality Among US Men and Women.
        J Am Heart Assoc. 2018; 7e010052
        • van Dam R.M.
        • Li T.
        • Spiegelman D.
        • Franco O.H.
        • Hu F.B
        Combined impact of lifestyle factors on mortality: prospective cohort study in US women.
        BMJ. 2008; 337: a1440
        • van den Brandt P.A.
        The impact of a Mediterranean diet and healthy lifestyle on premature mortality in men and women.
        Am J Clin Nutr. 2011; 94: 913-920