SCORE2 Calculator: 10-Year Cardiovascular Risk in Europe

SCORE2 Cardiovascular Risk Calculator

SCORE2 is a European risk model that estimates the chance a person has a first heart attack, stroke, or death from cardiovascular disease within the next ten years. This calculator runs that model from six answers: sex, age, smoking, systolic blood pressure, total cholesterol, and HDL cholesterol. It reports a percentage. It does not give medical advice.

The tool uses two models. SCORE2 covers ages 40 to 69. SCORE2-OP ("older persons") covers ages 70 to 89. Both come from the European Society of Cardiology and were published in the European Heart Journal in 2021.

What the calculator asks for

Cholesterol can be entered in mmol/L or mg/dL. The models are written in mmol/L, so an mg/dL entry is converted once, using 1 mmol/L = 38.67 mg/dL from the NCBI units conversion table (Bookshelf NBK83,505). Neither source paper prints a conversion factor of its own.

HDL cholesterol is part of total cholesterol, so the calculator refuses an HDL that is equal to or higher than the total. Every range above is checked in the calculation itself, not just in the input box, so a pasted or typed value cannot slip past it.

The SCORE2 formula

Each risk factor is measured as a distance from a reference value, multiplied by its published weight, and added up. That sum is called the linear predictor.

sum = Σ (centred value × weight)

The sum is turned into a risk using the model's ten-year baseline survival S0, then rescaled to a risk region:

uncalibrated risk = 1 − S0 ^ exp(sum − mean)

risk = 1 − exp(−exp(scale1 + scale2 × ln(−ln(1 − uncalibrated risk))))

The second line is a complementary log-log rescaling. It stretches the risk scale to match how much cardiovascular disease a region actually has.

The two models centre their inputs differently, because they were fitted on different age groups.

Every factor also carries an age interaction. Its weight is the base weight plus the centred age times an interaction weight. This is why smoking, blood pressure, and cholesterol each count for less as a person gets older. SCORE2 subtracts no mean (it is zero). SCORE2-OP subtracts a published mean of 0.0929 for men and 0.229 for women.

Worked example: a 50-year-old man

Inputs: male, age 50, current smoker, systolic pressure 140 mmHg, total cholesterol 5.5 mmol/L, HDL cholesterol 1.3 mmol/L, low-risk region. This is the illustration the SCORE2 paper itself publishes.

Centred values: age (50 − 60) ÷ 5 = −2, smoking = 1, pressure (140 − 120) ÷ 20 = 1, total cholesterol 5.5 − 6 = −0.5, HDL (1.3 − 1.3) ÷ 0.5 = 0.

With the male baseline survival S0 = 0.9605:

uncalibrated risk = 1 − 0.9605 ^ exp(0.2315) = 0.04953, or 4.95%.

The low-risk region uses scale1 = −0.5699 and scale2 = 0.7476:

risk = 1 − exp(−exp(−0.5699 + 0.7476 × ln(−ln(0.95047)))) = 0.0591, shown as 5.9%.

The same man scores 7.6% in the moderate region, 8.1% in the high region, and 14.0% in the very high region. The paper prints 5.9% and 14.0% for those two ends. A woman with the same numbers scores 4.2% and 13.7%, which are also the paper's figures.

Worked example: a 75-year-old woman

Inputs: female, age 75, current smoker, systolic pressure 160 mmHg, total cholesterol 6.5 mmol/L, HDL cholesterol 1.2 mmol/L, high-risk region. Age 75 selects SCORE2-OP, so the centring changes.

Centred values: age 75 − 73 = 2, smoking = 1, pressure 160 − 150 = 10, total cholesterol 6.5 − 6 = 0.5, HDL 1.2 − 1.4 = −0.2.

The female SCORE2-OP mean is 0.229 and its baseline survival is 0.8082:

uncalibrated risk = 1 − 0.8082 ^ exp(0.77689 − 0.229) = 0.3081, or 30.81%.

The high-risk region uses scale1 = 0.38 and scale2 = 1.09, giving 38.9%. The same woman scores 19.5% in the low-risk region, 26.0% in the moderate region, and 52.0% in the very high region.

