Primary prevention of cardiovascular diseases is crucial for public health, particularly among individuals at high risk. Correct cardiovascular risk assessment is essential for effective patient management and informed therapy selection. Finding the most accurate tools for calculating cardiovascular risk is a pressing problem.
OBJECTIVE
To compare the cardiovascular risk, assessed using the SCORE scale and the value of the calcium index of the coronary arteries (Agatston score), considering the endpoints.
MATERIALS AND METHODS
The database of patients who underwent multislice computed tomography to detect coronary calcium and calculate the Agatston score was analyzed at the National Medical Research Center for Therapy and Preventive Medicine from 2014 to 2023. Patients without clinical manifestations of atherosclerosis were included in the study. Six hundred twenty-seven medical records were reviewed. The study included 482 medical records. The age of the remaining patients was not suitable for assessing the risk using the SCORE scale.
RESULTS
A prospective study included 482 subjects, aged 40—65 years, with a mean age of 55.0±6.7 years. There were 349 females (72.4%) and 133 males (27.6%). Sixty-six patients (13.7%) were active smokers. Mean systolic blood pressure was 130.8±48.4 mmHg, diastolic blood pressure was 80.3±6.9 mmHg, and cholesterol level was 6.0±1.4 mmol/L. The average SCORE value was 2.5±3.1%. Low risk was determined in 161 (33.4%) patients, moderate risk in 270 (56%), high risk in 43 (8.9%), and very high risk in 8 (1.7%) patients. Depending on the value of the calcium index (CI), 343 (71.2%) patients had a low risk (0—10 points), 80 (16.6%) had a moderate risk (11—100 points), 46 (9.5%) had a moderately high risk (101—400 points), and 13 (2.7%) had a high risk (≥401 points). Fatal cardiovascular events were reported in 9 (47.4%) of the 19 high-risk individuals according to CI and 1 (5%) of the low-risk individuals according to CI, and there were no fatal events in the CI moderate-risk group. The number of deaths in the CI high-risk group was higher compared to the CI moderate and low-risk groups (p<0.0001).
CONCLUSION
The assessment of cardiovascular risk using the SCORE scale has limited prognostic value. To clarify the risk category, an additional examination of patients using instrumental methods is recommended, including multispiral computed tomography of the coronary arteries with calculation of the calcium index, which will help determine the further management approach and indicate the need for drug therapy. Patients with a high cardiovascular risk determined based on the calcium index should immediately start drug therapy.
