What is SCORE2?
SCORE2 is a model published by the European Society of Cardiology (ESC) in 2021 that estimates the 10-year risk of fatal and non-fatal heart attack and stroke in people aged 40-69 without known cardiovascular disease. It was developed with data from more than 677,000 people in about 45 studies and is recommended in the 2021 ESC guideline on cardiovascular disease prevention.
How is it calculated?
The model uses separate coefficients for women and men. It takes into account:
- Age
- Current smoking
- Systolic (upper) blood pressure
- Total cholesterol and HDL cholesterol
A risk score is calculated from these values and their interactions with age, then combined with the baseline 10-year risk. Finally the result is recalibrated to the cardiovascular disease rates of the region: Risk = 1 − exp(−exp(a + b × ln(−ln(1 − uncalibrated risk)))), where a and b are published region- and sex-specific constants. Türkiye is one of the "very high risk region" countries in SCORE2, so this tool uses that region's constants. Cholesterol entered in mg/dL is converted to mmol/L by dividing by 38.67.
How to read the result
For apparently healthy people the ESC guideline groups risk by age:
- Under 50: below 2.5% low-to-moderate, 2.5% to below 7.5% high, 7.5% or more very high risk.
- 50-69: below 5% low-to-moderate, 5% to below 10% high, 10% or more very high risk.
At low-to-moderate risk the priorities are healthy eating, regular exercise, stopping smoking and a healthy weight. At high risk, treatment of blood pressure and cholesterol may also be considered; at very high risk, treatment of risk factors is generally recommended. Even when the percentage looks low at a younger age, smoking, high blood pressure and cholesterol add up to a substantial long-term burden.
Why it matters for women
Cardiovascular disease is also among the leading causes of death in women, and risk rises after menopause. Women who had pre-eclampsia, gestational diabetes or high blood pressure in pregnancy are known to have a higher risk of cardiovascular disease later in life, and regular checks of blood pressure, blood sugar and cholesterol are recommended for them.
Limitations
- SCORE2 applies only to ages 40-69; from age 70 the SCORE2-OP model is used.
- It is not suitable for people with diabetes, known cardiovascular disease, moderate or severe kidney disease or familial hypercholesterolaemia; they are already considered high or very high risk.
- Total cholesterol above 8 mmol/L (about 310 mg/dL) or blood pressure of 180 mmHg or more counts as high risk on its own.
- The model does not directly include family history, weight, physical activity, stress or pregnancy history; your doctor assesses these separately.
When to see a doctor
See your doctor if your result is in the high or very high group, if your blood pressure is often above 140/90 mmHg, or if your cholesterol is high. Call emergency services immediately for chest pain, breathlessness, facial drooping, slurred speech or sudden weakness in an arm or leg. This tool is for information only; treatment decisions are made by your doctor after assessing your overall health.
Sources
- SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J. 2021;42:2439-2454 (supplementary methods).
- Visseren FLJ et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227-3337.