Heart & cardiovascular risk

SCORE2 calculator: 10-year cardiovascular risk

Estimate your 10-year risk of a heart attack or stroke (fatal or non-fatal) with the European Society of Cardiology (ESC) models for people without cardiovascular disease: SCORE2 for ages 40-69 and SCORE2-OP for ages 70-89. Choose the risk region of the country you live in, then see which ESC 2021 risk category the result falls into for your age. The figure is a population estimate to discuss with a clinician. It does not decide treatment.

AgeyearsFor ages 40-89. From 40 to 69 the calculator uses SCORE2; from 70 to 89 it switches to SCORE2-OP, the ESC model for older adults.SexCurrent smokerAnswer yes if you smoke now.Systolic blood pressure (top number)mmHgUse a typical reading, ideally the average of several taken at rest.Total cholesterolmg/dLHDL cholesterolmg/dLRisk region of your countrySCORE2 and SCORE2-OP are calibrated to four groups of European and Mediterranean countries, based on national cardiovascular death rates. The full country lists are in the table below the calculator. Neither model has a calibration for the US, Canada or Latin America.Diabetes (asked from age 70)Answer this if you are 70 or older, because SCORE2-OP counts diabetes as a risk factor. Under 70 you can leave it blank. SCORE2 is for people without diabetes, so at 40-69 a "yes" gives no result here; the ESC uses SCORE2-Diabetes instead.

Enter your values above to see your result and what it means.

SCORE2 and SCORE2-OP risk categories by age

The ESC 2021 prevention guideline sorts SCORE2 results into three categories, and the cut-offs depend on age because risk climbs steeply with age. The same 8% means very high risk at 45 and high risk at 55. The guideline notes that age is continuous, so a result near an age boundary deserves some flexibility. From age 70 the calculator switches to SCORE2-OP and uses the thresholds in the last row.

ESC 2021 risk categories for apparently healthy people (guideline Table 5).
Age	Low to moderate	High	Very high
Under 50	Below 2.5%	2.5% to under 7.5%	7.5% or more
50-69	Below 5%	5% to under 10%	10% or more
70 and over (SCORE2-OP)	Below 7.5%	7.5% to under 15%	15% or more

Which risk region should I choose?

SCORE2 and SCORE2-OP were recalibrated to the same four groups of countries using national cardiovascular death rates published by the WHO, so the same person gets a different estimate in each region. In the paper, a 50-year-old male smoker with a systolic pressure of 140 mmHg, total cholesterol of 5.5 mmol/L and HDL of 1.3 mmol/L had a 10-year risk of 5.9% in a low-risk country and 14.0% in a very high-risk country. Choose the region of the country you live in. For the US, Canada and Latin America there is no SCORE2 or SCORE2-OP region; US clinicians use the AHA PREVENT equations or the 2013 Pooled Cohort Equations instead.

ESC 2021 risk regions (guideline Figure 3).
Region	Countries
Low	Belgium, Denmark, France, Israel, Luxembourg, Netherlands, Norway, Spain, Switzerland, United Kingdom
Moderate	Austria, Cyprus, Finland, Germany, Greece, Iceland, Ireland, Italy, Malta, Portugal, San Marino, Slovenia, Sweden
High	Albania, Bosnia and Herzegovina, Croatia, Czechia, Estonia, Hungary, Kazakhstan, Poland, Slovakia, Turkey
Very high	Algeria, Armenia, Azerbaijan, Belarus, Bulgaria, Egypt, Georgia, Kyrgyzstan, Latvia, Lebanon, Libya, Lithuania, Moldova, Montenegro, Morocco, North Macedonia, Romania, Russia, Serbia, Syria, Tunisia, Ukraine, Uzbekistan

How SCORE2 and SCORE2-OP are calculated

SCORE2 was derived from 45 cohorts in 13 countries (677,684 people and 30,121 cardiovascular events) and validated in 25 further cohorts across 15 European countries. It uses sex-specific equations with five inputs: age, current smoking, systolic blood pressure, total cholesterol and HDL cholesterol, plus interactions between age and each risk factor, so each factor weighs less at older ages. The model works in mmol/L; values in mg/dL are divided by 38.67. The output is the 10-year risk of cardiovascular death, non-fatal heart attack or non-fatal stroke, adjusted for the competing risk of dying from other causes, then recalibrated to your country's risk region. SCORE2-OP, used from age 70, was derived in the Cohort of Norway (28,503 people over 65 and 10,089 cardiovascular events) and validated in six further study populations (338,615 people). It adds diabetes to the same inputs and allows for the higher chance of dying from other causes at older ages, which is why the categories for 70 and over start higher.

Who the calculator is for, and who should use a different tool

SCORE2 (ages 40-69) and SCORE2-OP (ages 70-89) estimate population risk for apparently healthy adults without established cardiovascular disease. They do not apply to people who have had a heart attack, stroke or other cardiovascular disease, or who have chronic kidney disease or familial hypercholesterolaemia: the ESC places these groups in high or very high risk categories by the condition itself. SCORE2 also excludes diabetes, and people aged 40-69 with type 2 diabetes have their own model, SCORE2-Diabetes. SCORE2-OP includes diabetes as an input, so from 70 you answer that question instead. The result is a starting point for a conversation with a clinician. It does not decide treatment, and nobody should start or stop a medicine because of it.

Frequently asked questions

What is SCORE2?

SCORE2 (Systematic Coronary Risk Evaluation 2) is the cardiovascular risk model recommended by the European Society of Cardiology since 2021. It estimates the chance of a heart attack or stroke, fatal or non-fatal, over the next 10 years for people aged 40-69 without cardiovascular disease or diabetes. Its companion model for ages 70 and over is SCORE2-OP.

What is a good SCORE2 result?

Below 2.5% if you are under 50, below 5% from 50 to 69, and below 7.5% from 70 (SCORE2-OP): that is the ESC low to moderate category. High risk is 2.5% to under 7.5% under 50, 5% to under 10% at 50-69, and 7.5% to under 15% from 70. Very high risk is 7.5% or more under 50, 10% or more at 50-69, and 15% or more from 70.

How is SCORE2 different from the original SCORE?

The original SCORE estimated only fatal cardiovascular events, which underestimated the total burden because more events are now non-fatal, especially in younger people. SCORE2 counts non-fatal heart attacks and strokes too, and is recalibrated to four groups of countries using contemporary incidence and risk factor data.

Can I use this calculator if I am 70 or older?

Yes, up to 89. SCORE2 itself is validated for ages 40-69, so from 70 the calculator switches to SCORE2-OP, the ESC model for older adults. It allows for the higher chance of dying from other causes at older ages, adds diabetes as an input, and uses higher risk categories: below 7.5%, 7.5% to under 15%, and 15% or more.

Does SCORE2 work in the United States?

SCORE2 and SCORE2-OP are calibrated to European and Mediterranean countries and have no US region. In the US, clinicians estimate 10-year risk with the AHA PREVENT equations or the 2013 ACC/AHA Pooled Cohort Equations.