Publication of October 2022

Since 2019, the SARS-CoV-2 has been associated with the occurrence of myocarditis. Moreover, specifically in the pediatric population, this virus can cause an exaggerated inflammatory response several weeks after the acute infection. This new entity is called “multisystem inflammatory syndrome in children” (MIS-C). Cardiovascular involvement is very common in this syndrome, particularly in the form of ventricular dysfunction with increased cardiac enzymes. As myocardial damage is one of the causes of sudden cardiac death in young athletes, resumption of sporting activities must be undertaken with caution. Depending on initial symptoms, a focused history taking and meticulous physical examination may be sufficient to permit resumption of sports after the legal duration of quarantine in case of simple COVID-19 infection. In other cases, the patient should be referred to a pediatric cardiologist for a more comprehensive workup. For patients with MIS-C, sport remains contraindicated for a period of 3 to 6 months. Sport should in any case be resumed gradually, with the patient, his parents, and trainers being made aware of the possible appearance of cardiorespiratory symptoms.

Primary prevention of cardiovascular disease (CVD) is actually needed, though poorly implemented as yet. The choice of the most optimal preventive strategy depends on the total cardiovascular (CV) risk of a given person. Several models have been developed to estimate total CV risk. Until recently, the SCORE model, calibrated for Belgium (SCORE-Belgium), has been recommended for that purpose.

A new model has now been developed and validated (SCORE 2), with certain advantages. Four systems have been advocated, and the ‘SCORE 2 low-risk’ system has been recommended for implementation in Belgium. This easy-to-use model allows for the stratification of the apparently healthy adult population into subgroups at low-to-moderate, high, and very-high total CV risk, so that preventive strategies can then be adapted accordingly. A recalibration of this ‘SCORE 2 low-risk’ model for Belgium seems unnecessary. The international model likely underestimates slightly the total CV risk in the population, which is in accordance with the position of Belgium as one of the countries with the highest CV mortality rates among the 10 countries considered being at ‘low CV risk’. Indeed, this only marginal difference does not justify a recalibration of the international model.