SCORE2 (ESC 2021, age 40–69)

Q: What is the difference between SCORE and SCORE2?

Old SCORE (2003) predicted 10-year cardiovascular death only. SCORE2 (2021) predicts fatal and non-fatal myocardial infarction and stroke, uses more recent data and is recalibrated to four risk regions.

Q: Which ESC risk region is Germany in?

Germany — like Austria, Italy and Sweden — belongs to the moderate-risk region in the 2021 ESC prevention guideline.

Q: What SCORE2 value is high risk?

Under 50 years: 2.5 to < 7.5 % is high and ≥ 7.5 % very high. From 50 to 69 years: 5 to < 10 % is high and ≥ 10 % very high.

Q: Can I use SCORE2 in patients with diabetes?

No. SCORE2 is for people without diabetes. For type 2 diabetes the ESC 2023 guideline recommends SCORE2-Diabetes.

10-year risk of fatal and non-fatal cardiovascular disease in apparently healthy Europeans aged 40–69

ESC Cardiovascular Risk Collaboration (derivation)
ESC 2021 CVD prevention guideline

Sources last checked: 2026-10-13

SCORE2 (ESC 2021, age 40–69)

10-year risk of fatal and non-fatal cardiovascular disease in apparently healthy Europeans aged 40–69

Sex

Age (years)Current smokerSystolic blood pressure (mmHg)Total cholesterol (mmol/L)mg/dL ÷ 38.67 = mmol/LHDL cholesterol (mmol/L)mg/dL ÷ 38.67 = mmol/L

ESC risk region (country of residence)

Fill in every field to see the result.

Only for apparently healthy people aged 40–69 WITHOUT established atherosclerotic CVD, diabetes, chronic kidney disease, familial hypercholesterolaemia or markedly elevated single risk factors — those patients are already high or very high risk. Risk thresholds are age-dependent (< 50 vs 50–69 years); read the band text for the patient's age. Bands follow the ESC 2021 prevention guideline; later ESC guidelines (2024 hypertension, 2025 dyslipidaemia update) use different, non-age-specific cut-offs.

Source: SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J 2021;42(25):2439-2454 (coefficients: Supplementary Methods Tables 2–3).Open

Interpretation

< 2.5 %	Low-to-moderate risk at every age 40–69 (ESC 2021).
2.5 to < 5 %	Age < 50: high risk; ESC 2021 states that risk-factor treatment should be considered in this group. Age 50–69: low-to-moderate risk.
5 to < 7.5 %	High risk at every age 40–69; ESC 2021 states that risk-factor treatment should be considered in this category.
7.5 to < 10 %	Age < 50: very high risk, a category for which ESC 2021 recommends risk-factor treatment. Age 50–69: high risk, for which ESC 2021 states that treatment should be considered.
≥ 10 %	Very high risk at every age 40–69, a category for which ESC 2021 recommends risk-factor treatment.

What is the SCORE2 (ESC 2021, age 40–69)?

SCORE2 estimates the 10-year risk of fatal and non-fatal cardiovascular disease (cardiovascular death, myocardial infarction, stroke) in apparently healthy people aged 40–69 in Europe. It was developed by the SCORE2 working group and the ESC Cardiovascular Risk Collaboration from 45 cohorts (about 680,000 people) and recalibrated to four European risk regions using national mortality and incidence data. It replaced the original SCORE in the 2021 ESC prevention guideline.

When to use it

Primary-prevention risk assessment in adults aged 40–69 without established CVD, diabetes or CKD.
Looking up whether ESC 2021 classes blood-pressure or lipid-lowering treatment as 'should be considered' or 'recommended' at a given risk.
Explaining risk to patients — including how stopping smoking or lowering blood pressure changes the estimate.

When not to use it

Established atherosclerotic CVD, diabetes, moderate-to-severe CKD, familial hypercholesterolaemia or a single markedly elevated risk factor — these are high or very high risk by definition.
Age ≥ 70 — use SCORE2-OP. Age < 40 — no SCORE2 model.
People with type 2 diabetes — the ESC 2023 diabetes guideline uses SCORE2-Diabetes instead.

