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Performance of SCORE2, PREVENT, and Coronary Artery Calcium Scoring in Cardiovascular Risk Prediction: Evidence from a Southern European Population
Session:
Sessão de Posters 16 - Mapeamento do risco: dos scores ao cálcio
Speaker:
francisco sousa
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Francisco Sousa; M. I. Mendonça; G. Abreu; Matilde Ferreira; F. Escórcio Silva; S. Freitas; E. Henriques; M. Rodrigues; S. Borges; A. Drumond; A.C. Sousa; R. Palma Dos Reis
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>SCORE2 and PREVENT are widely used tools for estimating 10-year cardiovascular disease (CVD) risk in individuals without prior CVD, having good accuracy across diverse populations. Coronary Artery Calcium (CAC) scoring provides direct imaging of atherosclerotic plaque, but its relationship with clinical scores in Southern Europeans requires further evaluation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objective: </strong>Assess the correlation and agreement between SCORE2, PREVENT, and CAC in a Southern European population, and compare their ability to discriminate cardiovascular events.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>In a cohort of 352 CVD-free individuals, SCORE2, PREVENT, and CAC scores were calculated. SCORE2 was computed using ESC risk variables for moderate-risk regions; PREVENT incorporated demographic, metabolic, renal and treatment data; CAC was measured using non-contrast CT and expressed in Agatston units. Spearman correlations and Bland–Altman analyses were used to assess agreement between scores. Discriminatory ability was evaluated through ROC and AUC analyses, with ROC curve comparisons performed using the DeLong test.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: There was a strong correlation between SCORE2 and PREVENT (r=0.894; p<0.0001), with a Bland–Altman plot indicating minor but potentially relevant differences (bias of –0.7; limits of agreement from –4.3 to 2.9). SCORE2 had a weak but significant correlation with CAC (r=0.392), and PREVENT showed a moderate correlation with CAC (r=0.356), both with wide limits of agreement, indicating substantial dispersion. ROC-based comparisons revealed no significant differences in AUCs among SCORE2, PREVENT, and CAC (all p>0.05), suggesting similar overall discriminatory accuracy for cardiovascular events.</span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">: Although SCORE2 and PREVENT show strong agreement and can be used interchangeably for population-level risk assessment, their variability relative to CAC underscores that clinical calculators cannot substitute for imaging-based plaque assessment. CAC provides incremental value for refining individual risk assessment, particularly by identifying low-clinical-risk individuals with significant subclinical atherosclerosis.</span></span></p>
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