IMPACT OF SCORE2 AND 2021 ESC GUIDELINES RECOMMENDATIONS ON CARDIOVASCULAR RISK CLASSIFICATION AND LDL-CHOLESTEROL CONTROL IN A POPULATION SCREENED FOR HYPERTENSION

Matteo Landolfo (1), Massimiliano Allevi (1), Francesco Spannella (1), Riccardo Sarzani (1)

(1) Università Politecnica delle Marche

Introduction: An updated cardiovascular risk (CVR) assessment model, the SCORE2, and several new equations to calculate low-density lipoprotein cholesterol (LDL-C) in clinical practice have been proposed and validated. We evaluated the impact of SCORE2 and 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice on CVR stratification and prevalence of LDL-C control in a population screened for hypertension. Methods: We conducted a cross-sectional study on 1539 consecutive screened for hypertension with 24-h ambulatory BP monitoring (ABPM). LDL-C was calculated using the formulas proposed by Friedewald (F), Martin (M), and Sampson (S). SCORE and 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias and SCORE2 and 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice have been used for individual CVR stratification and LDL-C targets. Results: Mean age 60 ± 12 years. Mean LDL-C 118 ± 38 mg/dl (F), 119 ± 37 mg/dl (M) and 120 ± 38 mg/dl (S). Median SCORE and SCORE2 were 2 (IQR 0-5) and 7 (IQR 4-11), respectively. SCORE and 2019 Guidelines classified 852 patients (55%) as low-moderate risk, 307 patients (20%) as high risk and 380 patients (25%) as very high risk. SCORE2 and 2021 Guidelines significantly reclassified the individual CVR. We found a 32% reduction in the low-moderate risk group and an 18% and 12% increment in the high and very-high-risk groups, respectively. Accordingly, we reported a significant reduction in the proportion of patients at the LDL-C target in the subgroups considered, independently of the equation for LDL-C calculation.Conclusion: Applying SCORE2 and 2021 Guidelines recommendations led to a non-negligible CVR reclassification and subsequent lack of LDL-C control in our population and subgroups, including those already in lipid-lowering therapy (LLT). These results suggest that a significant proportion of patients should be systematically and accurately (re)screened for individual CVR to assure the most adequate, personalized and effective treatments.