The contribution of educational class in improving accuracy of cardiovascular risk prediction across European regions: the MORGAM Project Cohort Component

Marco M. Ferrario (Lead / Corresponding author), Giovanni Veronesi, Lloyd E. Chambless, Hugh Tunstall-Pedoe, Kari Kuulasmaa, Veikko Salomaa, Anders Borglykke, Nigel Hart, Stefan Söderberg, Giancarlo Cesana, T. Jørgensen, C. Agger, A. Juolevi, E. Vartiainen, P. Jousilahti, Z. Cepaitis, A. Haukijärvi, B. Joseph, S. Kulathinal, M. NiemeläO. Saarela, P. Ducimetière, A. Bingham, D. Arveiler, B. Haas, A. Wagner, J. Ferrières, J-B. Ruidavets, V. Bongard, P. Amouyel, M. Montaye, J. Dallongeville, A. Döring, E. Wichmann, C. Fornari, R. Sega, G. Mancia, R. Facchetti, D. Vanuzzo, L. Pilotto, F. Picco, F. Mattiussi, S. Gigante, A. Tamosiunas, S. Domarkiene, D. Rastenyte, G. Bernotiene, R. Radisauskas, M. Baceviciene, D. Luksiene, V. Malinauskiene, L. Bernotaite, A. Pajak, E. Kawalec, G. Broda, P. Kurjata, S.L. Rywik, M. Polakowska, A. Pytlak, Y. Nikitin, S. Malyutina, V. Gafarov, V. Feigin, G. Siminova, M. Voevoda, T. Vinogradova, N. Nasonova, E. Veriovkin, M. Eliasson, B. Stegmayr, M. Eriksson, K. Asplund, F. Kee, A. Evans, J. Yarnell, E. Gardner, M. Woodward, A. Evans, S. Cashman, Alan Evans, S. Blankenberg, F. Kee, A. Palotie, M. Perola, A. Peters, V. Salomaa, D. Tregouet, K. Asplund, F. Cambien, L. Tiret, L. Peltonen, D. Shields, B. Stegmayr, P.-G. Wiklund

    Research output: Contribution to journalArticle

    12 Citations (Scopus)

    Abstract

    Objective To assess whether educational class, an index of socioeconomic position, improves the accuracy of the SCORE cardiovascular disease (CVD) risk prediction equation. Methods In a pooled analysis of 68 455 40-64-year-old men and women, free from coronary heart disease at baseline, from 47 prospective population-based cohorts from Nordic countries (Finland, Denmark, Sweden), the UK (Northern Ireland, Scotland), Central Europe (France, Germany, Italy) and Eastern Europe (Lithuania, Poland) and Russia, we assessed improvements in discrimination and in risk classification (net reclassification improvement (NRI)) when education was added to models including the SCORE risk equation. Results The lowest educational class was associated with higher CVD mortality in men (pooled age-adjusted HR=1.64, 95% CI 1.42 to 1.90) and women (HR=1.31, 1.02 to 1.68). In men, the HRs ranged from 1.3 (Central Europe) to 2.1 (Eastern Europe and Russia). After adjustment for the SCORE risk, the association remained statistically significant overall, in the UK and Eastern Europe and Russia. Education significantly improved discrimination in all European regions and classification in Nordic countries (clinical NRI=5.3%) and in Eastern Europe and Russia (NRI=24.7%). In women, after SCORE risk adjustment, the association was not statistically significant, but the reduced number of deaths plays a major role, and the addition of education led to improvements in discrimination and classification in the Nordic countries only. Conclusions We recommend the inclusion of education in SCORE CVD risk equation in men, particularly in Nordic and East European countries, to improve social equity in primary prevention. Weaker evidence for women warrants the need for further investigations.
    Original languageEnglish
    Pages (from-to)1179-1187
    Number of pages9
    JournalHeart
    Volume100
    Issue number15
    DOIs
    Publication statusPublished - Aug 2014

    Fingerprint

    Eastern Europe
    Russia
    Scandinavian and Nordic Countries
    Risk Adjustment
    Education
    Cardiovascular Diseases
    Lithuania
    Northern Ireland
    Scotland
    Poland
    Denmark
    Primary Prevention
    Finland
    Sweden
    Italy
    France
    Coronary Disease
    Germany
    Mortality
    Population

