Validation of the European SCORE2 algorithm in one European and one Latin-American cohort studies with contrasting populations.

BACKGROUND: SCORE2 estimates the 10-year risk of developing non-fatal and fatal cardiovascular disease (CVD), and it was designed for mostly Europeans. However, its transferability to non-European populations has not been extensively studied. AIM: To evaluate the performance of the SCORE2 in ethnically and socioeconomically diverse populations, including those outside of Europe. METHODS: We leveraged cohort studies from Mexico (N=95,660, mean age 52.4 years, 32.6% men, mean follow-up 9.7 years), and Portugal (N=1,216, 52.9 years, 36.9% men, 8.8 years follow-up). RESULTS: SCORE2 has differentially classified frequency of CVD events across levels of risk severity, ranging from 0.7-1.0% CVD events among those with low-moderate risk-profiles, versus 6.6-9.0% among those with high risk-profiles, respectively. The area under the receiver operating curve (AROC) was 0.762 in Mexico and 0.718 in Portugal. Sensitivities (95% CI) were 85.7 (84.2-87.2) and 95.0 (86.1-99.0), and specificities were 42.8 (42.5-43.1) and 24.3 (21.9-26.9) for Mexico and Portugal, respectively. In all cases, the positive predictive values were below 7%, whereas the negative predictive values were all above 98%. Harrell's C were 0.717 and 0.692, and Brier's scores were 0.022 and 0.052 for Mexico and Portugal, respectively. In Mexico, SCORE2 showed good calibration, with a slight overestimation in the higher-risk categories. In Portugal, overestimation in higher-risk categories was more substantial. CONCLUSION: SCORE2 estimates modest to acceptable performance for predicting the 10-year CVD in Mexicans but performed less favourably in the Portuguese cohort, indicating a need for recalibration.