What is a cardiovascular risk score?
A cardiovascular risk score estimates, from a handful of measurable factors (age, blood pressure, cholesterol, smoking...), the likelihood of developing heart or blood vessel disease — a heart attack or stroke — over the next 10 years. It isn't a certain individual prediction, but a statistical estimate, built from observing hundreds of thousands of people followed over several years.
Why does the calculation change depending on the country?
These equations are calibrated on the populations used to build them. In Europe, the SCORE2 score (and its SCORE2-OP variant for people over 70) is recommended by the European Society of Cardiology, with a specific calibration per group of countries based on their observed cardiovascular risk level — France is classified as a low-risk region. In the United States, the reference equation is the ASCVD Risk Estimator(Pooled Cohort Equations), recommended by the American Heart Association and the American College of Cardiology. The two equations don't use quite the same input variables, nor the same interpretation thresholds: applying one in place of the other would give a less reliable estimate.
Why do some situations exclude the calculation?
An already-diagnosed cardiovascular disease, chronic kidney disease, familial hypercholesterolemia, or (in Europe) diabetes already place a person in an already-high-risk category — something these equations, built on populations without those histories, don't correctly capture. In these situations, the question is no longer WHETHER cardiovascular follow-up is useful, but how to organize it with your doctor.
The importance of primary prevention
Most of the factors that go into this calculation — smoking, blood pressure, cholesterol — are modifiable. Identifying a high risk is only useful if it leads to a concrete action: that's the whole point of preventive medicine, a topic we cover in more depth in our article about the origin of the name Hygietest.
