Scientific Background
HeartScore® is aimed at supporting clinicians in optimising individual cardiovascular risk reduction.
The need to estimate total cardiovascular risk in apparently healthy individuals has since 1994 been strongly advocated by the joint recommendations from The European Society of Cardiology, European Society of Hypertension, European Atherosclerosis Society and other societies.
- the goal was to find a tool which clinicians could use to better identify patients at high total risk of developing cardiovascular disease
- the challenge is now to use this tool to reduce the risk of cardiovascular disease and death
The ESC has convened an effort to revise its recommended risk prediction algorithm, known as the Systematic COronary Risk Evaluation (SCORE) model, to address inter-related needs. SCORE includes only fatal CVD outcomes, meaning it underestimates total CVD burden, which in recent decades has shifted towards non-fatal outcomes, especially for younger people. SCORE does not allow for substantial variations of risk across countries from the same risk region, meaning it may mis-estimate risk in these circumstances. SCORE was developed from cohorts recruited before 1986 and has not been systematically ‘recalibrated’ (i.e. statistically adapted) to contemporary CVD rates, meaning it is not ideal for use in contemporary European populations. Finally, risk prediction models recommended for other global regions, may not be readily applicable to European populations because they typically include risk factors not available in routine European data sources needed for risk model recalibration.
To address these limitations, the authors of the SCORE2 and SCORE2-OP risk prediction algorithms provide the development, validation, and illustration of SCORE2 and SCORE2-OP to estimate 10-year fatal and non-fatal CVD risk in individuals in Europe without previous CVD or diabetes aged 40–69 years (SCORE2) and aged over 70 years (SCORE2-OP).
The SCORE2 project involved multiple data sources. First, to enable reliable estimation of age- and sex-specific relative risks, the authors derived prediction models for fatal and non-fatal CVD outcomes using individual-participant data from 45 prospective cohorts involving 677 684 participants in 13 countries. Second, to adapt risk prediction models to the circumstances of each European region, the authors recalibrated the derived risk models using estimated contemporary age- and sex-specific incidences and risk factor distributions. Third, to enhance validity and generalizability, the authors completed external validation using individual-participant data from a further 25 prospective cohorts (i.e. studies not in the model derivation) involving 1 133 181 individuals in 15 European countries. Fourth, to illustrate the variation of CVD risk across European regions, the authors applied the model to contemporary populations.
Read more: European Heart Journal, ehab309, https://doi.org/10.1093/eurheartj/ehab309
The SCORE2-OP project involved several interrelated components and data sources. The study design is closely related to the new SCORE2 model that estimates 10-year fatal and non-fatal CVD risk in individuals without previous CVD or diabetes aged 40–69 years. First, model coefficients were derived in the Cohort of Norway (CONOR) study. This study population was selected because it is a large, representative population-based cohort and has previously been used for model derivation. Second, the model was recalibrated to four geographical risk regions across Europe and beyond using estimated contemporary age- and sex-specific incidences and risk factor distributions. Third, external validation was performed in prospective cohorts from different risk regions. Finally, the model was applied to estimate individualized treatment benefit from blood pressure and cholesterol lowering to illustrate how SCORE2-OP can be used for treatment decision-making in clinical practice.
Read more: European Heart Journal, ehab312, https://doi.org/10.1093/eurheartj/ehab312
Benefits of using SCORE2 and SCORE2-OP
- reliable estimation of age- and sex-specific relative risks
- adapted risk prediction models to the circumstances of each European region
- intuitive, easy to use tool
- takes account of the multifactorial nature of CVD
- calculate the 10-year risk of fatal and non-fatal cardiovascular disease events of your patients
- allows flexibility in management
- allows a more objective assessment of risk over time
- establishes common language of risk for clinicians
- shows how risk increases with age
HeartScore® tailored to European regions
Discover HeartScore now! Choose from four European regions (low, moderate, high and very high risk)
Funding
The European Society of Cardiology is a professional medical society which is funded by its membership dues and the scientific activities and events it organises, such as congresses and seminars, scientific journals publishing, educational programmes (...).
HeartScore updates were supported by:
- AstraZeneca, Merck, Novartis and Pfizer in 2010-2011
- AstraZeneca, Servier and Roche in 2011-2012
- Amgen and Servier Affaires Medicales in 2019
Fundraising for the 2022-2023 update is currently in progress. For more information, please contact us.
The sponsors were not involved in the development of HeartScore and in no way influenced its scientific content.
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More information
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Our mission: To reduce the burden of cardiovascular disease.
