SCORE2 charts assign a different risk category than the underlying model in a large portion of Polish primary care patients

Marcin Goławski; Maciej Banach; Jacek Jóźwiak; Marek Gierlotka; Kamila Osadnik; Tadeusz Osadnik

doi:10.1093/eurjpc/zwaf555

SCORE2 charts assign a different risk category than the underlying model in a large portion of Polish primary care patients

Eur J Prev Cardiol. 2025 Aug 31:zwaf555. doi: 10.1093/eurjpc/zwaf555. Online ahead of print.

Authors

Marcin Goławski¹, Maciej Banach², Jacek Jóźwiak³, Marek Gierlotka⁴, Kamila Osadnik¹, Tadeusz Osadnik¹

Affiliations

¹ Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 41-808, Poland.
² Department of Preventive Cardiology and Lipidology, Medical University in Lodz (MUL), Lodz, 93-338, Poland.
³ Institute of Medical Sciences, Department of Biology and Genetics, Faculty of Medicine, University of Opole, Oleska 48, Opole, 45-052, Poland.
⁴ Department of Cardiology, Institute of Medical Sciences, Faculty of Medicine, University of Opole, Opole, 45-401, Poland.

PMID: 40885556
DOI: 10.1093/eurjpc/zwaf555

Abstract

Aims: To compare the estimates provided by the SCORE2/SCORE2-OP charts with the estimates obtained by using SCORE2 and SCORE2-OP risk model equations.

Methods: Patients were recruited from 16 major Polish administrative regions proportionally to the number of inhabitants through primary care practices. Patients with risk parameters exceeding permitted values and with comorbidities putting them in the very high-risk category were excluded, and a total of 6,621 patients were studied in this analysis. Each eligible patient was assigned SCORE2/SCORE2-OP risk estimate and category using the SCORE2 chart and the equations for high-risk countries provided in the original SCORE2/SCORE2-OP papers.

Results: Compared to the underlying model estimate, SCORE2 chart estimate was ≥20% higher for a total of 2,164 (32.7%) patients and 20% lower for a total of 382 (5.6%) patients; the assigned risks differed significantly between (p<0.0001; Wilcoxon rank test). It was also found that SCORE2 charts assigned 1,277 (19.3%) patients to a higher risk category and 122 (1.8%) patients to a lower category (p<0.001; McNemar-Bowker test). A clear saw-tooth pattern was observed in the difference between equation and chart estimate at different values of systolic blood pressure, age, and non-HDL and a clear bias towards risk overestimation at higher HDL concentrations was also noted for the charts.

Conclusions: SCORE2/SCORE2-OP charts tend to overestimate cardiovascular risk relative to the core risk models. The use of calculators that directly apply the model might help to determine more accurately the indications for blood pressure- and lipid-lowering therapies.

Keywords: SCORE2; charts; risk model.

Plain language summary

In this paper, estimates obtained from SCORE2 and SCORE2-OP cardiovascular risk charts were compared to estimates from the underlying risk models.SCORE2 and SCORE2-OP charts have a clear tendency to overestimate cardiovascular risk relative to the model obtained in their original publications.The overestimation is more likely at higher HDL values and at the bottom of the non-HDL cholesterol, systolic blood pressure and age intervals presented in the charts.