From the Guidelines
The SCORE-2 cardiovascular risk assessment should be performed every 5 years in adults over 40 years of age, or more frequently if significant risk factors change. For initial evaluation, all adults aged 40 and above should have their cardiovascular risk assessed using SCORE-2, which estimates the 10-year risk of fatal and non-fatal cardiovascular events, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. The SCORE-2 model is preferred over other 10-year risk-prediction models because it predicts both fatal and non-fatal CVD events, has been validated and recalibrated to European populations 1.
Key considerations for estimating the SCORE-2 include:
- Age: SCORE-2 is recommended for individuals aged 40–69 years, while SCORE2-Older Persons (SCORE2-OP) is recommended for individuals aged ≥70 years 1
- Blood pressure: Calculating SCORE2 or SCORE2-OP is recommended for individuals with elevated BP who are not already at sufficiently high CVD risk due to established CVD, moderate or severe CKD, probable or definite familial hypercholesterolaemia, diabetes mellitus, or HMOD 1
- Risk threshold: A predicted 10-year CVD risk of ≥10% by SCORE2 or SCORE2-OP is considered sufficiently high risk for BP-lowering treatment decisions 1
More frequent reassessment (annually) is recommended for patients with risks close to treatment thresholds or with significant changes in risk factors such as starting smoking, developing diabetes, or experiencing substantial weight gain. Additionally, reassessment should occur after any cardiovascular risk factor treatment is initiated to evaluate the effectiveness of interventions. This periodic assessment schedule allows for timely detection of increasing cardiovascular risk while avoiding unnecessary testing, ultimately prioritizing morbidity, mortality, and quality of life as the outcome.
From the Research
Estimating SCORE-2 in Adults Over 40 Years of Age
- The frequency of estimating SCORE-2 in adults over 40 years of age is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the SCORE2 risk prediction algorithm is designed to estimate 10-year fatal and non-fatal cardiovascular disease risk in individuals without previous cardiovascular disease or diabetes aged 40-69 years in Europe 3.
- The algorithm is based on contemporary data and predicts the risk of incident cardiovascular disease in addition to cardiovascular mortality, accounting for competing risks 3, 5.
- The studies suggest that SCORE2 can be used to reclassify cardiovascular risk and guide treatment decisions, such as lipid-lowering therapy 2, 4.
- It is recommended to estimate SCORE2 using office blood pressure (OBP) or ambulatory blood pressure measurement (ABPM), with no significant differences in results between the two methods 2.
- The frequency of estimation may depend on individual patient factors, such as changes in blood pressure or lipid profiles, but this is not explicitly stated in the provided studies.
Key Factors Influencing SCORE-2 Estimation
- Age: SCORE2 is designed for individuals aged 40-69 years 3.
- Blood pressure: OBP or ABPM can be used to estimate SCORE2 2.
- Lipid profiles: Total- and HDL-cholesterol are included in the SCORE2 algorithm 3.
- Smoking status: Smoking status is a factor in the SCORE2 algorithm 3.
- Geographic region: SCORE2 is calibrated for different European regions 3, 5.