EUROPEAN

SCORE MEMOCARD
European Association for
Cardiovascular Prevention
and Rehabilitation
EACPR
A Registered Branch of the ESC
WHY IS CVD PREVENTION NEEDED?
Atherosclerotic CVD, especially CHD, remains the leading cause of premature
death worldwide.
CVD affects both men and women; of all deaths that occur before the age of
75 years in Europe, 43% are due to CVD in women and 36% in men.
CVD mortality is changing, with declining age-standardized rates in most
European countries, but it remains high in Eastern Europe
Prevention works: over 50% of the reductions seen in CHD mortality relate to
changes in risk factors, and 40% to improved treatments.
Preventive efforts should be life-long, from birth (if not before) to old age.
Population and high-risk preventive strategies should be complementary; an
approach limited to high-risk persons will be less effective; population
education programmes are still needed.
Despite gaps in our understanding, there is ample evidence to justify intensive
public health and individual preventive efforts.
There is still substantial room for improvement in risk factor control, even in
individuals at very high risk.
WHAT ARE THE PRIORITIES?
Very high Risk: Subjects with any of the following:
CVD
Type 2 diabetes, or type 1 diabetes & target organ damage
Patients with moderate to severe CKD (GFR <60mL/min/1.73m
2
)
SCORE 10%
High Risk: Subjects with:
Markedly elevated single risk factors such as:
- Familial dyslipidaemias
- Severe hypertension.
SCORE 5% and <10%
Moderate Risk: SCORE is 1 and <5% at 10 years, further modulated by:
family history of premature CAD
abdominal obesity
physical activity pattern
Low Risk: SCORE less than 1% and free of qualifers
HDL-C
TG
hsCRP
social class
Smoking No exposure to tobacco in any form
Diet
Healthy diet- low in saturated fat with a focus on wholegrain
products, vegetables, fruit and fsh*
Physical Activity
2.5 to 5 hours moderately vigorous physical activity per week
or 30-60 minutes most days
Body weight
BMI 20-25. Waist circumference <94 cm (men)
or <80 cm (women)
Blood pressure BP <140/90
Lipids
Very high risk: LDL <1.8 mmol/L or >50% reduction
High risk: LDL <2.5 mmol/L
Low to moderate risk: LDL <3 mmol/L
HDL cholesterol: No target but >1.0 mmol/L in men
and >1.2 mmol/L in women indicates lower risk
Triglycerides: No target but <1.7 mmol/L indicates lower risk
and higher levels indicate a need to look for other risk factors
Diabetes HbA1C <7%, BP <140/80
WHAT ARE THE TARGETS?
* A healthy diet has the following characteristics:
Saturated fatty acids to account for <10% of total energy intake, through
replacement by polyunsaturated fatty acids.
Trans unsaturated fatty acids: as little as possible, preferably no intake from
processed food, and <1% of total energy intake from natural origin
<5 g of salt per day.
3045 g of fbre per day, from wholegrain products, fruits and vegetables.
200 g of fruit per day (2-3 servings).
200 g of vegetables per day (2-3 servings).
Fish at least twice a week, one of which to be oily fsh.
Consumption of alcoholic beverages should be limited to 2 glasses per day
(20 g/d of alcohol) for men and 1 glass per day (10 g/d of alcohol)
for women.
Source: European Guidelines on CVD Prevention in Clinical Practice (Version 2012)
European Society of Cardiology - DOI: 10.1093/eurheartj/EHS092
(Systematic COronary Risk Evaluation)
Think total cardiovascular risk
& act for better CVD prevention
www.escardio.org/EACPR
How do I use the SCORE charts to assess CVD risk in asymptomatic persons?
1. Use the low risk charts in Andorra, Austria, Belgium
*
, Cyprus, Denmark, Finland, France, Germany, Greece
*
, Iceland, Ireland, Israel, Italy, Luxembourg, Malta,
Monaco, The Netherlands
*
, Norway, Portugal, San Marino, Slovenia, Spain
*
, Sweden
*
, Switzerland and United Kingdom.
Use the high risk charts in other European countries. Of these, some are at very high risk and the charts may underestimate risk in these. These include Armenia,
Azerbaijan, Belarus, Bulgaria, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Macedonia FYR, Moldova, Russia, Ukraine and Uzbekistan.
*
Updated, re-calibrated charts are now available for Belgium, Germany, Greece, The Netherlands, Spain, Sweden and Poland.
2. Find the cell nearest to the persons age, cholesterol and BP values, bearing in mind that risk will be higher as the person approaches the next age, cholesterol
or BP category.
