SCORE2/SCORE2-OP

SCORE2/SCORE2-OP of the European Society of Cardiology (ESC) is the updated version of the calculation basis for estimating cardiovascular risk in healthy people aged 40 and over.

The risk of serious cardiovascular events within the next 10 years (10-year risk) is calculated on the basis of age, gender, blood pressure, cholesterol levels and smoking status.

The risk assessment serves as a basis for therapy decisions, e.g. lifestyle changes or additional drug therapy for the primary prevention of atherosclerosis and serious cardiovascular events. The indication for drug therapy exists at a 10-year risk of ≥10%.

For the indication for drug therapy to lower LDL-C, the risk assessment is also the basis for setting the target value.

SCORE2-OP is used for risk assessment for people aged 70 and over.

Based on the current ESC/EAS guideline update on the management of dyslipidemia in 2025, the following additional modifying factors and biomarkers should be included in SCORE2/SCORE2-OP, especially in the case of a moderate risk profile, and help with a more accurate risk assessment:

demographic and clinical signs:

a family history of premature cardiac death (men ≤55 LJ; women ≤60 LJ)

Belonging to a high-risk ethnic group (e.g. South Asia)

Presence of stress symptoms and psychosocial stressors

Social and socio-economic disadvantage

obesity

Physical inactivity (lack of exercise)

Chronic immune-mediated or chronic inflammatory diseases

severe psychiatric illnesses

early menopause

Pre-eclampsia or a history of hypertensive pregnancy disorders (HES)

HIV

Obstructive sleep apnea syndrome

Biomarkers:

constantly elevated high-sensitivity C reactive protein (hs-CRP; >2 mg/L)

elevated Lp(a) (>50 mg/dL or > 105 nmol/L)

Risk assessment with SCORE2/SCORE2-OP is not suitable for people who already have cardiovascular disease or have suffered a serious vascular event. These people are already at high or very high risk and therefore the indication for drug therapy in addition to lifestyle changes. In this case, the target value for drug therapy to lower LDL-C should be ≤55 mg/dl (1.4 mmol/l).

Patients with diabetes mellitus are also already at high or very high risk, especially if they have had the disease for ≥10 years or already have end organ damage. Here too, drug therapy is indicated in addition to lifestyle changes with a target LDL-C value ≤55 mg/dl (1.4 mol/l).

Familial hypercholesterolemia is also not covered by SCORE2/SCORE-OP, as even in this case there is already a high or very high risk and the indication for drug therapy in combination with lifestyle measures is given.

ESC SCORE2/SCORE2-OP (APP for risk calculation).

Mach F, Koskinas KC, Roeters van Lennep JE et al (2025). 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Developed by the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS), European Heart Journal 46, 42, 7: 4359-4378. doi.org/10.1093/eurheartj/ehaf190

SCORE2 working group and ESC Cardiovascular risk collaboration (2021). SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Europ Heart J 42, 25: 2439-2454. doi.org/10.1093/eurheartj/ehub309