Development and External Validation of the SANTANDER Score: A Primary Care Clinical Decision Tool for Cardiovascular Risk Stratification in Colombia

Background: Cardiovascular disease (CVD) remains the leading cause of mortality in Colombia [1,2]. Existing risk scores require laboratory parameters not readily available in resource-limited primary care settings. We developed and validated a simplified clinical decision tool using point-of-care glucose testing. Methods: Cross-sectional study using cardiovascular risk assessment databases from four Colombian municipalities (2023-2025). Derivation cohort: 742 patients from El Peñón and Sucre. External validation: 255 patients from Matanza and Vetas [12]. Primary outcome: guideline-defined high cardiovascular risk (ESC 2021 [9]/ACC-AHA 2019 [10]). Performance assessed using discrimination (AUC), calibration, and decision curve analysis [13]. The SANTANDER Score clinical decision pathway is illustrated in Figure 1, showing the complete workflow from data collection through risk stratification and management recommendations. Results: Seven predictors retained: age (OR 1.08, 95%CI 1.06-1.10), male sex (OR 1.85, 95%CI 1.32-2.59), systolic BP (OR 1.03 per 10 mmHg), BMI (OR 1.12), glucose (OR 1.02 per 10 mg/dL), family history (OR 2.34, 95%CI 1.67-3.28), smoking (OR 2.91, 95%CI 1.89-4.48). AUC: 0.760 (derivation), 0.701 (validation). Superior calibration vs Framingham (slope 0.98 vs 0.76, p<0.001), indicating Framingham overestimates risk by approximately 8 percentage points, translating to greater net benefit (0.124 vs 0.108). Annual savings: $95,250 per 10,000 patients.