Review Note

SCORE2: Systematic Coronary Risk Evaluation 2

• Purpose: Estimates age-specific cardiovascular risk in different European regions, categorizing countries as low, moderate, high, or very high cardiovascular risk.
• Risk Assessment: Estimates the 10-year risk of cardiovascular events, such as myocardial infarction, stroke, or cardiovascular death.
  • Risk Categories:
    • Low: <5%
    • Moderate: 5–10%
    • High: 10–15%
    • Very High: >15%
• Calculation Factors:
  • Smoking status, age, gender, systolic BP, and cholesterol.
  • To estimate 10-year risk, identify the correct country cluster and risk table based on sex, smoking status, and age, then locate the nearest values for BP and non-HDL-C.

Prevention of Cardiovascular Disease (CVD)

• Lifestyle Modifications:
  • Smoking Cessation: Essential for risk reduction.
  • Physical Activity:
    • Minimum of 150-300 minutes/week of moderate-intensity aerobic exercise (e.g., brisk walking, cycling) OR 75-150 minutes/week of vigorous exercise.
  • Diet:
    • Emphasize vegetables, fruits, whole grains, legumes, nuts, and seeds.
    • Limit saturated fats, reduce salt intake (<5 g/day), and limit alcohol use (<100g per week).
• Manage Risk Factors:
  • Blood Pressure:
    • Target <140/90 mmHg for most; <130/80 mmHg if at high cardiovascular risk (if tolerated).
  • Cholesterol:
    • LDL Goals:
      • <1.4 mmol/L for very high risk.
      • <1.8 mmol/L for high risk.
    • Medications: Statins first-line; if insufficient, consider adding ezetimibe or PCSK9 inhibitors.
  • Manage Diabetes:
    • Target HbA1c <7% 
    • SGLT2 and GLP-1 receptor agonists recommended for patients with diabetes and CVD/high cardiovascular risk.
• Obesity and Weight Management:
  • Weight loss is recommended if BMI >25 (overweight) or >30 (obese).
  • A reduction of 5-10% in body weight can lower cardiovascular risk.
• Antithrombotic Therapy:
  • Secondary Prevention (for patients with a history of cardiovascular events):
    • Aspirin 75-100 mg daily.
    • Dual Antiplatelet Therapy (DAPT): Aspirin + P2Y12 inhibitor (e.g., clopidogrel) for up to 12 months post-acute coronary syndrome or after coronary stenting.
  • Primary Prevention: Routine use of aspirin is not recommended.
• Specific Recommendations:
  • Atrial Fibrillation: Use oral anticoagulants for high stroke risk (CHA₂DS₂-VASc score ≥2 for men and ≥3 for women).
  • Chronic Kidney Disease (CKD): Managed as high or very high-risk patients.
  • Heart Failure: Follow guideline-specific therapy with ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors.

Pharmacologic Treatment

• Statins: First-line treatment for lowering LDL-C in high and very high-risk individuals.
• ACE Inhibitors or ARBs: Preferred for blood pressure control in patients with cardiovascular disease or high-risk conditions.
• PCSK9 Inhibitors: Considered in cases where LDL remains high despite statin and other lipid-lowering therapies.