About the SCORE2 Cardiovascular Risk Calculator
SCORE2 is the European Society of Cardiology’s model for estimating the 10-year risk of a first fatal or non-fatal cardiovascular event — myocardial infarction, stroke or cardiovascular death — in apparently healthy people aged 40 to 69. It was developed by the SCORE2 working group from 45 cohorts in 13 countries (677,684 people) and published in the European Heart Journal in 2021, and it underpins the 2021 ESC prevention guideline.
The model uses age, sex, current smoking, systolic blood pressure, total cholesterol and HDL cholesterol (non-HDL cholesterol is derived from these), then recalibrates the result to one of four European risk regions grouped by national cardiovascular mortality: low (for example the UK, France, Spain, the Netherlands, Belgium and Denmark), moderate (for example Germany, Italy, Sweden, Ireland and Greece), high (for example Poland, Hungary, Czechia and Türkiye) and very high (for example Russia, Ukraine, Bulgaria, Serbia and Egypt). Choose the region that matches the country whose population the person belongs to.
SCORE2 is not meant for people with established cardiovascular disease, diabetes, chronic kidney disease, familial hypercholesterolaemia or very high single risk factors, who are managed as high risk directly. For people aged 70 and over the ESC uses SCORE2-OP, and for people with type 2 diabetes SCORE2-Diabetes.
With the default inputs, the 10-year cvd risk (score2) is 5.9%. Change any value above to recalculate instantly.
How to use the score2 cardiovascular risk calculator
- 1Pick the risk region for the person’s country.
- 2Select sex and enter age (40–69).
- 3Tick current smoking and enter systolic blood pressure.
- 4Enter total and HDL cholesterol in mmol/L or mg/dL.
- 5Read the 10-year risk, the ESC category and the region comparison chart.
Formula and method
SCORE2 is a sex-specific competing-risk-adjusted Cox model. Centred and scaled risk factors (age in 5-year steps from 60, systolic pressure in 20 mmHg steps from 120, total cholesterol from 6 mmol/L and HDL in 0.5 mmol/L steps from 1.3) are multiplied by published coefficients, with interaction terms between age and each risk factor so that their effect weakens with age. Baseline 10-year survival is 0.9605 for men and 0.9776 for women.
The uncalibrated risk is then recalibrated to the chosen region with the published region- and sex-specific scale factors on the complementary log-log scale. ESC 2021 categories: under 50 years, < 2.5% low-to-moderate, 2.5 to < 7.5% high, ≥ 7.5% very high; 50–69 years, < 5%, 5 to < 10% and ≥ 10%. Cholesterol in mg/dL is converted with 38.67.
- S₀
- Baseline 10-year survival (0.9605 men, 0.9776 women)
- scale1, scale2
- Region- and sex-specific recalibration factors
- TC, HDL
- Total and HDL cholesterol, mmol/L
Worked examples
SCORE2 paper example: 50-year-old male smoker, low-risk region
With SBP 140 mmHg, total cholesterol 5.5 and HDL 1.3 mmol/L, the risk is 5.9% in a low-risk country — the figure quoted in the SCORE2 publication.
Same man in a very-high-risk region
Recalibrating the identical profile to a very-high-risk country raises the risk to 14.0%, matching the range of 5.9% to 14.0% reported in the paper.
45-year-old non-smoking woman, moderate region (mg/dL)
Total cholesterol 210 mg/dL (5.43 mmol/L) and HDL 60 mg/dL (1.55 mmol/L) with SBP 125 give a 10-year risk of about 1.1% — low-to-moderate for her age group.
Frequently asked questions
What does SCORE2 predict?+
The 10-year risk of a first fatal or non-fatal cardiovascular event — myocardial infarction, stroke or cardiovascular death — in apparently healthy adults aged 40 to 69. The older SCORE system predicted only fatal events.
Which risk region should I choose?+
Use the region for the country whose cardiovascular mortality the person shares. Low-risk countries include the UK, France, Spain, the Netherlands, Belgium and Denmark; moderate-risk include Germany, Italy, Sweden and Ireland; high- and very-high-risk regions are mainly in Central and Eastern Europe, North Africa and the Middle East.
What SCORE2 result is high risk?+
Under the 2021 ESC guideline, for people under 50 a risk of 2.5 to < 7.5% is high and ≥ 7.5% very high; for ages 50–69, 5 to < 10% is high and ≥ 10% very high.
Can I use SCORE2 if I have diabetes?+
No. People with diabetes are assessed with SCORE2-Diabetes, which adds age at diagnosis, HbA1c and kidney function. People with established cardiovascular disease or significant kidney disease are already high or very high risk.
How is SCORE2 different from QRISK3 or the US ASCVD calculator?+
QRISK3 is derived from UK general-practice data and includes many extra conditions and ethnicity; the US Pooled Cohort Equations were derived from US cohorts. SCORE2 is calibrated to four European risk regions and is the ESC’s recommended tool.
For healthcare professionals and education only. This calculator implements a published formula or score but is not a diagnosis and does not replace clinical judgment. Verify inputs and results against the original source before using them in patient care.