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The importance and usefulness of SCORE2 in cardiovascular prevention
Importância e utilidade do SCORE2 na Prevenção Cardiovascular
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Carvalho, Patrícia Correia, Isabel Lourenço Ribeiro, Ângela M. Teixeira" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Sara" "apellidos" => "Pereira Santos" ] 1 => array:2 [ "nombre" => "Sara" "apellidos" => "Guedes" ] 2 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Pesqueira" ] 3 => array:2 [ "nombre" => "João" "apellidos" => "Stuart" ] 4 => array:2 [ "nombre" => "Ana M." "apellidos" => "Carvalho" ] 5 => array:2 [ "nombre" => "Patrícia" "apellidos" => "Correia" ] 6 => array:2 [ "nombre" => "Isabel" "apellidos" => "Lourenço Ribeiro" ] 7 => array:2 [ "nombre" => "Ângela M." "apellidos" => "Teixeira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255124002233?idApp=UINPBA00004E" "url" => "/08702551/0000004300000011/v1_202410292055/S0870255124002233/v1_202410292055/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "The importance and usefulness of SCORE2 in cardiovascular prevention" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "611" "paginaFinal" => "612" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luís Cotrim, Carlos Rabaçal" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Luís" "apellidos" => "Cotrim" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Carlos" "apellidos" => "Rabaçal" "email" => array:1 [ 0 => "rabacal.carlos@sapo.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "ULS Estuário do Tejo, Vila Franca Xira, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Clínica Hospital CUF-Sintra, Sintra, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Importância e utilidade do SCORE2 na Prevenção Cardiovascular" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular (CV) prevention strategies in individuals without established atherosclerotic disease are based on risk assessment using easy-to-scrutinize clinical indicators, known as risk scores. After the release of the Framingham Risk Score in 1998,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> several other scores were developed, including the SCORE (Systemic Coronary Risk Estimation) in 2003 and the recent SCORE2 and SCORE2-OP, incorporated into the 2021 CV Prevention Guidelines of the European Society of Cardiology.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> These guidelines recommend that, in the opportunistic or systematic assessment of apparently healthy asymptomatic individuals, these scores be used to clarify CV risk, particularly in primary health care.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The availability online of calculators for these scores enables immediate risk stratification of individuals, facilitates doctor–patient communication and guides the most appropriate therapeutic decisions.</p><p id="par0010" class="elsevierStylePara elsevierViewall">However, a word of caution is appropriate because although these tools have been robustly validated and standardize procedures, they are not infallible, therefore justifying the exercise of clinical reasoning in many day-to-day situations.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this issue of the Journal, Pereira Santos et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> present the results of a study carried out in the field of primary care in which they compared the performance of SCORE and SCORE2 in assessing CV risk in a population of individuals with uncomplicated arterial hypertension. This initiative, due to the information it details and the challenges it projects, deserves careful reading and our praise.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The population eligible for the study is from the database of a family health unit and includes 1212 individuals with uncomplicated hypertension and aged between 40 and 69 years, of whom 558 (46%) were excluded. Some caution is required when generalizing the results, which is made clear by the authors.</p><p id="par0025" class="elsevierStylePara elsevierViewall">As already reported by others,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> the use of SCORE2 promoted a significant transfer of individuals to higher risk classes. In the present work, it meant the reallocation of 381 of the 636 (60%) low/moderate risk individuals in SCORE to the high or very high-risk class in SCORE2. As a natural consequence of this transition, the desirable LDL-C target values according to the standard of care have fallen, and have become more demanding, revealing, for example, that only 21 [of 378 individuals (8.6%)] high/very high risk reached it, which, incidentally, is in line with recent data from the Portuguese context.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This study raises some questions: how was the diagnosis of hypertension made? What methodology was followed? Does the quality of the procedures guarantee that there are no individuals with white-coat hypertension or masked hypertension?<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although recognized as one of the limitations of the study, how can the high number of patients without medical appointment (n=303) and analysis of the lipid profile (n=220) be explained and what reflection does it deserve, when this is imperative in a disease with high vascular risk?<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> However, the authors rightly acknowledged the importance of these exclusions in the limitations of the study.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In SCORE2, the lipid profile is represented by non-HDL cholesterol (non-HDL COL), which was certainly used by the authors. It is worth remembering that non-HDL idCOL represents all lipoproteins that contain apolipoprotein-B and is considered an alternative to LDL-C, both in diagnosis and treatment, especially in obese individuals or those with hypertriglyceridemia or metabolic syndrome/diabetes.