The four risk regions

The region is not a label. It rescales the whole answer, and it can change the result by more than a factor of two. Regions are defined by a country's WHO age- and sex-standardised cardiovascular mortality rate, counting deaths per 100,000 people per year under ICD-10 chapter IX (I00-I99).

These groupings come from the SCORE2 paper, Figure 2 and Supplementary Table S6. They are a fixed snapshot that took effect with the models' publication in 2021, not a live feed. Real mortality rates have moved since. For that reason the calculator does not guess a region from a location: the region is chosen by hand, the tool shows each region's death-rate band and country list, and a user whose country has moved band, or is not listed, can pick the band that matches their own country's rate instead. The result is also shown for all four regions at once.

The four regions do not always run in name order. At a low starting risk the published scales can put the high-risk region a shade below the moderate one. A 50-year-old non-smoking man with a pressure of 140 mmHg, total cholesterol 5.5 mmol/L and HDL 1.3 mmol/L scores 3.4%, 4.2%, 4.1%, and 7.8% across the four regions. That is what the published constants do.

Risk bands

The 2021 European Society of Cardiology prevention guideline labels where a SCORE2 number falls. The edges move with age, because the same percentage means something different at 45 and at 75.

These bands describe the number. They are not treatment thresholds, and the calculator publishes none. The band is applied to the percentage after it is rounded to one decimal place, so the label can never disagree with the figure printed beside it.

What the models do not cover

SCORE2 was derived in 45 cohorts covering 677,684 people and validated in 25 more. Both models are for people who do not already have cardiovascular disease.

The published charts are drawn over a narrower window than this page accepts: systolic pressure 100 to 179 mmHg and non-HDL cholesterol 3 to 6.9 mmol/L. The wider input ranges exist so a real lab value is not rejected, but a value far outside the charted window is an estimate the charts do not show.

Neither model applies to people with diabetes. There is no diabetes input here for that reason. Diabetes has its own separately fitted model, SCORE2-Diabetes (European Heart Journal 2023;44(28):2544). The region calibration is European, so the numbers are not meaningful for someone living outside the covered countries. Calculators built for the United States, such as PREVENT or the Pooled Cohort Equations, are separate models with separate inputs.

The tool works out a number and stops there. It sets no treatment threshold, suggests no medicine, gives no doses, and diagnoses nothing.

Frequently asked questions

What does the SCORE2 percentage mean? It is the estimated chance, out of 100 people with the same six answers, of a first fatal or non-fatal cardiovascular event in the next ten years. An event means cardiovascular death, a heart attack, or a stroke.

Why does the model change at age 70? SCORE2-OP is a separate model, not SCORE2 stretched past 69. It has its own coefficients, its own reference values, and its own region scales, fitted on people aged 70 and over. The calculator switches at 70 and never blends the two. The step is visible: a 69-year-old profile that scores 12.2% in the moderate region scores 11.8% at age 70.

Does the risk region really matter that much? Yes. In the first worked example above, the same man scores 5.9% in a low-risk region and 14.0% in a very high-risk region. Only the region changed.

Why is there no diabetes checkbox? SCORE2 and SCORE2-OP are for people without diabetes. Both published models carry a diabetes coefficient, but their intended population excludes diabetes, and a separate model exists for it. Offering the box would answer a question this model was not built for.

Can LDL cholesterol be entered instead of HDL? No. The models take total cholesterol and HDL cholesterol. The difference between them, non-HDL cholesterol, is the form the published charts are drawn in, and the calculator shows it alongside the result.

Where do the numbers on this page come from? SCORE2 working group and ESC Cardiovascular Risk Collaboration, "SCORE2 risk prediction algorithms", European Heart Journal 2021;42(25):2439-2448. SCORE2-OP working group and ESC Cardiovascular Risk Collaboration, "SCORE2-OP risk prediction algorithms", European Heart Journal 2021;42(25):2455-2467. Risk bands come from the 2021 ESC prevention guideline. The cholesterol conversion factor comes from the NCBI units conversion table.