https://orcid.org/0000-0003-1712-0984
Abstract
To evaluate whether integrating Apolipoprotein B (ApoB) into the Systematic Coronary Risk Evaluation 2 (SCORE2) cardiovascular risk prediction framework improves its predictive accuracy and clinical applicability within the UK Biobank population.
A 10-year prospective cohort study was conducted with 448 303 UK Biobank participants eligible for SCORE2 calculation. Three approaches were employed: (i) threshold analysis to determine the optimal ApoB cutoff for cardiovascular disease (CVD) risk prediction using Youden’s Index, (ii) assessment of the synergistic effect of SCORE2 and ApoB through concordant and discordant classifications, and (iii) recalibration of the SCORE2 model by incorporating ApoB as an additional predictor. Each 0.2 g/L increase in ApoB was associated with an increased subdistribution hazard for CVD events [subdistribution hazard ratio (SHR): 1.13; 95% CI: 1.11–1.14, P < 0.001], accounting for non-cardiovascular death as a competing risk. Threshold analysis identified an optimal ApoB cutoff at 1.18 g/L; however, it demonstrated limited discriminatory performance (area under the curve 0.54), with low sensitivity (32.4%), and moderate specificity (74.4%). Individuals with both low ApoB (<1.18 g/L) and low SCORE2 risk (<5%) had a lower CVD incidence rate (232.51 per 100 000 person-years) compared with those identified as low risk by SCORE2 alone (253.69 per 100 000 person-years). Integration of ApoB into the SCORE2 model did not significantly improve the model discrimination, calibration, and net reclassification improvement.
Apolipoprotein B exhibited a dose–response relationship with cardiovascular risk but had limited standalone predictive utility within the UK Biobank population. However, combining ApoB with SCORE2 thresholds improved the identification of low-risk individuals, suggesting a complementary role for ApoB in refining cardiovascular risk stratification.
Lay Summary
Predicting the risk of developing heart disease is essential for preventing heart attacks. Systematic Coronary Risk Evaluation 2 (SCORE2) is a widely used tool that estimates the likelihood of developing cardiovascular disease within the next 10 years. This study investigated whether adding a blood test called apolipoprotein B (ApoB), a type of cholesterol-related protein, could improve the accuracy of SCORE2 in predicting heart disease risk.
ApoB should be used as a supplementary tool rather than a replacement for existing risk assessments, offering a more comprehensive approach to evaluating heart disease risk.
The combination of ApoB and SCORE2 allows healthcare providers to more accurately identify people who are truly at low risk of heart disease, enabling more personalized and potentially less intensive treatments for these individuals.
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