3. Check the qualifers
4. Establish the total 10 year risk for fatal CVD.
LOW RISK COUNTRIES
Risk estimation using SCORE: Qualiers
The charts should be used in the light of the clinicians knowledge and
judgement, especially with regard to local conditions.
As with all risk estimation systems, risk will be over-estimated in countries
with a falling CVD mortality rate, and under estimated if it is rising.
At any given age, risk appears lower for women than men. However,
inspection of the charts shows that their risk is merely deferred by 10 years,
with a 60 year old woman resembling a 50 year old man in terms of risk.
Risk may be higher than indicated in the chart in:
- Sedentary or obese subjects, especially those with central obesity
- Those with a strong family history of premature CVD
- Socially deprived individuals and those from some ethnic minorities
- Individuals with diabetes- the SCORE charts should only be used in
those with type 1 diabetes without target-organ damage; other
diabetic subjects are already at very high risk.
- Those with low HDL cholesterol* or increased triglyceride, fbrinogen,
opoB, Lp(a) levels and perhaps increased high-sensitivity CRP.
- Asymptomatic subjects with evidence of pre-clinical atherosclerosis,
for example plaque on ultrasonography.
- Those with moderate to severe chronic kidney disease
(GFR <60 mL/min/1.73 m
2
)
*Note that HDL cholesterol impacts on risk in both sexes, at all ages, and at all level of risk. This effect can be estimatedusing
the electronic version of SCORE, HeartScore, which has been updated to include HDL cholesterol level.
HOW DO I ASSESS RISK?
The Priorities section indicates that certain subject declare themselves to be at very high or high risk without requiring the use a chart such as SCORE (Systematic COronary
Risk Evaluation), which is designed for use in apparently healthy individuals. These are those with known CVD, type 2 diabetes or type 1 diabetes with target organ damage
and those with moderate to severe CKD (all very high risk), and those with markedly elevated single risk factors (high risk). Such individuals require immediate attention to
all risk factors. For others, the SCORE charts may be used to assign them to the appropriate risk category.
Relative Risk
Note that a low total cardiovascular risk in a young person may conceal a
high relative risk; this may be explained to the person by using the relative
risk chart. As the person ages, a high relative risk will translate into a high total
risk. More intensive lifestyle advice will be needed in such persons.
This chart refers to relative risk, not percentage risk, so that a person in the top
right corner is at 12 times higher risk than a person in the bottom left corner.
Another approach to explaining risk to younger persons is to use cardiovascular
risk age.
For example, in the high risk chart, a 40 year
old male hypertensive smoker has a risk of
4%, which is the same as a 65 year old with
no risk factors, so that his risk age is 65. This
can be reduced by reducing his risk factors.
4 5 6 6 7
3 3 4 4 5
2 2 2 3 3
1 1 2 2 2
3 3 3 4 4
2 2 2 2 3
1 1 1 2 2
1 1 1 1
1 1 2 2 2
1 1 1 1 1
1 1 1 1 1
0 0 1 1 1
1 1 1 1 1
0 0 1 1 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
9 9 11 12 14
6 6 7 8 10
4 4 5 6 7
3 3 3 4 4
5 5 6 7 8
3 4 4 5 9
2 2 3 3 4
1 2 2 2 3
3 3 3 4 4
2 2 2 3 3
1 1 1 2 2
1 1 1 1 1
1 1 2 2 2
1 1 1 1 1
1 1 1 1 1
0 0 0 1 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1
8 9 10 12 14
5 6 7 8 10
4 4 5 6 7
2 3 3 4 5
5 6 7 8 9
4 3 5 5 6
2 3 3 4 4
2 2 2 3
3 4 4 5 6
2 2 3 3 4
1 2 2 2 3
1 1 1 2 2
2 2 3 3 4
1 1 2 2 2
1 1 1 1 2
1 1 1 1 1
0 1 1 1 1
0 0 0 1 1
0 0 0 0 0
0 0 0 0 0
15 17 20 23 26
10 12 14 16 19
7 8 9 11 13
5 5 6 8 9
10 11 13 15 18
7 8 9 11 13
5 5 6 7 9
3 4 4 5 6
6 7 8 10 12
4 5 6 7 8
3 3 4 5 6
2 2 3 3 4
4 4 5 6 7
2 3 3 4 5
2 2 2 3 3
1 1 2 2 2
1 1 1 2 2
1 1 1 1 1
0 1 1 1 1
0 0 0 1 1
3
180
160
140
120
Women Men
Cholesterol (mmol/L)
Age
65
60
55
50
40
Non-smoker Smoker
180
160
140
120
180
160
140
120
180
160
140
120
4 5 6 7 8
180
160
140
120
4 5 6 7 8
150 200
mg/dL
250 300
Non-smoker Smoker
4 5 6 7 8 4 5 6 7 8
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Low Risk Countries Chart
SCORE
15% and over
10% - 14%
5% - 9%
3% - 4%
2%
1%
< 1%
10-year risk of
fatal CVD in
populations at
low CVD Risk
HIGH RISK COUNTRIES
Cholesterol (mmol/L)
150 200
mg/dL
250 300
180
160
140
120
Women Men
Age
65
60
55
50
40
Non-smoker Smoker
7 89 10 12
5 56 7 8
3 34 5 6
2 23 3 4
180
160
140
120
4 45 6 7
3 3 3 4 5
2 22 3 3
1 12 2
180
160
140
120
2 23 3 4
1 22 2 3
1 11 1 2
1 11 1 1
180
160
140
120
1 11 2 2
4 56 7 8
1 11 1 1
0 11 1 1
0 01 1 1
180
160
140
120
0 00 0 0
0 00 0 0
0 00 0 0
0 00 0 0
13 15 17 19 22
9 10 12 13 16
6 7 8 9 11
4 5 5 6 7
8 9 10 11 13
5 6 7 8 9
3 4 5 5 6
2 3 3 4 4
4 5 5 6 7
3 3 4 4 5
2 2 2 3 3
1 1 2 2 2
2 2 3 3 4
4 5 6 7 8
1 2 2 2 3
1 1 1 1 2
1 1 1 1 1
0 0 0 1 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2
Non-smoker Smoker
14 16 19 22 26
9 11 13 15 16
6 8 9 11 13
4 5 6 7 9
9 11 13 15 18
7 6 9 10 12
4 5 6 7 9
3 3 4 5
6 7 8 10 12
4 5 6 7 8
3 3 4 5 6
2 2 3 3 4
4 4 5 6 7
4 5 6 7 8
2 3 3 4 5
2 2 2 3 3
1 1 2 2 2
1 1 1 2 2
1 1 1 1 1
0 1 1 1 1
0 0 1 1 1
26 30 35 41 47
18 21 25 29 34
13 15 17 20 24
9 10 12 14 17
18 21 24 28 33
12 14 17 20 24
8 10 12 14 17
6 7 8 10 12
12 13 16 19 22
8 9 11 13 16
5 6 8 9 11
4 4 5 6 8
7 8 10 12 14
4 5 6 7 8
5 6 7 8 10
3 4 5 6 7
2 3 3 4 5
2 2 3 3 4
1 2 2 2 3
1 1 1 2 2
1 1 1 1 1
6
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SCORE
15% and over
10% - 14%
5% - 9%
3% - 4%
2%
1%
< 1%
10-year risk of
fatal CVD in
populations at
high CVD Risk
E U R O P E A N S C O R E C H A R T S
Online CVD Risk Assessment
Visit www.heartScore.org

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180
160
140
120
Women
Non-smoker Smoker
7 8 9 10 12
5 5 6 7 8
3 3 4 5 6
2 2 3 3 4
180
160
140
120
4 4 5 6 7
3 3 3 4 5
2 2 2 3 3
1 1 2 2
180
160
140
120
2 2 3 3 4
1 2 2 2 3
1 1 1 1 2
1 1 1 1 1
180
160
140
120
1 1 1 2 2
4 5 6 7 8
1 1 1 1 1
0 1 1 1 1
0 0 1 1 1
180
160
140
120
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
13 15 17 19 22
9 10 12 13 16
6 7 8 9 11
4 5 5 6 7
8 9 10 11 13
5 6 7 8 9
3 4 5 5 6
2 3 3 4 4
4 5 5 6 7
3 3 4 4 5
2 2 2 3 3
1 1 2 2 2
2 2 3 3 4
4 5 6 7 8
1 2 2 2 3
1 1 1 1 2
1 1 1 1 1
0 0 0 1 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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Cholesterol (mmol/L)
Non-Smoker Smoker
180
160
140
120
3 3 4 5 6
2 3 3 4 4
1 2 2 2 3
1 1 1 2 2
6 7 8 10 12
4 5 6 7 8
3 3 4 5 6
2 2 3 3 4
4 5 6 7 8 4 5 6 7 8
150 200
mg/dL
250 300

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