Clinical Report: Reevaluation of SCORE2 Model for Cardiovascular Risk in Primary Care
Overview
This study evaluated the accuracy of the SCORE2 cardiovascular risk prediction model in a large Dutch primary care cohort. Findings revealed that SCORE2 significantly underestimates the 10-year risk of first cardiovascular events, with observed risks exceeding predicted risks by approximately 50%. This underestimation may lead to missed opportunities for preventive treatment in primary care.
Background
Cardiovascular events remain the leading cause of morbidity and mortality in Europe, with risk factors including hypertension, diabetes, smoking, and hypercholesterolemia. Primary care physicians commonly use risk prediction models like SCORE and SCORE2 to estimate 10-year cardiovascular event risk and guide preventive interventions. SCORE2 improves upon SCORE by estimating both fatal and non-fatal events and incorporating country-specific mortality data. However, its performance in routine primary care populations has not been thoroughly validated, particularly in the Netherlands.
Data Highlights
Parameter
Observed 10-year Risk (%)
Predicted 10-year Risk (%)
Observed-to-Expected (O/E) Ratio
Overall cohort (n=205,548)
10.1
6.2
1.63
Females
Not specified
Not specified
1.54
Males
Not specified
Not specified
1.68
Age <50 years
6.9
Not specified
1.78
Age ≥50 years
11.0
Not specified
1.62
Key Findings
The SCORE2 model predicted a mean 10-year cardiovascular event risk of 6.2%, whereas the observed risk was 10.1%, indicating significant underestimation.
Observed-to-expected risk ratios were elevated in both sexes: 1.54 in females and 1.68 in males.
Underestimation was present across age groups, with O/E ratios of 1.78 for patients under 50 and 1.62 for those 50 and older.
Approximately 35% of patients may have missed preventive treatment opportunities due to SCORE2 underestimating their risk.
The study utilized a large, representative primary care database (IPCI) including over 200,000 patients aged 40–69 years in the Netherlands.
Clinical Implications
Clinicians should be aware that the SCORE2 model may underestimate cardiovascular risk in primary care populations, potentially leading to under-treatment. Consideration should be given to recalibrating the model or integrating additional clinical judgment when assessing patients’ cardiovascular risk. Enhanced risk assessment may improve identification of patients who would benefit from preventive interventions.
Conclusion
The SCORE2 cardiovascular risk prediction model underestimates the actual 10-year risk of first cardiovascular events in Dutch primary care patients. This highlights the need for recalibration or supplementary assessment strategies to optimize preventive care.
References
Erasmus MC, IPCI Database Study 2024 -- Reevaluation of Cardiovascular Risk Assessment in Primary Care
