SCORE2-Older Persons (SCORE2-OP): Validation and Added Value of Excessive Daytime Sleepiness in a French Cohort.

Background: Cardiovascular diseases are the leading cause of death worldwide, particularly in older adults. While the Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP) model estimates 10-year cardiovascular risk in this population, its validation in general European cohorts remains limited. Given growing relationships between sleep disturbances and cardiovascular risk, we aimed to validate SCORE2-OP in a French cohort and assess the incremental value of excessive daytime sleepiness (EDS).

Methods: We included 4626 participants aged 70+ from the Three-City cohort, without cardiovascular disease and dementia at baseline. The SCORE2-OP model calibrated for low-cardiovascular risk regions was used to estimate 10-year cardiovascular risk. Calibration was assessed using observed-to-expected cumulative incidence ratios and calibration curves; discrimination using the area under the curve (AUC). Cox proportional hazards models examined associations between sleep symptoms (poor sleep quality, EDS, insomnia symptoms, sleep apnea [proxy]) and cardiovascular events. Incremental predictive value of significant symptoms was quantified by ΔAUC and net reclassification improvement (NRI).

Results: Over 10 years, the observed cumulative incidence of fatal and non-fatal coronary heart disease or stroke was 10.55%; 95% confidence intervals (CI) = (9.62; 11.48), while the SCORE2-OP predicted risk was 14.04%; 95% CI = (13.85; 14.24), yielding an observed-to-expected ratio of 0.75; 95% CI = (0.69; 0.80). Discrimination was moderate (AUC = 61.71%, 95% CI = [58.64; 64.78]). EDS was the only sleep symptom independently associated with cardiovascular events (adjusted hazard-ratio = 1.32, 95% CI = [1.05; 1.65]). Adding EDS to SCORE2-OP did not improve overall discrimination (ΔAUC = +0.72%, 95% CI = [-0.05; 1.50]) or reclassification (NRI = +1.33%, 95% CI = [-3.27; 5.93]). Sex-stratified analyses showed significant improvement in discrimination in men (ΔAUC = +2.27%, 95% CI = [0.54; 4.00]), but not in women. Moreover, EDS improved reclassification in low (< 7.5%) and intermediate (7.5%-15%) cardiovascular risk groups (NRI = +12%, 95% CI = [3.56; 20.43] and NRI = +12.44%, 95% CI = [7.23; 17.65], respectively).

Conclusions: In this French cohort, SCORE2-OP overestimated cardiovascular risk and showed moderate discrimination. EDS improved SCORE2-OP performance in intermediate cardiovascular risk groups where treatments are uncertain, highlighting its clinical relevance; although implications for prevention strategies require further study.