    Cite this

    Ferrario, Marco M. ; Veronesi, Giovanni ; Chambless, Lloyd E. ; Tunstall-Pedoe, Hugh ; Kuulasmaa, Kari ; Salomaa, Veikko ; Borglykke, Anders ; Hart, Nigel ; Söderberg, Stefan ; Cesana, Giancarlo ; Jørgensen, T. ; Agger, C. ; Juolevi, A. ; Vartiainen, E. ; Jousilahti, P. ; Cepaitis, Z. ; Haukijärvi, A. ; Joseph, B. ; Kulathinal, S. ; Niemelä, M. ; Saarela, O. ; Ducimetière, P. ; Bingham, A. ; Arveiler, D. ; Haas, B. ; Wagner, A. ; Ferrières, J. ; Ruidavets, J-B. ; Bongard, V. ; Amouyel, P. ; Montaye, M. ; Dallongeville, J. ; Döring, A. ; Wichmann, E. ; Fornari, C. ; Sega, R. ; Mancia, G. ; Facchetti, R. ; Vanuzzo, D. ; Pilotto, L. ; Picco, F. ; Mattiussi, F. ; Gigante, S. ; Tamosiunas, A. ; Domarkiene, S. ; Rastenyte, D. ; Bernotiene, G. ; Radisauskas, R. ; Baceviciene, M. ; Luksiene, D. ; Malinauskiene, V. ; Bernotaite, L. ; Pajak, A. ; Kawalec, E. ; Broda, G. ; Kurjata, P. ; Rywik, S.L. ; Polakowska, M. ; Pytlak, A. ; Nikitin, Y. ; Malyutina, S. ; Gafarov, V. ; Feigin, V. ; Siminova, G. ; Voevoda, M. ; Vinogradova, T. ; Nasonova, N. ; Veriovkin, E. ; Eliasson, M. ; Stegmayr, B. ; Eriksson, M. ; Asplund, K. ; Kee, F. ; Evans, A. ; Yarnell, J. ; Gardner, E. ; Woodward, M. ; Evans, A. ; Cashman, S. ; Evans, Alan ; Blankenberg, S. ; Kee, F. ; Palotie, A. ; Perola, M. ; Peters, A. ; Salomaa, V. ; Tregouet, D. ; Asplund, K. ; Cambien, F. ; Tiret, L. ; Peltonen, L. ; Shields, D. ; Stegmayr, B. ; Wiklund, P.-G. / The contribution of educational class in improving accuracy of cardiovascular risk prediction across European regions : the MORGAM Project Cohort Component. In: Heart. 2014 ; Vol. 100, No. 15. pp. 1179-1187.
    @article{c4249a81f286447f9251a7e707daf6f6,
    title = "The contribution of educational class in improving accuracy of cardiovascular risk prediction across European regions: the MORGAM Project Cohort Component",
    abstract = "Objective To assess whether educational class, an index of socioeconomic position, improves the accuracy of the SCORE cardiovascular disease (CVD) risk prediction equation. Methods In a pooled analysis of 68 455 40-64-year-old men and women, free from coronary heart disease at baseline, from 47 prospective population-based cohorts from Nordic countries (Finland, Denmark, Sweden), the UK (Northern Ireland, Scotland), Central Europe (France, Germany, Italy) and Eastern Europe (Lithuania, Poland) and Russia, we assessed improvements in discrimination and in risk classification (net reclassification improvement (NRI)) when education was added to models including the SCORE risk equation. Results The lowest educational class was associated with higher CVD mortality in men (pooled age-adjusted HR=1.64, 95{\%} CI 1.42 to 1.90) and women (HR=1.31, 1.02 to 1.68). In men, the HRs ranged from 1.3 (Central Europe) to 2.1 (Eastern Europe and Russia). After adjustment for the SCORE risk, the association remained statistically significant overall, in the UK and Eastern Europe and Russia. Education significantly improved discrimination in all European regions and classification in Nordic countries (clinical NRI=5.3{\%}) and in Eastern Europe and Russia (NRI=24.7{\%}). In women, after SCORE risk adjustment, the association was not statistically significant, but the reduced number of deaths plays a major role, and the addition of education led to improvements in discrimination and classification in the Nordic countries only. Conclusions We recommend the inclusion of education in SCORE CVD risk equation in men, particularly in Nordic and East European countries, to improve social equity in primary prevention. Weaker evidence for women warrants the need for further investigations.",
    author = "Ferrario, {Marco M.} and Giovanni Veronesi and Chambless, {Lloyd E.} and Hugh Tunstall-Pedoe and Kari Kuulasmaa and Veikko Salomaa and Anders Borglykke and Nigel Hart and Stefan S{\"o}derberg and Giancarlo Cesana and T. J{\o}rgensen and C. Agger and A. Juolevi and E. Vartiainen and P. Jousilahti and Z. Cepaitis and A. Haukij{\"a}rvi and B. Joseph and S. Kulathinal and M. Niemel{\"a} and O. Saarela and P. Ducimeti{\`e}re and A. Bingham and D. Arveiler and B. Haas and A. Wagner and J. Ferri{\`e}res and J-B. Ruidavets and V. Bongard and P. Amouyel and M. Montaye and J. Dallongeville and A. D{\"o}ring and E. Wichmann and C. Fornari and R. Sega and G. Mancia and R. Facchetti and D. Vanuzzo and L. Pilotto and F. Picco and F. Mattiussi and S. Gigante and A. Tamosiunas and S. Domarkiene and D. Rastenyte and G. Bernotiene and R. Radisauskas and M. Baceviciene and D. Luksiene and V. Malinauskiene and L. Bernotaite and A. Pajak and E. Kawalec and G. Broda and P. Kurjata and S.L. Rywik and M. Polakowska and A. Pytlak and Y. Nikitin and S. Malyutina and V. Gafarov and V. Feigin and G. Siminova and M. Voevoda and T. Vinogradova and N. Nasonova and E. Veriovkin and M. Eliasson and B. Stegmayr and M. Eriksson and K. Asplund and F. Kee and A. Evans and J. Yarnell and E. Gardner and M. Woodward and A. Evans and S. Cashman and Alan Evans and S. Blankenberg and F. Kee and A. Palotie and M. Perola and A. Peters and V. Salomaa and D. Tregouet and K. Asplund and F. Cambien and L. Tiret and L. Peltonen and D. Shields and B. Stegmayr and P.-G. Wiklund",
    year = "2014",
    month = "8",
    doi = "10.1136/heartjnl-2013-304664",
    language = "English",
    volume = "100",
    pages = "1179--1187",
    journal = "Heart",
    issn = "1355-6037",
    publisher = "BMJ Publishing Group",
    number = "15",

    }

    Ferrario, MM, Veronesi, G, Chambless, LE, Tunstall-Pedoe, H, Kuulasmaa, K, Salomaa, V, Borglykke, A, Hart, N, Söderberg, S, Cesana, G, Jørgensen, T, Agger, C, Juolevi, A, Vartiainen, E, Jousilahti, P, Cepaitis, Z, Haukijärvi, A, Joseph, B, Kulathinal, S, Niemelä, M, Saarela, O, Ducimetière, P, Bingham, A, Arveiler, D, Haas, B, Wagner, A, Ferrières, J, Ruidavets, J-B, Bongard, V, Amouyel, P, Montaye, M, Dallongeville, J, Döring, A, Wichmann, E, Fornari, C, Sega, R, Mancia, G, Facchetti, R, Vanuzzo, D, Pilotto, L, Picco, F, Mattiussi, F, Gigante, S, Tamosiunas, A, Domarkiene, S, Rastenyte, D, Bernotiene, G, Radisauskas, R, Baceviciene, M, Luksiene, D, Malinauskiene, V, Bernotaite, L, Pajak, A, Kawalec, E, Broda, G, Kurjata, P, Rywik, SL, Polakowska, M, Pytlak, A, Nikitin, Y, Malyutina, S, Gafarov, V, Feigin, V, Siminova, G, Voevoda, M, Vinogradova, T, Nasonova, N, Veriovkin, E, Eliasson, M, Stegmayr, B, Eriksson, M, Asplund, K, Kee, F, Evans, A, Yarnell, J, Gardner, E, Woodward, M, Evans, A, Cashman, S, Evans, A, Blankenberg, S, Kee, F, Palotie, A, Perola, M, Peters, A, Salomaa, V, Tregouet, D, Asplund, K, Cambien, F, Tiret, L, Peltonen, L, Shields, D, Stegmayr, B & Wiklund, P-G 2014, 'The contribution of educational class in improving accuracy of cardiovascular risk prediction across European regions: the MORGAM Project Cohort Component', Heart, vol. 100, no. 15, pp. 1179-1187. https://doi.org/10.1136/heartjnl-2013-304664

