CAROC Score: Definition and Clinical Application
What CAROC Actually Is
CAROC is not a cardiovascular risk assessment tool—it is the Canadian Association of Radiologists and Osteoporosis Canada fracture risk assessment system used to estimate 10-year osteoporotic fracture risk, not cardiovascular disease risk. The question appears to contain a misunderstanding, as the evidence provided discusses cardiovascular risk assessment tools (SCORE, Pooled Cohort Equations, etc.), none of which are called "CAROC."
Cardiovascular Risk Assessment Tools (What You May Be Looking For)
If you are seeking information about cardiovascular risk estimation, the following are the major validated tools:
Primary Risk Assessment Models
Pooled Cohort Equations (PCE): The American College of Cardiology recommends using the ACC/AHA Pooled Cohort Equations to estimate 10-year atherosclerotic cardiovascular disease risk in adults aged 40-79 years in the United States, incorporating age, total cholesterol, HDL cholesterol, systolic blood pressure, diabetes status, smoking status, and antihypertensive treatment 1.
SCORE/SCORE2: The European Society of Cardiology recommends the SCORE (Systemic COronary Risk Evaluation) model for prediction of 10-year risk of CV death, with SCORE2 now estimating 10-year risk of combined fatal and nonfatal CVD events 2, 3.
SCORE2-OP: For elderly patients (≥70 years) in Europe, SCORE2-OP estimates 5- and 10-year CVD risk, accounting for competing non-vascular mortality 2.
Risk Categories and Thresholds
U.S. Guidelines: Risk categories are defined as low (<5%), borderline (5-7.4%), intermediate (7.5-19.9%), and high (≥20%) using the Pooled Cohort Equations 1.
European Guidelines: The 2016 European guideline recommends classification based on cardiovascular mortality risk as low (<1%), moderate (1% to <5%), high (5% to <10%) or very high (≥10%) 2.
Additional Risk Stratification Tools
For intermediate-risk patients (7.5-19.9% 10-year risk), the American College of Cardiology recommends considering coronary artery calcium (CAC) scoring as the most accurate additional tool to clarify treatment decisions 2, 1.
A CAC score >100 is associated with high event rates and may trigger statin therapy discussion, while a CAC score = 0 is associated with very low event rates and may support deferring statin therapy 1.
Common Pitfall
Do not confuse CAROC (osteoporosis fracture risk) with cardiovascular risk assessment tools. If you need cardiovascular risk estimation, use the Pooled Cohort Equations for U.S. populations 1, SCORE2 for European populations 2, 3, or region-specific calibrated models like the WHO cardiovascular disease risk charts for other global regions 4.