Identification and Validation of a Prediction Model for CARDIOvascular Events in Patients With Multiple COMorbidities (CARDIO-COM)

Introduction Cardiovascular risk assessment is of fundamental importance in medicine, especially given the high prevalence of cardiovascular diseases and their association with a wide range of comorbidities. Cardiovascular diseases are a major cause of morbidity and mortality worldwide, and correct risk assessment is essential for prevention, early diagnosis and optimal management of patients. Cardiovascular risk stratification allows physicians to identify high-risk subjects who could benefit from targeted preventive interventions, thus improving clinical outcomes and reducing healthcare costs associated with acute cardiovascular events.

Currently available cardiovascular risk assessment tools, such as SCORE2 and the CUORE project, represent significant steps towards preventive and personalized medicine. However, despite their usefulness, these scores have some intrinsic limitations that reduce their effectiveness in considering the entire spectrum of risk factors, especially in patients with multiple comorbidities.

SCORE2 (Systematic Coronary Risk Evaluation 2) is an evolution of the original SCORE model, developed to improve the estimation of cardiovascular risk in several European populations2. This tool takes into account variables such as age, sex, blood pressure, total cholesterol and cigarette smoking to calculate the 10-year risk of a fatal cardiovascular event. Despite the update compared to the previous model, SCORE2 continues to be based on a limited number of risk factors and may not accurately reflect the clinical complexity of patients with multiple conditions, such as diabetes, obesity, chronic kidney disease and other comorbidities.

The CUORE project, developed in Italy, aims to provide a cardiovascular risk assessment tool specific to the Italian population. It also uses traditional risk factors such as age, sex, blood pressure, cholesterol, diabetes and smoking to estimate the 10-year risk of major cardiovascular events, such as myocardial infarction and stroke. Although the CUORE project represents an important contribution to preventive medicine, its limitations are similar to those of SCORE2: a partial view of risk factors that does not always capture the complexity of patients with multiple comorbidities.

The importance of cardiovascular risk estimation lies in the possibility of adopting effective and personalized preventive strategies. However, the accuracy of these tools is crucial for the success of preventive measures. Comorbidities, such as diabetes mellitus, hypertension, dyslipidemia, obesity, chronic kidney disease and neoplastic diseases, are often present simultaneously in patients and can interact with each other, amplifying cardiovascular risk in a non-linear way. Current tools tend to consider these factors in isolation, failing to adequately represent the complex interaction between different comorbidities.