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Cited by 1,810Health Promotion and Cardiovascular PreventionCardiovascular Health and Risk FactorsLipoproteins and Cardiovascular Health

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SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe

Open access
SCORE2 working group and ESC Cardiovascular risk collaboration, Hageman, Steven, Pennells, Lisa, Ojeda, Francisco, Kaptoge, Stephen, Kuulasmaa, Kari, de Vries, Tamar, Xu, Zhe, Kee, Frank, Chung, Ryan, Wood, Angela, McEvoy, John William, Veronesi, Giovanni, Bolton, Thomas, Achenbach, Stephan, Aleksandrova, Krasimira, Amiano, Pilar, Sebastian, Donostia-San, Amouyel, Philippe, Andersson, Jonas, Bakker, Stephan J L, Da Providencia Costa, Rui Bebiano, Beulens, Joline W J, Blaha, Michael, Bobak, Martin, Boer, Jolanda M A, Bonet, Catalina, Bonnet, Fabrice, Boutron-Ruault, Marie-Christine, Braaten, Tonje, Brenner, Hermann, Brunner, Fabian, Brunner, Eric J, Brunström, Mattias, Buring, Julie, Butterworth, Adam S, Capkova, Nadezda, Cesana, Giancarlo, Chrysohoou, Christina, Colorado-Yohar, Sandra, Cook, Nancy R, Cooper, Cyrus, Dahm, Christina C, Davidson, Karina, Dennison, Elaine, Di Castelnuovo, Augusto, Donfrancesco, Chiara, Dörr, Marcus, Doryńska, Agnieszka, Eliasson, Mats, Engström, Gunnar, Ferrari, Pietro, Ferrario, Marco, Ford, Ian, Fu, Michael, Gansevoort, Ron T, Giampaoli, Simona, Gillum, Richard F, Gómez de la Cámara, Agustin, Grassi, Guido, Hansson, Per-Olof, Huculeci, Radu, Hveem, Kristian, Iacoviello, Licia, Ikram, M Kamran, Jørgensen, Torben, Joseph, Bijoy, Jousilahti, Pekka, Wouter Jukema, J, Kaaks, Rudolf, Katzke, Verena, Kavousi, Maryam, Kiechl, Stefan, Klotsche, Jens, König, Wolfgang, Kronmal, Richard A, Kubinova, Ruzena, Kucharska-Newton, Anna, Läll, Kristi, Lehmann, Nils, Leistner, David, Linneberg, Allan, Pablos, David Lora, Lorenz, Thiess, Lu, Wentian, Luksiene, Dalia, Lyngbakken, Magnus, Magnussen, Christina, Malyutina, Sofia, Ibañez, Alejandro Marín, Masala, Giovanna, Mathiesen, Ellisiv B, Matsushita, Kuni, Meade, Tom W, Melander, Olle, Meyer, Haakon E, Moons, Karel G M, Moreno-Iribas, Conchi, Muller, David, Münzel, Thomas, Nikitin, Yury, Nordestgaard, Børge G, Omland, Torbjørn, Onland, Charlotte, Overvad, Kim, Packard, Chris, Pająk, Andrzej, Palmieri, Luigi, Panagiotakos, Demosthenes, Panico, Salvatore, Perez-Cornago, Aurora, Peters, Annette, Pietilä, Arto, Pikhart, , Hynek, Psaty, Bruce M, Quarti-Trevano, Fosca, Garcia, J Ramón Quirós, Riboli, Elio, Ridker, Paul M, Rodriguez, Beatriz, Rodriguez-Barranco, Miguel, Rosengren, Annika, Roussel, Ronan, Sacerdote, Carlotta, Sans, Susana, Sattar, Naveed, Schiborn, Catarina, Schmidt, Börge, Schöttker, Ben, Schulze, Matthias, Schwartz, Joseph E, Selmer, Randi Marie, Shea, Steven, Shipley, Martin J, Sieri, Sabina, Söderberg, Stefan, Sofat, Reecha, Tamosiunas, Abdonas, Thorand, Barbara, Tillmann, Taavi, Tjønneland, Anne, Tong, Tammy Y N, Trichopoulou, Antonia, Tumino, Rosario, Tunstall-Pedoe, Hugh, Tybjaerg-Hansen, Anne, Tzoulaki, Joanna, van der Heijden, Amber, van der Schouw, Yvonne T, Verschuren, W M Monique, Völzke, Henry, Waldeyer, Christoph, Wareham, Nicholas J, Weiderpass, Elisabete, Weidinger, Franz, Wild, Philipp, Willeit, Johann, Willeit, Peter, Wilsgaard, Tom, Woodward, Mark, Zeller, Tanja, Zhang, Dudan, Zhou, Bin, Dendale, Paul, Ference, Brian A, Halle, Martin, Timmis, Adam, Vardas, Panos, Danesh, John, Graham, Ian, Salomaa, Veikko, Visseren, Frank, De Bacquer, Dirk, Blankenberg, Stefan, Dorresteijn, Jannick, Di Angelantonio, Emanuele·2021·European Heart Journal
DOI 10.1093/eurheartj/ehab309PMC PMC8248998
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Abstract

Aims: The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40–69 years in Europe. Methods and results: We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65–0.68) to 0.81 (0.76–0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. Conclusion: SCORE2—a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations—enhances the identification of individuals at higher risk of developing CVD across Europe.

