Qualifiers

Risk estimation using SCORE2 and SCORE2-OP: Qualifiers

The charts should be used in the light of the clinician’s knowledge and judgement, especially with regard to local conditions.

As with all risk estimation systems, risk will be overestimated in countries with a falling CVD mortality rate, and under estimated if it is rising.

Risk may be higher than indicated in the chart in:

• Patients with psychosocial stress, which is associated, in a dose-response pattern, with the development and progression of ASCVD. Psychosocial factors include: stress symptoms, loneliness and critical life events.
• Subjects with evidence of pre-clinical atherosclerosis (a higher-than-expected coronary artery calcium score relative to patients of the same age and sex)

Europe includes many citizens whose ethnic background originates in other countries. Given the considerable variability in ASCVD risk factors between immigrant groups, no single CVD risk score performs adequately in all groups. The following correction factors, based on data from the UK, could be applied when assessing CVD risk using risk calculators (105). Ideally, country and risk-calculator-specific RRs should be used, as the impact of ethnicity may vary between regions and risk calculators.

• Southern Asian: multiply the risk by 1.3 for Indians and Bangladeshis, and 1.7 for Pakistanis.
• Other Asian: multiply the risk by 1.1.
• Black Caribbean: multiply the risk by 0.85.
• Black African and Chinese: multiply the risk by 0.7

Risk may be lower than indicated in the chart in:

• Subjects without evidence of pre-clinical atherosclerosis (a lower-than-expected coronary artery calcium score relative to patients of the same age and sex)