How does the risk of cardiovascular death and cardiovascular risk factor profiles differ between socioeconomic classes in Poland: A country in transition

Background: Socioeconomic status (SES) is an important factor for cardiovascular diseases (CVD) development. A decline in death rate from CVD among subjects with high SES is observed in developed countries. The aim of this study was to assess differences in cardiovascular risk (CV) between socioeconomic classes in Poland, a country currently in transition. Methods: A sample of 15,200 people was drawn. A three stage selection was performed. Eventually, 6170 patients were examined (2013/2014). Data was collected using a questionnaire in face-to-face interviews, anthropometric data and blood tests were also obtained. Education was categorized asincomplete secondary, secondary and higher than secondary school. Monthly income per person was categorized as low (≤ 1000 PLN), medium (1001–2000 PLN) and high (≥ 2001 PLN). Education and income groups were analyzed by prevalence of CVD risk factors and high CVD risk (SCORE ≥ 5%). Results: Higher education was associated with lower prevalence of all analyzed CVD risk factors (p < 0.001), having the highest income with lower prevalence of hypertension, currently smoking, obesity and lower high density lipoprotein cholesterol. Multivariable analysis showed that frequency of high CVD risk decreased with increasing education level (OR 0.61; 95% CI 0.49–0.76; p < 0.01), a similar favorable impact of higher income on high CVD risk was demonstrated in the whole group (OR 0.81; 95% CI 0.67–0.99; p = 0.04). Conclusions: Socioeconomic status is an independent predictor of high CV risk of death. A favorable impact on the prevalence of high CV risk was demonstrated for education and partly for income in the whole group. It may reflect a transition being undergone in Poland, moreover, it predicts how socioeconomic factors may generate health inequalities in other transitioning countries

SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe

Aims The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe. Methods and results We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low- risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. Conclusion SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe