Cardiovascular Risk Calculator SCORE2 / SCORE2-OP
Estimate cardiovascular risk (heart attack, stroke) in 10 years using SCORE2 and SCORE2-OP models (ESC 2021). Valid for Moderate Risk region (Italy). Calculations in browser - no data sent to server.
SCORE2 (Systematic COronary Risk Evaluation 2) is the ESC 2021 model for primary cardiovascular prevention in people aged 40–69 years without prior cardiovascular disease. It updates and replaces the old SCORE 2003 by including non-fatal events (non-lethal heart attacks and strokes) and recalibrating parameters on contemporary European cohorts. For the age range of 70–89 years, SCORE2-OP (Older Persons) is used, with distinct risk thresholds for advanced age.
The model uses a multifactorial Cox approach with centered predictors: age, systolic blood pressure (SBP, mmHg), total cholesterol (TC, mmol/L), and current smoking status. The 10-year risk is calculated as risk = 1 − S₀^exp(LP), where LP is the linear predictor and S₀ is the baseline survival at 10 years for the Moderate risk region (Italy). Cholesterol should be entered in mmol/L (conversion: mg/dL ÷ 38.67).
The ESC 2021 risk categories for the Moderate region (Italy) vary by age group: under 50 years old, the thresholds are lower (low <2.5%, moderate 2.5–7.5%, high 7.5–10%, very high ≥10%), while for 50–69 years old they increase (low <5%, moderate 5–10%, high 10–20%, very high ≥20%). SCORE2-OP uses specific thresholds for seniors.
Fonte: SCORE2 working group and ESC. Eur Heart J 2021;42:2439-2454 (DOI 10.1093/eurheartj/ehab309). SCORE2-OP: Eur Heart J 2021;42:2455-2467 (DOI 10.1093/eurheartj/ehab312).
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Calculation example
Patient type: Female, 55 years old, BP 130 mmHg, total cholesterol 5.5 mmol/L, non-smoker, Italy (moderate region).
- Model: SCORE2 (40-69 years)
- Linear predictor LP = β_age × (55−55) + β_BP × (130−135) + β cholesterol × (5.5−5.8) + β_smoke × 0 + interactions
- S₀ (10-year baseline survival, Moderate Region, female): 0.9776 [ASSUMED]
- Risk ≈ 1 − 0.9776^exp(LP) ≈ 2.0% → Category: Low risk
[The model constants are ASSUMED normative with [ASSUMED] tag - to be verified against ESC 2021 Supplementary Table S1. The original research (52-CLINICAL-FORMULAS-RESEARCH.md) estimated 3-4%; the implemented model gives ~2.0% with currently assumed coefficients.]
Glossary
- Score 2
- Systematic Coronary Risk Evaluation 2 - ESC 2021 model for estimating the risk of fatal and non-fatal cardiovascular events over 10 years in adults aged 40–69 without prior cardiovascular disease.
- SCORE2-OPT
- SCORE2 Older Persons - variant of the ESC 2021 model for people aged 70–89. Uses European elderly cohorts and risk thresholds adapted (e.g., low <7.5% vs low <2.5–5% for SCORE2).
- SAP (Systolic Blood Pressure)
- The "maximum" pressure of the cardiac cycle, expressed in mmHg. Normal values <120 mmHg; Grade 1 hypertension: 140–159 mmHg; Grade 2: ≥160 mmHg (ESC/ESH 2023).
- Total Cholesterol (TC)
- Total lipid fraction sum (LDL + HDL + VLDL), expressed in mmol/L. For the SCORE2 model, enter total cholesterol in mmol/L (1 mmol/L = 38.67 mg/dL).
- Risk Zone ESC (Italy)
- The ESC 2021 ranks Europe into 4 risk regions (Low, Moderate, High, Very High) based on historical cardiovascular mortality. Italy is in the Moderate region [ASSUMED - to be verified in ESC 2021 Table 1].
Frequently Asked Questions
What is SCORE2 and who is it for?
SCORE2 (Systematic COronary Risk Evaluation 2) is the ESC 2021 model for estimating the risk of fatal and non-fatal cardiovascular events over 10 years in patients aged 40–69 without prior cardiovascular disease. For people aged 70–89, the SCORE2-OP (Older Persons) model applies, with risk thresholds adjusted for advanced age.
What is the difference between SCORE2 and the old SCORE?
The old SCORE model (2003) only estimated fatal cardiovascular events. SCORE2 (2021) also includes non-fatal events (non-lethal heart attacks and strokes), has been recalibrated on contemporary European cohorts, uses age-adjusted risk thresholds, and added the SCORE2-OP model for older adults.
Why is total cholesterol requested instead of LDL?
The original SCORE2 ESC 2021 model uses total cholesterol (TC, mmol/L) as the lipid predictor, not just LDL. This is because total cholesterol is the parameter available in the derivation and recalibration cohorts of the model. To convert: if you have LDL (mg/dL), divide by 38.67 to get mmol/L, then add HDL (mmol/L) and triglycerides/5 (mmol/L) to estimate total cholesterol.
What are the ESC 2021 risk categories?
For SCORE2 (40-69 years, Moderate region like Italy): Low (<2.5% if <50, or <5% if 50-69), Moderate (2.5-7.5% if <50, or 5-10% if 50-69), High (7.5-10% if <50, or 10-20% if 50-69), Very high (≥10% if <50, or ≥20% if 50-69). For SCORE2-OP (70-89 years): Low (<7.5%), Moderate (7.5-15%), High (15-30%), Very high (≥30%). [Threshold values are from ESC 2021 guidelines - to be verified with your cardiologist.]
Is the data entered safe?
Yes. All calculations happen locally in your browser using the SCORE2/SCORE2-OP ESC 2021 model. No clinical data is transmitted to external servers, AI, or third parties. The tool does not store or process personal data.
Can I use this calculator for therapeutic decisions?
This tool is for informational purposes only and IS NOT a medical device. The SCORE2 score is a clinical decision support tool that a cardiologist or internist integrates with a complete clinical evaluation (medical history, physical exam, imaging, risk factors not included in the model). Always consult your doctor for interpretation of results and therapeutic decisions.
How is it used?
- Enter clinical data
Select biological sex, enter age (40–89 years), systolic blood pressure in mmHg, total cholesterol in mmol/L, and indicate if you are a current smoker. The calculator uses the SCORE2 model (40–69 years) or SCORE2-OP (70–89 years) ESC 2021.
- Start calculation
Press "Calculate Risk". The result is processed in the browser - no data is sent to external servers.
- Assess cardiovascular risk
The tool shows the estimated 10-year cardiovascular risk (%) and the 2021 ESC category: Low, Moderate, High, Very high. For age ≥70, the SCORE2-OP model with adapted thresholds is applied.
- Discuss the result with your doctor
The SCORE2 result is a clinical decision support tool. The doctor integrates this data with additional factors (family history, diabetes, renal function, atherosclerotic imaging) to plan personalized cardiovascular prevention.
Do you need a custom analysis?
This tool is free and informative. For in-depth analysis with AI on-prem - private data, zero cloud - contact Federico.