Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines

- The European Society of Cardiology (ESC) has changed the prevention guidelines.
- We examined the presence of coronary atherosclerosis and risk of cardiovascular events applying the new guidelines.
- Using the new ESC guidelines, more people with objective evidence of severe atherosclerosis might be misclassified.
- This suggest the need for further diagnostic testing in particular of individuals at intermediate risk.

ObjectivesThe European HeartScore has traditionally differentiated between low and high-risk countries. Until 2012 Germany and Denmark were considered to be high-risk countries but have now been defined as low-risk countries. In this survey we aim to address the consequences of this downgrading.MethodsA screening of 3932 randomly selected (mean age 56 years, 46% male) individuals from Germany and Denmark free of cardiovascular disease was performed. Traditional risk factors were determined, and the HeartScore was measured using both the low-risk and the high-risk country models. A non-contrast Cardiac-CT scan was performed to detect coronary artery calcification (CAC).ResultsAgreement of HeartScore risk groups with CAC groups was poor, but higher when applying the algorithm for the low-risk compared to the high-risk country model (agreement rate: 77% versus 63%, and weighted Kappa: 0.22 versus 0.15). However, the number of subjects with severe coronary calcification (CAC score ≥400) increased in the low and intermediate HeartScore risk group from 78 to 147 participants (from 2.7 % to 4.2 %, p = 0.001), when estimating the risk based on the algorithm for low-risk countries.ConclusionAs a consequence of the reclassification of Germany and Denmark as low-risk countries more people with severe atherosclerosis will be classified as having a low or intermediate risk of fatal cardiovascular disease.