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In our opinion, it deserved to be incorporated into the results and discussion.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally, this study highlights the importance of CV risk assessment in primary health care, which continues to be the gateway to the health system for everyone; it advises the use of the SCORE2 algorithm, due to the fact that Portugal, contrary to what was understood in the old SCORE, is now considered a country with moderate risk and, as a result, has seen the individual risk of our fellow citizens increased; it reveals the slowness of the Direção Geral Saúde (DGS) in scientifically updating its recommendations, which discredits the directives [see the Hypertension Standards (DGS Standard 020/2011 updated on 03/19/2013) and CV Risk Standards (Norm 005/2013, updated on 01/21/2015)]; it recognizes the need to improve medical records, especially in diseases with high CV risk; it highlights and confirms, like others, the low rate of lipid control in all risk classes; and indicates the need for greater commitment and firmness in implementing more effective therapeutic measures.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of coronary heart disease using risk factor categories" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.W. Wilson" 1 => "R.B. D’Agostino" 2 => "D. Levy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.cir.97.18.1837" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1998" "volumen" => "97" "paginaInicial" => "1837" "paginaFinal" => "1847" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9603539" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New way to “SCORE” risk: updates on the ESC scoring system and incorporation into ESC cardiovascular prevention guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I.M. Graham" 1 => "E. Di Angelantonio" 2 => "R. Huculeci" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Cardiol Rep" "fecha" => "2022" "volumen" => "24" "paginaInicial" => "1679" "paginaFinal" => "1684" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2021 ESC Guidelines on cardiovascular disease prevention in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F.L.J. Visseren" 1 => "M. Francois" 2 => "Y.M. Smulders" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Eur Heart J" "fecha" => "2021" "paginaInicial" => "1111" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical reasoning and prevention of cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Sniderman" 1 => "M. Pencina" 2 => "G. Thanassoulis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacl.2021.04.001" "Revista" => array:6 [ "tituloSerie" => "J Clin Lipidol" "fecha" => "2021" "volumen" => "15" "paginaInicial" => "394" "paginaFinal" => "398" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33992590" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular risk assessment using SCORE2 in a hypertensive population – the reality from a primary health care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Pereira Santos" 1 => "S. Guedes" 2 => "R. Pesqueira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2024" "volumen" => "43" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of the SCORE2 risk prediction algorithm in a Portuguese population: a new model to estimate 10-year cardiovascular disease incidence in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Temtem" 1 => "M.I. Mendonça" 2 => "M. Santos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2023.10.011" "Revista" => array:7 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2024" "volumen" => "43" "paginaInicial" => "437" "paginaFinal" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38395299" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S001650851200892X" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differences of cardiovascular risk assessment in clinical practice using SCORE and SCORE2" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "O. Csenteri" 1 => "Z. Jancso" 2 => "G.J. Szollosi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Open Heart" "fecha" => "2022" "volumen" => "9" "paginaInicial" => "e002087" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular risk profile and lipid management in the population-based cohort study LATINO: 20 years of real-world data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Gavina" 1 => "D.S. Carvalho" 2 => "M. Pardal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/jcm11226825" "Revista" => array:3 [ "tituloSerie" => "J Clin Med" "fecha" => "2022" "volumen" => "11" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cumprimento das boas práticas de medição da pressão arterial nos cuidados de saúde primários. Mestrado Integrado de Medicina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Magalhães" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2019" "editorial" => "Universidade Coimbra, Faculdade de Medicina" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Direção-Geral da Saúde" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Processo Assistencial Integrado do Risco Cardiovascular no Adulto" "fecha" => "2014" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004300000011/v1_202410292055/S0870255124002610/v1_202410292055/en/main.assets" "Apartado" => array:4 [ "identificador" => "93359" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004300000011/v1_202410292055/S0870255124002610/v1_202410292055/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255124002610?idApp=UINPBA00004E" ]
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