SCORE2-OP (ESC 2021, age ≥ 70)

Q: What is SCORE2-OP?

The ESC's 10-year cardiovascular risk model for people aged 70 and over, published in 2021 alongside SCORE2 for ages 40–69.

Q: What SCORE2-OP risk is high?

7.5 to < 15 % is high risk and ≥ 15 % very high risk in the 2021 ESC prevention guideline.

Q: Why does SCORE2-OP need the country?

Cardiovascular event rates differ widely across Europe, so the model is recalibrated to low-, moderate-, high- and very-high-risk regions. Germany and Austria are moderate, Turkey is high.

Q: Does SCORE2-OP account for death from other causes?

Yes. It uses a competing-risk model, so the estimate is not inflated by the high non-cardiovascular mortality of older age.

10-year risk of fatal and non-fatal cardiovascular disease in apparently healthy Europeans aged 70 and over

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

Sources last checked: 2026-10-13

SCORE2-OP (ESC 2021, age ≥ 70)

10-year risk of fatal and non-fatal cardiovascular disease in apparently healthy Europeans aged 70 and over

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 ≥ 70 without established atherosclerotic CVD, diabetes, CKD or familial hypercholesterolaemia. The model accounts for competing non-cardiovascular death, but in older people treatment decisions depend heavily on frailty, life expectancy and preferences.

Source: SCORE2-OP working group and ESC Cardiovascular risk collaboration. SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. Eur Heart J 2021;42(25):2455-2467 (coefficients: Table 2 and Supplementary Methods Table 1).Open

Interpretation

< 7.5 %	Low-to-moderate risk for age ≥ 70 (ESC 2021).
7.5 to < 15 %	High risk (ESC 2021). The guideline states that risk-factor treatment should be considered in this category, weighing frailty, comorbidity, life expectancy and patient preference.
≥ 15 %	Very high risk (ESC 2021). The guideline foresees a discussion of risk-factor treatment in this category; in older people the benefit depends on frailty, comorbidity, life expectancy and patient preference.

What is the SCORE2-OP (ESC 2021, age ≥ 70)?

SCORE2-OP (older persons) estimates the 10-year risk of fatal and non-fatal cardiovascular disease in apparently healthy people aged 70 and over. It was derived by the SCORE2-OP working group from the CONOR cohort and validated in further European cohorts, using a competing-risk approach so that the rising chance of dying from other causes does not inflate the cardiovascular estimate. Like SCORE2 it is recalibrated to the four ESC risk regions and is part of the 2021 ESC prevention guideline.

When to use it

Primary-prevention risk assessment in people aged ≥ 70 without established CVD, diabetes or CKD.
Providing a risk figure for shared decision-making on statins or blood-pressure treatment in older adults.
Showing how much of an older person's risk is driven by modifiable factors such as smoking or blood pressure.

When not to use it

Established atherosclerotic CVD, diabetes, CKD or familial hypercholesterolaemia.
Age < 70 — use SCORE2.
Severe frailty or limited life expectancy, where a 10-year risk estimate has little bearing on care.

How it is calculated

Centred: cage = age − 73; csbp = SBP − 150; ctc = TC − 6; chdl = HDL − 1.4 Men: LP = 0.0634·cage + 0.3524·smoker + 0.0094·csbp + 0.0850·ctc − 0.3564·chdl − 0.0247·cage·smoker − 0.0005·cage·csbp + 0.0073·cage·ctc + 0.0091·cage·chdl; S0 = 0.7576; mean LP = 0.0929 Women: LP = 0.0789·cage + 0.4921·smoker + 0.0102·csbp + 0.0605·ctc − 0.3040·chdl − 0.0255·cage·smoker − 0.0004·cage·csbp − 0.0009·cage·ctc + 0.0154·cage·chdl; S0 = 0.8082; mean LP = 0.229 Uncalibrated risk p = 1 − S0^exp(LP − mean LP) 10-year risk = 1 − exp(−exp(scale1 + scale2 · ln(−ln(1 − p)))) Scales (men | women): low −0.34, 1.19 | −0.52, 1.01; moderate 0.01, 1.25 | −0.10, 1.10; high 0.08, 1.15 | 0.38, 1.09; very high 0.05, 0.70 | 0.38, 0.69

Clinical pearls and limitations

Only for apparently healthy people aged ≥ 70 without established atherosclerotic CVD, diabetes, CKD or familial hypercholesterolaemia. The model accounts for competing non-cardiovascular death, but in older people treatment decisions depend heavily on frailty, life expectancy and preferences.
Thresholds are higher than for SCORE2: < 7.5 % low-to-moderate, 7.5 to < 15 % high, ≥ 15 % very high (ESC 2021).
In older people the ESC 2021 guideline puts more weight on frailty, multimorbidity, polypharmacy and life expectancy than on the risk number alone.
The model's coefficients are per year of age and per mmHg (not per 5 years / 20 mmHg as in SCORE2), centred at 73 years and 150 mmHg.
The supplement's worked example uses calibration values that do not match the published scale table; this calculator uses the scale table, which also matches the paper's risk-by-age figures.

Frequently asked questions

What is SCORE2-OP?

The ESC's 10-year cardiovascular risk model for people aged 70 and over, published in 2021 alongside SCORE2 for ages 40–69.

What SCORE2-OP risk is high?

7.5 to < 15 % is high risk and ≥ 15 % very high risk in the 2021 ESC prevention guideline.

Why does SCORE2-OP need the country?

Cardiovascular event rates differ widely across Europe, so the model is recalibrated to low-, moderate-, high- and very-high-risk regions. Germany and Austria are moderate, Turkey is high.

Does SCORE2-OP account for death from other causes?

Yes. It uses a competing-risk model, so the estimate is not inflated by the high non-cardiovascular mortality of older age.

Evidence and guidelines

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