Cardiovascular risk analysis: comparison between SCORE and SCORE2 – the reality of a Family Health Unit

Authors

  • Inês Guimarães Médica Interna de Medicina Geral e Familiar. USF Laços, ULS Entre Douro e Vouga. Cortegaça, Portugal.
  • Miguel Moreira Médico Interno de Medicina Geral e Familiar. USF Laços, ULS Entre Douro e Vouga. Cortegaça, Portugal.
  • Ana Falcão e Cunha Médica Especialista de Medicina Geral e Familiar. USF Laços, ULS Entre Douro e Vouga. Cortegaça, Portugal.
  • Anabela Pena Médica Especialista de Medicina Geral e Familiar. USF Laços, ULS Entre Douro e Vouga. Cortegaça, Portugal.
  • Cláudis Airosa Médica Especialista de Medicina Geral e Familiar. USF Laços, ULS Entre Douro e Vouga. Cortegaça, Portugal.
  • Joana Castanheira Médica Especialista de Medicina Geral e Familiar. USF Laços, ULS Entre Douro e Vouga. Cortegaça, Portugal.
  • Júlio Santos Médico Especialista de Medicina Geral e Familiar. USF Laços, ULS Entre Douro e Vouga. Cortegaça, Portugal.

DOI:

https://doi.org/10.32385/rpmgf.v42i1.14158

Keywords:

Heart disease risk factors, Cardiovascular diseases, Primary Prevention

Abstract

Introduction: Cardiovascular risk assessment is essential to determine the level and intensity of intervention, with the aim of reducing the occurrence of adverse cardiovascular events. For this purpose, the Systematic Coronary Risk Evaluation (SCORE) method was implemented in Europe. In 2021, the SCORE2 algorithm was introduced as a more accurate risk model, replacing the original SCORE. However, primary healthcare software in Portugal continues to use SCORE.

Objectives: To determine if differences can be found between SCORE and SCORE2 in cardiovascular risk assessment.

Methods: A cross-sectional and retrospective study that included 299 patients from a Family Health Unit (USF), aged between 40 and 65 years, with no previous cardiovascular disease. Cardiovascular risk was calculated using both SCORE and SCORE2. The study variables were analyzed using SPSS® software.

Results: Among those classified as «Low to Moderate Risk» by SCORE, 62.54% (n=182) remained in the same category under SCORE2; 33.33% (n=97) were reclassified as «High Risk» and 4.12% (n=12) to «Very High Risk». Regarding the «High Risk» group according to SCORE, 28.57% (n=2) remained in the same category, while 71.42% (n=5) were reclassified to «Very High Risk». No patients were changed to a lower-risk category. Statistically significant differences were found when comparing the distribution of groups obtained with the different risk calculators (p<0.001). According to the groups established by SCORE, 37.1% (n=111) met the target LDL value, whereas under SCORE2, only 22.1% (n=66) met the target, with a statistically significant difference (p<0.001).

Conclusions: SCORE2 compared to SCORE resulted in a significantly higher proportion of patients being classified into a higher risk category, with implications regarding appropriate therapeutic management.

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References

1. Deaton C, Froelicher ES, Wu LH, Ho C, Shishani K, Jaarsma T. The global burden of cardiovascular disease. Eur J Cardiovasc Nurs. 2011;10 Suppl 2:S5-13.

2. Instituto Nacional de Estatística. Anuário estatístico de Portugal 2021 [homepage]. Lisboa: INE; 2022. Available from: https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_publicacoes&PUBLICACOESpub_boui=6174083&PUBLICACOESmodo=2&xlang=pt

3. Bourbon M, Alves AC, Rato Q. Prevalência de fatores de risco cardiovascular na população portuguesa [Internet]. Lisboa: Instituto Nacional de Saúde Dr. Ricardo Jorge; 2019. Available from: https://www.insa.min-saude.pt/wp-content/uploads/2020/02/e_COR_relatorio.pdf

4. Direção-Geral da Saúde. Avaliação do risco cardiovascular SCORE (Systematic Coronary Risk Evaluation): norma nº 05/2013, de 19/03/2013, atualizada em 21/01/2015. Lisboa: DGS; 2015.

5. Barreto M, Gaio V, Kislaya I, Antunes L, Rodrigues AP, Silva AC, et al. 1º Inquérito Nacional de Saúde com Exame Físico (INSEF 2015): estado de saúde. Lisboa: Instituto Nacional de Saúde Dr. Ricardo Jorge; 2016. ISBN 9789898794314

6. Instituto Nacional de Saúde Dr. Ricardo Jorge. Cardiovascular risk: population living in Portugal in 2015 (40-65 years) [homepage]. Lisboa: INSA; s.d. Available from: https://www.insa.min-saude.pt/infografico-insa-%E2%94%80-risco-cardiovascular/

7. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24(11):987-1003.

8. 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):2439-54.

9. Csenteri O, Jancsó Z, Szöllösi GJ, Andréka P, Vajer P. Differences of cardiovascular risk assessment in clinical practice using SCORE and SCORE2. Open Heart. 2022;9(2):e002087.

10. Silva C, Mendes JE, Ramos R, Gaspar A, Leal F, Mendes N. Cardiovascular risk assessment in Portugal's primary health care system: SCORE vs. SCORE2. Rev Port Cardiol. 2024;43(8):449-55.

11. D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743-53.

12. Khan SS, Ning H, Wilkins JT, Allen N, Carnethon M, Berry JD, et al. Association of Body Mass Index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3(4):280-7.

13. Koskinas KC, Van Craenenbroeck EM, Antoniades C, Blüher M, Gorter TM, Hanssen H, et al. Obesity and cardiovascular disease: an ESC clinical consensus statement. Eur Heart J. 2024;45(38):4063-98. Erratum in: Eur Heart J. 2025;46(9):876.

14. Caleyachetty R, Thomas GN, Toulis KA, Mohammed N, Gokhale KM, Balachandran K, et al. Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women. J Am Coll Cardiol. 2017;70(12):1429-37.

15. Di Chiara T, Scaglione A, Corrao S, Argano C, Pinto A, Scaglione R. Association between low education and higher global cardiovascular risk. J Clin Hypertens (Greenwich). 2015;17(5):332-7.

16. Bays HE, Taub PR, Epstein E, Michos ED, Ferraro RA, Bailey AL, et al. Ten things to know about ten cardiovascular disease risk factors. Am J Prev Cardiol. 2021;5:100149.

17. Araújo PM, Nunes A, Torres S, Resende CX, Leite SM, Rodrigues JD, et al. Temporal trends of lipid control in very high cardiovascular risk patients. Rev Port Cardiol. 2021;40(9):641-8.

Published

2026-03-04

How to Cite

Cardiovascular risk analysis: comparison between SCORE and SCORE2 – the reality of a Family Health Unit. (2026). Portuguese Journal of Family Medicine and General Practice, 42(1), 45-51. https://doi.org/10.32385/rpmgf.v42i1.14158

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