(Hellenic Journal of Cardiology) HJC • 391 Hellenic J Cardiol 2011; 52: 391-398 Original Research Original Research Manuscript received: July 28, 2010; Accepted: September 4, 2010. Address: Demosthenes B. Panagiotakos 46 Paleon Polemiston St. 166 74 Glyfada, Attica, Greece e-mail: d.b.panagiotakos@usa.net Key words: Socioeconomic, epidemiology, risk, diet, prediction, cardiovascular. The Role of Dietary and Socioeconomic Status Assessment on the Predictive Ability of the HellenicSCORE Konstantinos Vlismas 1 , Demosthenes B. PanagiotaKos 1 , Christos PitsaVos 2 , Christina Chrysohoou 2 , yannis sKoumas 2 , Vassilios staVrinos 1 , ChristoDoulos stefanaDis 2 1 Harokopio University, Department of Nutrition Science-Dietetics, 2 First Cardiology Department, School of Medicine, University of Athens, Athens, Greece Introduction: The optimal performance of cardiovascular disease (CVD) risk models in various populations (such as the Framingham Heart Sheet or the ESC SCORE) is of major interest in risk prediction modeling nowadays. We evaluated whether the inclusion of socioeconomic status (SES) in the HellenicSCORE would increase the accuracy of prediction, irrespectively of dietary information and the classical CVD risk factors. Methods: Data from 1514 men and 1528 women (age >18 years), who were free of known CVD on enrol- ment in 2001-02, were studied (the ATTICA study). Five years later a follow up was performed and the de- velopment of CVD was defined (WHO-ICD-10 criteria). As SES indicators, education status and mean annual income were recorded, and a special SES 3-class index was calculated (low, moderate and high). The Med- DietScore, which incorporates the inherent characteristics of the Mediterranean diet, was used as a dietary assessment tool, while the HellenicSCORE, which reflects the level of CVD risk factors, was also calculated. Additive logistic regression models were used to test the additive effect of SES and dietary assessment on the predictive ability of the HellenicSCORE. Results: SES assessment did not improve the predictive ability of the estimated risk model compared to the model that included the HellenicSCORE, physical activity status, waist-to-hip ratio, diabetes and family his- tory of CVD. Additionally, SES did not improve the predictive ability of the estimated risk model even when dietary assessment was added to the above model. Conclusions: Socioeconomic status does not improve the predictive ability of a CVD risk model, even when dietary information is also taken into account. T he cardiovascular disease (CVD) epidemic still constitutes the lead- ing cause of death worldwide. 1 It is a general belief nowadays that pre- vention strategy should not only focus on people who are at high risk for develop- ing CVD, but needs to be used in a wider perspective in terms of reduction of risk factors, if CVD is to be substantially re- duced. 2 Effective prevention is primarily based on the accurate identification of in- dividuals at risk, through the global assess- ment of risk factors. 3 Many risk predic- tion models have been developed over the years in order to provide an overall assess- ment of CVD risk. Two of the most well- known CVD predictive risk models are the Framingham risk score 4 and the ESC SCORE (European Society of Cardiolo- gy: Systematic Coronary Risk Evaluation) system. 5 Other predictive models to mea- sure the risk of future CVD events are: the PROCAM (Prospective Cardiovascu- lar Münster) study, which uses neural net-