SCORE2-OP Risk Prediction Algorithms in Older Persons

Quick Takes

  • Validation of a SCORE model to predict CVD events has good discrimination.
  • Individual risk factors can be applied to SCORE2-OP charts to estimate 5- and 10-year risk for events by gender and region of origin.
  • Such models can be used to estimate CVD risk and the possible need for risk factor management.

Study Questions:

Can improved cardiovascular disease (CVD) risk prediction models be created for older adults?


Data from the CONOR (Cohort of Norway) study, which included 28,503 adults and 10,089 CVD events, were used for the current project. Sex-specific competing risk-adjusted models were derived to estimate CVD risk using adults aged ≥65 years who had no known pre-existing atherosclerotic CVD. CVD was defined as CVD mortality, myocardial infarction, or stroke. Models included age, smoking status, diabetes, systolic blood pressure, and total and high-density lipoprotein cholesterol. Four geographical risk regions were defined based on country-specific CVD mortality rates. Models were recalibrated to each region using region-specific estimated CVD incidence rates and risk factor distributions.


A total of 211,184 women and 155,934 men aged ≥65 years from seven studies were included in this analysis (for model derivation and validation). A total of 10,089 nonfatal and fatal CVD events occurred in the 305,640 person-years of follow-up among the 28,503 participants from the CONOR study. Internal validation of the 10-year estimated risk showed good agreement with the 10-year observed risk overall deciles of age for all outcomes of interest. External validation was performed using data from six additional study populations with 338,615 adults and 33,219 CVD events. C-indices ranged between 0.63 (95% confidence interval [CI], 0.61–0.65) and 0.67 (95% CI, 0.64–0.69). Regional calibration of expected versus observed risks was satisfactory. For the given risk factor profiles, there was substantial variation across the four risk regions in the estimated 10-year CVD event risk.


The investigators concluded that the competing risk-adjusted SCORE2-Older Persons (SCORE2-OP) model was derived, recalibrated, and externally validated to estimate 5- and 10-year CVD risk in older adults (aged ≥70 years) in four geographical risk regions. These models can be used to communicate the risk of CVD and the potential benefit from risk factor treatment, and to facilitate shared decision making between clinicians and patients in CVD risk management in older persons.


The study outlines the derivation and evaluation of models to predict CVD risk among older adults. Given the increasing age of current populations, these models can assist older adults and providers in understanding CVD risk with age.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Prevention, Lipid Metabolism, Nonstatins, Smoking

Keywords: Aged, 80 and over, Blood Pressure, Cardiovascular Diseases, Cholesterol, HDL, Diabetes Mellitus, Geriatrics, Myocardial Infarction, Primary Prevention, Risk Factors, Risk Management, Smoking, Stroke, Vascular Diseases

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