Matthew Cavender, MD, MPH: Evolving Landscape of Risk Scores in Cardiology

In recent years, the need to streamline optimal care and better identify patients at risk for cardiovascular events has become a focal point of research efforts in the field of cardiology. Driven by the rising burden of cardiovascular disease and a growing physician shortage, hundreds of different risk scores, algorithms, and machine learning models have been developed for stratifying risk.

At the European Society of Cardiology (ESC) Congress 2024, Matthew Cavender, MD, associate professor of Medicine at the University of North Carolina School of Medicine, presented data assessing the predictive value of the SCORE2-Diabetes risk score, which was debuted at ESC Congress 2023 and is recommended for use by ESC guidelines, for identify patients with type 2 diabetes at risk for cardiovascular events using data from 4 clinical trials.

For the purpose of analysis, Cavender and colleagues pooled data from the DEVOTE, LEADER, PIONEER-6, and SUSTAIN-6 trials, which allowed for the creation of a 23,464-patient cohort for the current study. Among this cohort, the mean follow-up time was 2.6 years.

Investigators stratified patients as low (<5%), moderate (5-<10%), high (10-<20%), and very high risk (≥20%) groups using the uncalibrated version of the score, which does not account for risk-region. Although the risk model is designed to predict 10-year risk, investigators noted outcomes for the current study were reported at 36 months owing to the length of the follow-up period.

Results of the study indicated use of the SCORE2-Diabetes risk score underestimated the incidence of cardiovascular outcomes at 36 months. Further analysis using a regression model found the score independently predicted cardiovascular death, myocardial infarction, or stroke (HRadj 1.03, P <.001) and non-cardiovascular death (HRadj 1.05, P <.001).

Additionally, investigators found including the score in models with only age and sex improved the discrimination and performance of the model. Furthermore, investigators highlighted the c-index for the risk score was 0.62 and 0.66 in the overall cohort and the cohort without known cardiovascular disease, respectively.

For more on the study and the evolving landscape of risk scores and predictive models for cardiovascular disease, check out our interview with Cavender from the conference floor at ESC Congress 2024.

Relevant disclosures for Cavender include Amgen, Bayer, Boehringer Ingelheim, Medtronic, Merck, and Novo Nordisk.

References:

1. M Cavender, A Sorensen, M Bonaca, C Cannon, K Clemmensen, J Buse, K Kvist. Prediction of cardiovascular risk in patients type 2 diabetes using the SCORE2-Diabetes risk score. Presented at: European Society of Cardiology Congress 2024. August 30 - September 2, 2024. London, UK.
2. European Society of Cardiology. Recommendations to reduce cardiovascular risk in patients with diabetes published today. European Society of Cardiology. August 25, 2023. Accessed September 1, 2024. https://escardio.org/The-ESC/Press-Office/Press-releases/Recommendations-to-reduce-cardiovascular-risk-in-patients-with-diabetes-published-today.