{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T16:38:15Z","timestamp":1770914295043,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100007542","name":"AFSSAPS","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007542","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["06\u2010PNRA\u2010005"],"award-info":[{"award-number":["06\u2010PNRA\u2010005"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["07 LVIE 004"],"award-info":[{"award-number":["07 LVIE 004"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008018","name":"Mutuelle G\u00e9n\u00e9rale de l'Education Nationale","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008018","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002915","name":"Fondation pour la Recherche M\u00e9dicale","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002915","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004431","name":"Fondation de France","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004431","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003769","name":"Eisai","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003769","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiovascular diseases are the leading cause of death worldwide, particularly in older adults. While the Systematic Coronary Risk Evaluation 2\u2010Older Persons (SCORE2\u2010OP) model estimates 10\u2010year 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\u2010OP in a French cohort and assess the incremental value of excessive daytime sleepiness (EDS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included 4626 participants aged 70+ from the Three\u2010City cohort, without cardiovascular disease and dementia at baseline. The SCORE2\u2010OP model calibrated for low\u2010cardiovascular risk regions was used to estimate 10\u2010year cardiovascular risk. Calibration was assessed using observed\u2010to\u2010expected 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 \u0394AUC and net reclassification improvement (NRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over 10\u2009years, the observed cumulative incidence of fatal and non\u2010fatal coronary heart disease or stroke was 10.55%; 95% confidence intervals (CI)\u2009=\u2009(9.62; 11.48), while the SCORE2\u2010OP predicted risk was 14.04%; 95% CI\u2009=\u2009(13.85; 14.24), yielding an observed\u2010to\u2010expected ratio of 0.75; 95% CI = (0.69; 0.80). Discrimination was moderate (AUC\u2009=\u200961.71%, 95% CI\u2009=\u2009[58.64; 64.78]). EDS was the only sleep symptom independently associated with cardiovascular events (adjusted hazard\u2010ratio\u2009=\u20091.32, 95% CI\u2009=\u2009[1.05; 1.65]). Adding EDS to SCORE2\u2010OP did not improve overall discrimination (\u0394AUC\u2009=\u2009+0.72%, 95% CI\u2009=\u2009[\u22120.05; 1.50]) or reclassification (NRI\u2009=\u2009+1.33%, 95% CI\u2009=\u2009[\u22123.27; 5.93]). Sex\u2010stratified analyses showed significant improvement in discrimination in men (\u0394AUC\u2009=\u2009+2.27%, 95% CI\u2009=\u2009[0.54; 4.00]), but not in women. Moreover, EDS improved reclassification in low (&lt;\u20097.5%) and intermediate (7.5%\u201315%) cardiovascular risk groups (NRI\u2009=\u2009+12%, 95% CI\u2009=\u2009[3.56; 20.43] and NRI\u2009=\u2009+12.44%, 95% CI\u2009=\u2009[7.23; 17.65], respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this French cohort, SCORE2\u2010OP overestimated cardiovascular risk and showed moderate discrimination. EDS improved SCORE2\u2010OP performance in intermediate cardiovascular risk groups where treatments are uncertain, highlighting its clinical relevance; although implications for prevention strategies require further study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70047","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:20:31Z","timestamp":1756380031000},"page":"3519-3525","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>SCORE2<\/scp>\n                    \u2010Older Persons (\n                    <scp>SCORE2<\/scp>\n                    \u2010\n                    <scp>OP<\/scp>\n                    ): Validation and Added Value of Excessive Daytime Sleepiness in a French Cohort"],"prefix":"10.1111","volume":"73","author":[{"given":"Tahiana","family":"Andriambelosoa","sequence":"first","affiliation":[{"name":"Institute for Neurosciences of Montpellier (INM), Inserm University of Montpellier  Montpellier France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cl\u00e9mence","family":"Cavaill\u00e8s","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean\u2010Philippe","family":"Empana","sequence":"additional","affiliation":[{"name":"Inserm, PARCC, F\u201075015, Team Integrative Epidemiology of Cardiovascular Diseases Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thibault","family":"Mura","sequence":"additional","affiliation":[{"name":"Institute for Neurosciences of Montpellier (INM), Inserm University of Montpellier  Montpellier France"},{"name":"Department of Biostatistics, Epidemiology &amp; Public Health, CHRU N\u00eemes University of Montpellier  N\u00eemes France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5169-7421","authenticated-orcid":false,"given":"Catherine","family":"Helmer","sequence":"additional","affiliation":[{"name":"Bordeaux Population Health Center, UMR U1219, Inserm University of Bordeaux  Bordeaux France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yves","family":"Dauvilliers","sequence":"additional","affiliation":[{"name":"Institute for Neurosciences of Montpellier (INM), Inserm University of Montpellier  Montpellier France"},{"name":"Sleep\u2010Wake Disorders Unit, Department of Neurology Gui\u2010de\u2010Chauliac Hospital, CHU Montpellier  Montpellier France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8205-7590","authenticated-orcid":false,"given":"Isabelle","family":"Jaussent","sequence":"additional","affiliation":[{"name":"Institute for Neurosciences of Montpellier (INM), Inserm University of 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