Risk Scores for Asymptomatic Individuals & Tools for Predicting Cardiovascular Risk
Risk Scores for Asymptomatic Individuals & Tools for Predicting Cardiovascular Risk
These tools are designed to estimate the future risk of cardiovascular events—such as myocardial infarction or stroke—over a specific period (usually 10 years or over a lifetime). They are preventive in nature and do not require symptoms. Based on clinical and/or imaging markers, they support decision-making in lifestyle modifications and primary prevention strategies (e.g., statins).
Below is a summary of the most relevant and widely used risk assessment tools in asymptomatic populations:
1. SCORE2 / SCORE2-OP (Europe – ESC)
• Target: Adults aged 40–69 (SCORE2), and ≥70 (SCORE2-OP)
• Purpose: 10-year risk of first fatal and non-fatal CVD event
• Ideal for: European general population
• Variables: Age, sex, systolic BP, cholesterol, smoking, diabetes
2. ASCVD Risk Estimator Plus (USA – ACC/AHA)
• Target: Adults aged 40–79 without known ASCVD
• Purpose: 10-year and lifetime ASCVD risk
• Variables: Race, cholesterol, BP, smoking, diabetes, medications
• Features: Includes therapy adjustment (e.g., statins, aspirin)
3. QRISK3 (UK – NHS)
• Target: Adults aged 25–84 without CVD
• Purpose: 10-year risk of MI or stroke
• Variables: Comorbidities, ethnicity, medications, social factors
• Tailored for: UK population and NHS use
4. Framingham Risk Score (USA – NHLBI)
• Target: Adults aged 30–74 without prior CVD
• Purpose: 10-year CHD/CVD risk estimate
• Notes: Historic model, may overestimate risk in modern settings
5. Reynolds Risk Score (USA – Harvard)
• Target: Men ≥50, Women ≥45, healthy individuals
• Purpose: 10-year CVD risk
• Includes: hs-CRP and family history in addition to classic factors
• Best for: Patients with suspected inflammatory risk profile
6. MESA Risk Score (USA – MESA Study)
• Target: Intermediate-risk, asymptomatic adults
• Purpose: 10-year CHD risk
• Variables: Clinical + CAC score from cardiac CT
• Use: Excellent for reclassification and personalized therapy
7. CAC Score (Agatston Score)
• Type: Imaging-only via coronary CT
• Best for: Intermediate-risk patients without symptoms
• Interpretation:
• CAC = 0: Very low risk
• CAC 1–100: Mild/moderate
• CAC >100 or >75th percentile: High risk
• Use: Supports statin decision-making
• Endorsed: 2018 AHA/ACC Guidelines and 2021 AHA Scientific Statement
Direct Access Links:
1. SCORE2 Risk Calculator – ESC:
2. ASCVD Risk Estimator Plus:
3. QRISK3 Calculator:
4. Framingham Risk Score Tool – MDCalc:
5. Reynolds Risk Score:
6. MESA Risk Score Calculator:
7. 2021 AHA Scientific Statement on CAC: