Does inclusion of education and marital status improve SCORE performance in central and eastern europe and former soviet union? findings from MONICA and HAPIEE cohorts

Research output: Contribution to journalArticle


  • Grazyna Broda
  • Ruzena Kubinova
  • Sofia Malyutina
  • Andrzej Pająk
  • Abdonas Tamosiunas
  • Zdena Skodova
  • Galina Simonova
  • Martin Bobak
  • Hynek Pikhart

Colleges, School and Institutes

External organisations

  • Department of CVD Epidemiology, Prevention, and Health Promotion, the Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland.
  • Environmental Health Monitoring System, National Institute of Public Health, Prague, Czech Republic.
  • Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia; State Novosibirsk Medical University, Novosibirsk, Russia.
  • Department of Epidemiology and Population Sciences, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
  • Laboratory of Population Research, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
  • Preventive Cardiology Department, Institute of Clinical and Experimental Medicine, Prague, Czech Republic.
  • Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia.
  • University College London


BACKGROUND AND OBJECTIVE: The SCORE scale predicts the 10-year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk version of SCORE is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), due to high CVD mortality rates in these countries. Given the pronounced social gradient in cardiovascular mortality in the region, it is important to consider social factors in the CVD risk prediction. We investigated whether adding education and marital status to SCORE benefits its prognostic performance in two sets of population-based CEE/FSU cohorts.

METHODS: The WHO MONICA (MONItoring of trends and determinants in CArdiovascular disease) cohorts from the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s (577 atherosclerotic CVD deaths among 14,969 participants with non-missing data). The HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05 (395 atherosclerotic CVD deaths in 19,900 individuals with non-missing data).

RESULTS: In MONICA and HAPIEE, the high-risk SCORE ≥5% at baseline strongly and significantly predicted fatal CVD both before and after adjustment for education and marital status. After controlling for SCORE, lower education and non-married status were significantly associated with CVD mortality in some samples. SCORE extension by these additional risk factors only slightly improved indices of calibration and discrimination (integrated discrimination improvement <5% in men and ≤1% in women).

CONCLUSION: Extending SCORE by education and marital status failed to substantially improve its prognostic performance in population-based CEE/FSU cohorts.


Original languageEnglish
Pages (from-to)e94344
JournalPLoS ONE
Issue number4
Publication statusPublished - 2014


  • Adult, Aged, Aged, 80 and over, Atherosclerosis, Cardiovascular Diseases, Cohort Studies, Europe, Eastern, Female, Humans, Male, Marital Status, Middle Aged, Prognosis, Risk Factors, Russia, Socioeconomic Factors, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't