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Authors
SCORE2 working group and ESC Cardiovascular risk collaboration, Hageman, S., Pennells, L., Ojeda, F., Kaptoge, S., Kuulasmaa, K., de Vries, T., Xu, Z., Kee, F., Chung, R., Wood, A., McEvoy, J. W., Veronesi, G., Bolton, T., Achenbach, S., Aleksandrova, K., Amiano, P., Sebastian, D.-S., Amouyel, P., Andersson, J., Bakker, S. J. L., Da Providencia Costa, R. B., Beulens, J. W. J., Blaha, M., Bobak, M., Boer, J. M. A., Bonet, C., Bonnet, F., Boutron-Ruault, M.-C., Braaten, T., Brenner, H., Brunner, F., Brunner, E. J., Brunström, M., Buring, J., Butterworth, A. S., Capkova, N., Cesana, G., Chrysohoou, C., Colorado-Yohar, S., Cook, N. R., Cooper, C., Dahm, C. C., Davidson, K., Dennison, E., Di Castelnuovo, A., Donfrancesco, C., Dörr, M., Doryńska, A., Eliasson, M., Engström, G., Ferrari, P., Ferrario, M., Ford, I., Fu, M., Gansevoort, R. T., Giampaoli, S., Gillum, R. F., Gómez de la Cámara, A., Grassi, G., Hansson, P.-O., Huculeci, R., Hveem, K., Iacoviello, L., Ikram, M. K., Jørgensen, T., Joseph, B., Jousilahti, P., Wouter Jukema, J., Kaaks, R., Katzke, V., Kavousi, M., Kiechl, S., Klotsche, J., König, W., Kronmal, R. A., Kubinova, R., Kucharska-Newton, A., Läll, K., Lehmann, N., Leistner, D., Linneberg, A., Pablos, D. L., Lorenz, T., Lu, W., Luksiene, D., Lyngbakken, M., Magnussen, C., Malyutina, S., Ibañez, A. M., Masala, G., Mathiesen, E. B., Matsushita, K., Meade, T. W., Melander, O., Meyer, H. E., Moons, K. G. M., Moreno-Iribas, C., Muller, D., Münzel, T., Nikitin, Y., Nordestgaard, B. G., Omland, T., Onland, C., Overvad, K., Packard, C., Pająk, A., Palmieri, L., Panagiotakos, D., Panico, S., Perez-Cornago, A., Peters, A., Pietilä, A., Pikhart, Psaty, B. M., Quarti-Trevano, F., Garcia, J. R. Q., Riboli, E., Ridker, P. M., Rodriguez, B., Rodriguez-Barranco, M., Rosengren, A., Roussel, R., Sacerdote, C., Sans, S., Sattar, N., Schiborn, C., Schmidt, B., Schöttker, B., Schulze, M., Schwartz, J. E., Selmer, R. M., Shea, S., Shipley, M. J., Sieri, S., Söderberg, S., Sofat, R., Tamosiunas, A., Thorand, B., Tillmann, T., Tjønneland, A., Tong, T. Y. N., Trichopoulou, A., Tumino, R., Tunstall-Pedoe, H., Tybjaerg-Hansen, A., Tzoulaki, J., van der Heijden, A., van der Schouw, Y. T., Verschuren, W. M. M., Völzke, H., Waldeyer, C., Wareham, N. J., Weiderpass, E., Weidinger, F., Wild, P., Willeit, J., Willeit, P., Wilsgaard, T., Woodward, M., Zeller, T., Zhang, D., Zhou, B., Dendale, P., Ference, B. A., Halle, M., Timmis, A., Vardas, P., Danesh, J., Graham, I., Salomaa, V., Visseren, F., De Bacquer, D., Blankenberg, S., Dorresteijn, J., & Di Angelantonio, E.
Affiliations
  • Institut Pasteur de Lille (FR)
  • Centre de Recherche des Cordeliers (FR)
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2021-06-13
Volume
42
Issue
25
Pages
2439-2454
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehab309
PMC
PMC8248998
OpenAlex
W3166015112
Cited by
1,810
References
46
Citations by year
2026: 467 · 2025: 442 · 2024: 395 · 2023: 301 · 2022: 173 · 2021: 32
FWCI
194.65
Type
journal article
Language
en
Open access
Licence
Locations
  • European Heart Journal (publishedVersion, other-oa)
  • PubMed Central (publishedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (publishedVersion, other-oa)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
  • Leiden Repository (Leiden University) (submittedVersion, cc-by)
  • Lithuanian University of Health Sciences (submittedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
  • HAL (submittedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • BOA (University of Milano-Bicocca) (submittedVersion)
  • Document Server@UHasselt (UHasselt) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • IrInSubria (University of Insubria) (submittedVersion)
  • Site cant be reached (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
  • PuSH - Publication Server of Helmholtz Zentrum München (submittedVersion)
  • STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
  • WOS
Funders
  • British Heart Foundation (SP/09/002, RG/13/13/30194, RG/18/13/33946)
  • BHF Centre of Research Excellence (RE/18/1/34212)
  • UK Medical Research Council (MR/L003120/1)
  • National Institute for Health Research
  • Cambridge Biomedical Research Centre (BRC-1215-20014)
  • Wellcome Trust (064947/Z/01/Z, WT081081)
  • National Institute on Aging (AG23522)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Keywords
SCORE2, cardiovascular risk prediction, 10-year cardiovascular risk, risk prediction model, smoking, systolic blood pressure, total cholesterol, HDL cholesterol, sex differences, middle-aged adults, external validation
MeSH terms
Algorithms, Blood Pressure, Cardiovascular Diseases, Europe, Female, Humans, Male, Middle Aged, Risk Factors

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