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ASCORE: an up-to-date cardiovascular risk score for hypertensive patients reflecting contemporary clinical practice developed using the (ASCOT-BPLA) trial data

Journal of Human Hypertension volume 27, pages 492–496 (2013)Cite this article

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Abstract

A number of risk scores already exist to predict cardiovascular (CV) events. However, scores developed with data collected some time ago might not accurately predict the CV risk of contemporary hypertensive patients that benefit from more modern treatments and management. Using data from the randomised clinical trial Anglo-Scandinavian Cardiac Outcomes Trial-BPLA, with 15 955 hypertensive patients without previous CV disease receiving contemporary preventive CV management, we developed a new risk score predicting the 5-year risk of a first CV event (CV death, myocardial infarction or stroke). Cox proportional hazard models were used to develop a risk equation from baseline predictors. The final risk model (ASCORE) included age, sex, smoking, diabetes, previous blood pressure (BP) treatment, systolic BP, total cholesterol, high-density lipoprotein–cholesterol, fasting glucose and creatinine baseline variables. A simplified model (ASCORE-S) excluding laboratory variables was also derived. Both models showed very good internal validity. User-friendly integer score tables are reported for both models. Applying the latest Framingham risk score to our data significantly overpredicted the observed 5-year risk of the composite CV outcome. We conclude that risk scores derived using older databases (such as Framingham) may overestimate the CV risk of patients receiving current BP treatments; therefore, ‘updated’ risk scores are needed for current patients.

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Acknowledgements

The ASCOT trial and associated analyses were supported by research grants from Pfizer. However, the study is investigator-led and independent of any influence from the funder. Neil Poulter and Peter Sever are supported by the National Institute for Health Research Senior Investigator Awards, Biomedical Research Centre funding and the British Heart Foundation Research Centre Excellence Awards. The ASCOT trial was ratified by the central and regional ethics review boards in the United Kingdom, and by national ethics and statutory bodies in Ireland and Nordic countries. Patients gave written informed consent to participate in the trial before randomisation.

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Authors and Affiliations

  1. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK

    D Prieto-Merino, J Dobson & S Pocock

  2. International Centre for Circulatory Health, Imperial College London, London, UK

    A K Gupta, C-L Chang, P S Sever & N Poulter

  3. Department of Medicine, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden

    B Dahlöf

  4. Nordic School of Public Health, Gothenburg, Sweden

    H Wedel

Authors
  1. D Prieto-Merino
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  2. J Dobson
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  3. A K Gupta
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  4. C-L Chang
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  5. P S Sever
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  6. B Dahlöf
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  7. H Wedel
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  8. S Pocock
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  9. N Poulter
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On Behalf of the ASCOT-BPLA Investigators

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Correspondence to D Prieto-Merino.

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Competing interests

The International Centre for Circulatory Health, Imperial College London, where N Poulter and P Sever are based, received support from Pfizer for the submitted work; N Poulter, P Sever, A Gupta, B Dahlof, H Wedel and S Pocock have served as consultants to and/or received funding for research, and/or received travel expenses or payment for speaking at meetings from one or more pharmaceutical companies marketing blood-pressure-lowering or lipid-lowering drugs that might have an interest in the submitted work in the previous 3 years; their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and all authors have no non-financial interests that may be relevant to the submitted work.

Additional information

Parts of this work have been presented as oral communications at the Annual Scientific Meeting of the British Hypertension Society, September 2009, and at the 19th Meeting of the European Hypertension Society, June 2009.

Supplementary Information accompanies the paper on the Journal of Human Hypertension website

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Prieto-Merino, D., Dobson, J., Gupta, A. et al. ASCORE: an up-to-date cardiovascular risk score for hypertensive patients reflecting contemporary clinical practice developed using the (ASCOT-BPLA) trial data. J Hum Hypertens 27, 492–496 (2013). https://doi.org/10.1038/jhh.2013.3

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