How it is calculated

Centred: cage = (age − 60)/5; csbp = (SBP − 120)/20; ctc = TC − 6; chdl = (HDL − 1.3)/0.5 Men: LP = 0.3742·cage + 0.6012·smoker + 0.2777·csbp + 0.1458·ctc − 0.2698·chdl − 0.0755·cage·smoker − 0.0255·cage·csbp − 0.0281·cage·ctc + 0.0426·cage·chdl; S0 = 0.9605 Women: LP = 0.4648·cage + 0.7744·smoker + 0.3131·csbp + 0.1002·ctc − 0.2606·chdl − 0.1088·cage·smoker − 0.0277·cage·csbp − 0.0226·cage·ctc + 0.0613·cage·chdl; S0 = 0.9776 Uncalibrated risk p = 1 − S0^exp(LP) 10-year risk = 1 − exp(−exp(scale1 + scale2 · ln(−ln(1 − p)))) Scales (men | women): low −0.5699, 0.7476 | −0.7380, 0.7019; moderate −0.1565, 0.8009 | −0.3143, 0.7701; high 0.3207, 0.9360 | 0.5710, 0.9369; very high 0.5836, 0.8294 | 0.9412, 0.8329

Clinical pearls and limitations

Only for apparently healthy people aged 40–69 WITHOUT established atherosclerotic CVD, diabetes, chronic kidney disease, familial hypercholesterolaemia or markedly elevated single risk factors — those patients are already high or very high risk. Risk thresholds are age-dependent (< 50 vs 50–69 years); read the band text for the patient's age. Bands follow the ESC 2021 prevention guideline; later ESC guidelines (2024 hypertension, 2025 dyslipidaemia update) use different, non-age-specific cut-offs.
The country of residence matters: the same profile gives roughly twice the risk in a very-high-risk region as in a low-risk region.
Germany and Austria are moderate-risk countries; Turkey is a high-risk country; France, the Netherlands, Switzerland and the UK are low-risk.
Thresholds are age-dependent: in people under 50, 2.5 % already counts as high risk and 7.5 % as very high; from 50 to 69 the cut-offs are 5 % and 10 %.
SCORE2 predicts fatal plus non-fatal events — its numbers are higher than old SCORE (fatal only) and must not be read against old SCORE cut-offs.
The ESC charts display non-HDL cholesterol; the underlying model uses total and HDL cholesterol, as this calculator does.

Frequently asked questions

What is the difference between SCORE and SCORE2?

Old SCORE (2003) predicted 10-year cardiovascular death only. SCORE2 (2021) predicts fatal and non-fatal myocardial infarction and stroke, uses more recent data and is recalibrated to four risk regions.

Which ESC risk region is Germany in?

Germany — like Austria, Italy and Sweden — belongs to the moderate-risk region in the 2021 ESC prevention guideline.

What SCORE2 value is high risk?

Under 50 years: 2.5 to < 7.5 % is high and ≥ 7.5 % very high. From 50 to 69 years: 5 to < 10 % is high and ≥ 10 % very high.

Can I use SCORE2 in patients with diabetes?

No. SCORE2 is for people without diabetes. For type 2 diabetes the ESC 2023 guideline recommends SCORE2-Diabetes.

Evidence and guidelines

Have a follow-up question?

Medelix answers clinical questions from current guidelines and studies — every statement with its source.

Ask Medelix about the SCORE2 (ESC 2021, age 40–69)

Related calculators

Embed this calculatorFree to use on your website, intranet or teaching page. Copy the code below.

<iframe src="https://medelix.ai/en/embed/score2" title="SCORE2 (ESC 2021, age 40–69) – Medelix" width="100%" height="620" style="border:0;max-width:720px" loading="lazy"></iframe>
<p><a href="https://medelix.ai/en/calculators/score2">SCORE2 (ESC 2021, age 40–69) calculator by Medelix</a></p>

For healthcare professionals and medical students. These tools support, and do not replace, clinical judgement. Always check results against the original source and your local protocols.