ESC 2021 10-year fatal + non-fatal CV event risk (low-risk region).

What it is and when to use it

SCORE2 and SCORE2-OP estimate the 10-year risk of fatal and non-fatal atherosclerotic cardiovascular events (myocardial infarction and stroke) in people without established cardiovascular disease, diabetes or chronic kidney disease. SCORE2 applies to adults aged 40 to 69 years and SCORE2-OP (Older Persons) to those aged 70 years and over. They combine age, sex, smoking, systolic blood pressure and non-HDL cholesterol, calibrated to European risk regions (low, moderate, high and very high). They are the algorithms recommended by the 2021 ESC guidelines on cardiovascular disease prevention.

How to interpret it

The result is a 10-year risk percentage, interpreted by age band. In adults <50 years: <2.5% low-to-moderate risk, 2.5-7.5% high risk, ≥7.5% very high risk. In those 50-69 years: <5% low-to-moderate, 5-10% high, ≥10% very high. In those ≥70 years (SCORE2-OP): <7.5% low-to-moderate, 7.5-15% high, ≥15% very high. The category guides treatment intensity: in high or very high risk, more intensive lipid-lowering and blood pressure treatment is considered, always within shared decision-making with the patient.

Limitations and when not to use it

Validated in European populations aged 40 years or older without prior cardiovascular events. It should not be applied to patients with established atherosclerotic cardiovascular disease, diabetes mellitus, chronic kidney disease, familial hypercholesterolaemia or secondary hypertension, who are already at high or very high risk or have dedicated tools. The correct risk-region chart must be selected. It does not estimate the risk of heart failure, atrial fibrillation or all-cause mortality, and may underestimate risk in some groups (chronic inflammatory disease, South Asian ethnicity, socioeconomic deprivation).

Frequently asked questions

What is the difference between SCORE2 and the original SCORE?

SCORE2 estimates fatal AND non-fatal cardiovascular events over 10 years and uses non-HDL cholesterol, whereas the older SCORE estimated cardiovascular mortality only. SCORE2 is also recalibrated to European risk regions.

Which regional risk chart should I use in Spain?

Spain is classified as a low-risk region in the SCORE2 calibration; the chart for that region must be selected to obtain a correct estimate.

Can I use SCORE2 in a patient with diabetes?

No. In diabetes, dedicated tools such as SCORE2-Diabetes should be used; SCORE2 and SCORE2-OP are intended for people without diabetes, cardiovascular disease or chronic kidney disease.