    The contribution of educational class in improving accuracy of cardiovascular risk prediction across European regions : the MORGAM Project Cohort Component. / Ferrario, Marco M. (Lead / Corresponding author); Veronesi, Giovanni; Chambless, Lloyd E.; Tunstall-Pedoe, Hugh; Kuulasmaa, Kari; Salomaa, Veikko; Borglykke, Anders; Hart, Nigel; Söderberg, Stefan; Cesana, Giancarlo; Jørgensen, T.; Agger, C.; Juolevi, A.; Vartiainen, E.; Jousilahti, P.; Cepaitis, Z.; Haukijärvi, A.; Joseph, B.; Kulathinal, S.; Niemelä, M.; Saarela, O.; Ducimetière, P.; Bingham, A.; Arveiler, D.; Haas, B.; Wagner, A.; Ferrières, J.; Ruidavets, J-B.; Bongard, V.; Amouyel, P.; Montaye, M.; Dallongeville, J.; Döring, A.; Wichmann, E.; Fornari, C.; Sega, R.; Mancia, G.; Facchetti, R.; Vanuzzo, D.; Pilotto, L.; Picco, F.; Mattiussi, F.; Gigante, S.; Tamosiunas, A.; Domarkiene, S.; Rastenyte, D.; Bernotiene, G.; Radisauskas, R.; Baceviciene, M.; Luksiene, D.; Malinauskiene, V.; Bernotaite, L.; Pajak, A.; Kawalec, E.; Broda, G.; Kurjata, P.; Rywik, S.L.; Polakowska, M.; Pytlak, A.; Nikitin, Y.; Malyutina, S.; Gafarov, V.; Feigin, V.; Siminova, G.; Voevoda, M.; Vinogradova, T.; Nasonova, N.; Veriovkin, E.; Eliasson, M.; Stegmayr, B.; Eriksson, M.; Asplund, K.; Kee, F.; Evans, A.; Yarnell, J.; Gardner, E.; Woodward, M.; Evans, A.; Cashman, S.; Evans, Alan; Blankenberg, S.; Kee, F.; Palotie, A.; Perola, M.; Peters, A.; Salomaa, V.; Tregouet, D.; Asplund, K.; Cambien, F.; Tiret, L.; Peltonen, L.; Shields, D.; Stegmayr, B.; Wiklund, P.-G.

    In: Heart, Vol. 100, No. 15, 08.2014, p. 1179-1187.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - The contribution of educational class in improving accuracy of cardiovascular risk prediction across European regions

    T2 - the MORGAM Project Cohort Component

    AU - Ferrario, Marco M.

    AU - Veronesi, Giovanni

    AU - Chambless, Lloyd E.

    AU - Tunstall-Pedoe, Hugh

    AU - Kuulasmaa, Kari

    AU - Salomaa, Veikko

    AU - Borglykke, Anders

    AU - Hart, Nigel

    AU - Söderberg, Stefan

    AU - Cesana, Giancarlo

    AU - Jørgensen, T.

    AU - Agger, C.

    AU - Juolevi, A.

    AU - Vartiainen, E.

    AU - Jousilahti, P.

    AU - Cepaitis, Z.

    AU - Haukijärvi, A.

    AU - Joseph, B.

    AU - Kulathinal, S.

    AU - Niemelä, M.

    AU - Saarela, O.

    AU - Ducimetière, P.

    AU - Bingham, A.

    AU - Arveiler, D.

    AU - Haas, B.

    AU - Wagner, A.

    AU - Ferrières, J.

    AU - Ruidavets, J-B.

    AU - Bongard, V.

    AU - Amouyel, P.

    AU - Montaye, M.

    AU - Dallongeville, J.

    AU - Döring, A.

    AU - Wichmann, E.

    AU - Fornari, C.

    AU - Sega, R.

    AU - Mancia, G.

    AU - Facchetti, R.

    AU - Vanuzzo, D.

    AU - Pilotto, L.

    AU - Picco, F.

    AU - Mattiussi, F.

    AU - Gigante, S.

    AU - Tamosiunas, A.

    AU - Domarkiene, S.

    AU - Rastenyte, D.

    AU - Bernotiene, G.

    AU - Radisauskas, R.

    AU - Baceviciene, M.

    AU - Luksiene, D.

    AU - Malinauskiene, V.

    AU - Bernotaite, L.

    AU - Pajak, A.

    AU - Kawalec, E.

    AU - Broda, G.

    AU - Kurjata, P.

    AU - Rywik, S.L.

    AU - Polakowska, M.

    AU - Pytlak, A.

    AU - Nikitin, Y.

    AU - Malyutina, S.

    AU - Gafarov, V.

    AU - Feigin, V.

    AU - Siminova, G.

    AU - Voevoda, M.

