A competing risk approach for the European Heart SCORE model based on cause-specific and all-cause mortality

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  • Henrik Støvring
  • Charlotte G Harmsen, Forskningsenheden for Almen Praksis, Syddansk Universitet, Denmark
  • Torbjørn Wisløff, Norwegian Knowledge Centre for the Health Services, Norway
  • Dorte E Jarbøl, Forskningsenheden for Almen Praksis, Syddansk Universitet, Denmark
  • Jørgen Nexøe, Forskningsenheden for Almen Praksis, Denmark
  • Jesper B Nielsen, Institut for Sundhedstjenesteforskning, Syddansk Universitet, Denmark
  • Ivar S Kristiansen, Institute of Health Management and Health Economics, Oslo University, Norway
Background: The European Heart SCORE model constitutes the basis for national guidelines for primary prevention and treatment of cardiovascular disease (CVD) in several European countries. The model estimates individuals' 10-year CVD mortality risks from age, sex, smoking status, systolic blood pressure, and total cholesterol level. The SCORE model, however, is not mathematically consistent and does not estimate all-cause mortality. Our aim is to modify the SCORE model to allow consistent estimation of both CVD-specific and all-cause mortality.Methods: Using a competing risk approach, we first re-estimated the cause-specific risk of dying from cardiovascular disease, and secondly we incorporated non-CVD mortality. Finally, non-CVD mortality was allowed to also depend on smoking status, and not only age and sex. From the models, we estimated CVD-specific and all-cause 10-year mortality risk, and the expected residual lifetime together with corresponding expected effects of statin treatment.Results: The modified model provided CVD-specific 10-year mortality risks similar to those of the European Heart SCORE model. Incorporation of non-CVD mortality increased 10-year mortality risks, in particular for older individuals. When non-CVD mortality was assumed unaffected by smoking status, the absolute risk reduction due to statin treatment ranged from 0.0% to 3.5%, whereas the gain in expected residual lifetime ranged from 3 to 11 months. Statin effectiveness increased for non-smokers and declined for smokers, when smoking was allowed to influence non-CVD mortality.Conclusion: The modified model provides mathematically consistent estimates of mortality risk and expected residual lifetime together with expected benefits from statin treatment.
Original languageEnglish
JournalEuropean Journal of Preventive Cardiology
Volume20
Issue5
Pages (from-to)827-36
Number of pages10
ISSN2047-4873
DOIs
Publication statusPublished - Oct 2013

    Research areas

  • absolute risk reduction, cardiovascular mortality, competing risk model, prolongation of life, risk prediction

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