SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe
Authors:   SCORE2 working group and ESC Cardiovascular risk collaboration, Hageman Steven , Pennells Lisa , Ojeda Francisco , Kaptoge Stephen , Kuulasmaa Kari , de Vries Tamar , Xu Zhe , Kee Frank , Chung Ryan , Wood Angela , McEvoy John William , Veronesi Giovanni , Bolton Thomas , Achenbach Stephan , Aleksandrova Krasimira , Amiano Pilar , Sebastian Donostia-San , Amouyel Philippe , Andersson Jonas , Bakker Stephan J L , Da Providencia Costa Rui Bebiano , Beulens Joline W J , Blaha Michael , Bobak Martin , Boer Jolanda M A , Bonet Catalina , Bonnet Fabrice , Boutron-Ruault Marie-Christine , Braaten Tonje , Brenner Hermann , Brunner Fabian , Brunner Eric J , Brunström Mattias , Buring Julie , Butterworth Adam S , Capkova Nadezda , Cesana Giancarlo , Chrysohoou Christina , Colorado-Yohar Sandra , Cook Nancy R , Cooper Cyrus , Dahm Christina C , Davidson Karina , Dennison Elaine , Di Castelnuovo Augusto , Donfrancesco Chiara , Dörr Marcus , Doryńska Agnieszka , Eliasson Mats , Engström Gunnar , Ferrari Pietro , Ferrario Marco , Ford Ian , Fu Michael , Gansevoort Ron T , Giampaoli Simona , Gillum Richard F , Gómez de la Cámara Agustin , Grassi Guido , Hansson Per-Olof , Huculeci Radu , Hveem Kristian , Iacoviello Licia , Ikram M Kamran , Jørgensen Torben , Joseph Bijoy , Jousilahti Pekka , Wouter Jukema J , Kaaks Rudolf , Katzke Verena , Kavousi Maryam , Kiechl Stefan , Klotsche Jens , König Wolfgang , Kronmal Richard A , Kubinova Ruzena , Kucharska-Newton Anna , Läll Kristi , Lehmann Nils , Leistner David , Linneberg Allan , Pablos David Lora , Lorenz Thiess , Lu Wentian , Luksiene Dalia , Lyngbakken Magnus , Magnussen Christina , Malyutina Sofia , Ibañez Alejandro Marín , Masala Giovanna , Mathiesen Ellisiv B , Matsushita Kuni , Meade Tom W , Melander Olle , Meyer Haakon E , Moons Karel G M , Moreno-Iribas Conchi , Muller David , Münzel Thomas , Nikitin Yury , Nordestgaard Børge G , Omland Torbjørn , Onland Charlotte , Overvad Kim , Packard Chris , Pająk Andrzej , Palmieri Luigi , Panagiotakos Demosthenes , Panico Salvatore , Perez-Cornago Aurora , Peters Annette , Pietilä Arto , Pikhart , Hynek , Psaty Bruce M , Quarti-Trevano Fosca , Garcia J Ramón Quirós , Riboli Elio , Ridker Paul M , Rodriguez Beatriz , Rodriguez-Barranco Miguel , Rosengren Annika , Roussel Ronan , Sacerdote Carlotta , Sans Susana , Sattar Naveed , Schiborn Catarina , Schmidt Börge , Schöttker Ben , Schulze Matthias , Schwartz Joseph E , Selmer Randi Marie , Shea Steven , Shipley Martin J , Sieri Sabina , Söderberg Stefan , Sofat Reecha , Tamosiunas Abdonas , Thorand Barbara , Tillmann Taavi , Tjønneland Anne , Tong Tammy Y N , Trichopoulou Antonia , Tumino Rosario , Tunstall-Pedoe Hugh , Tybjaerg-Hansen Anne , Tzoulaki Joanna , van der Heijden Amber , van der Schouw Yvonne T , Verschuren W M Monique , Völzke Henry , Waldeyer Christoph , Wareham Nicholas J , Weiderpass Elisabete , Weidinger Franz , Wild Philipp , Willeit Johann , Willeit Peter , Wilsgaard Tom , Woodward Mark , Zeller Tanja , Zhang Dudan , Zhou Bin , Dendale Paul , Ference Brian A , Halle Martin , Timmis Adam , Vardas Panos , Danesh John , Graham Ian , Salomaa Veikko , Visseren Frank , De Bacquer Dirk , Blankenberg Stefan , Dorresteijn Jannick , Di Angelantonio Emanuele 
Published: May 2021

Abstract

Aims
The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40–69 years in Europe.

Methods and results
We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65–0.68) to 0.81 (0.76–0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries.

Conclusion
SCORE2—a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations—enhances the identification of individuals at higher risk of developing CVD across Europe.