    AU - Vinogradova, T.

    AU - Nasonova, N.

    AU - Veriovkin, E.

    AU - Eliasson, M.

    AU - Stegmayr, B.

    AU - Eriksson, M.

    AU - Asplund, K.

    AU - Kee, F.

    AU - Evans, A.

    AU - Yarnell, J.

    AU - Gardner, E.

    AU - Woodward, M.

    AU - Evans, A.

    AU - Cashman, S.

    AU - Evans, Alan

    AU - Blankenberg, S.

    AU - Kee, F.

    AU - Palotie, A.

    AU - Perola, M.

    AU - Peters, A.

    AU - Salomaa, V.

    AU - Tregouet, D.

    AU - Asplund, K.

    AU - Cambien, F.

    AU - Tiret, L.

    AU - Peltonen, L.

    AU - Shields, D.

    AU - Stegmayr, B.

    AU - Wiklund, P.-G.

    PY - 2014/8

    Y1 - 2014/8

    N2 - Objective To assess whether educational class, an index of socioeconomic position, improves the accuracy of the SCORE cardiovascular disease (CVD) risk prediction equation. Methods In a pooled analysis of 68 455 40-64-year-old men and women, free from coronary heart disease at baseline, from 47 prospective population-based cohorts from Nordic countries (Finland, Denmark, Sweden), the UK (Northern Ireland, Scotland), Central Europe (France, Germany, Italy) and Eastern Europe (Lithuania, Poland) and Russia, we assessed improvements in discrimination and in risk classification (net reclassification improvement (NRI)) when education was added to models including the SCORE risk equation. Results The lowest educational class was associated with higher CVD mortality in men (pooled age-adjusted HR=1.64, 95% CI 1.42 to 1.90) and women (HR=1.31, 1.02 to 1.68). In men, the HRs ranged from 1.3 (Central Europe) to 2.1 (Eastern Europe and Russia). After adjustment for the SCORE risk, the association remained statistically significant overall, in the UK and Eastern Europe and Russia. Education significantly improved discrimination in all European regions and classification in Nordic countries (clinical NRI=5.3%) and in Eastern Europe and Russia (NRI=24.7%). In women, after SCORE risk adjustment, the association was not statistically significant, but the reduced number of deaths plays a major role, and the addition of education led to improvements in discrimination and classification in the Nordic countries only. Conclusions We recommend the inclusion of education in SCORE CVD risk equation in men, particularly in Nordic and East European countries, to improve social equity in primary prevention. Weaker evidence for women warrants the need for further investigations.

    AB - Objective To assess whether educational class, an index of socioeconomic position, improves the accuracy of the SCORE cardiovascular disease (CVD) risk prediction equation. Methods In a pooled analysis of 68 455 40-64-year-old men and women, free from coronary heart disease at baseline, from 47 prospective population-based cohorts from Nordic countries (Finland, Denmark, Sweden), the UK (Northern Ireland, Scotland), Central Europe (France, Germany, Italy) and Eastern Europe (Lithuania, Poland) and Russia, we assessed improvements in discrimination and in risk classification (net reclassification improvement (NRI)) when education was added to models including the SCORE risk equation. Results The lowest educational class was associated with higher CVD mortality in men (pooled age-adjusted HR=1.64, 95% CI 1.42 to 1.90) and women (HR=1.31, 1.02 to 1.68). In men, the HRs ranged from 1.3 (Central Europe) to 2.1 (Eastern Europe and Russia). After adjustment for the SCORE risk, the association remained statistically significant overall, in the UK and Eastern Europe and Russia. Education significantly improved discrimination in all European regions and classification in Nordic countries (clinical NRI=5.3%) and in Eastern Europe and Russia (NRI=24.7%). In women, after SCORE risk adjustment, the association was not statistically significant, but the reduced number of deaths plays a major role, and the addition of education led to improvements in discrimination and classification in the Nordic countries only. Conclusions We recommend the inclusion of education in SCORE CVD risk equation in men, particularly in Nordic and East European countries, to improve social equity in primary prevention. Weaker evidence for women warrants the need for further investigations.

    UR - http://www.scopus.com/inward/record.url?scp=84899469212&partnerID=8YFLogxK

    U2 - 10.1136/heartjnl-2013-304664

    DO - 10.1136/heartjnl-2013-304664

    M3 - Article

    C2 - 24794139

    VL - 100

    SP - 1179

    EP - 1187

    JO - Heart

    JF - Heart

    SN - 1355-6037

    IS - 15

    ER -