Ways to measure cardiovascular risk

Certain people such as those with established CVD, existing diabetes or presence of further risk factors are automatically considered at ‘very high’ or ‘high’ total cardiovascular risk, requiring active evaluation and management of all risk factors4,6. For all others, current guidelines on CVD prevention recommend the use of a risk estimation model such as Systemic Coronary Risk Estimation (SCORE) to estimate total CVD risk, because in most people atherosclerotic CVD is the result of a combination of different risk factors that interact with each other in a complex way4,6.

Another commonly used system is the Framingham model.

In order to estimate the lifetime CVD risk, the Joint British Societies (JBS) “HeartAge” risk calculator might be a useful tool15.

Risk assessment systems


Risk charts such as SCORE are designed to assist with risk estimation in healthy people with no signs of disease4. The SCORE system, based on European data, estimates the 10-year risk of a first fatal atherosclerotic event, for example a heart attack, stroke, or other occlusive arterial disease including sudden cardiac death4.

Risk estimates have been produced for high and low risk regions in Europe. A relative risk chart has also been produced for younger people, as a low absolute risk may conceal a high relative risk, requiring lifestyle advice.

To find out more about how to use the SCORE risk assessment system please see the joint EAS/ESC guidelines on the management of dyslipidemias.

Table 1: Recreated from 2019 ESC/EAS Guidelines for the management of dyslipidaemias6

* Systemic Coronary Risk Evaluation – www.escardio.org

** l = is recommended lla = should be considered

*** A=Data derived from multiple randomised clinical trials or meta-analyses, C=Consensus of opinion of the experts and/or small studies, retrospective studies, registries


Other systems also exist, for example, the Framingham system is similar and based on US data, using information from the Framingham Heart Study to assess 10-year risk of fatal and non-fatal CVD events in patients4,13.

However, it has been found that it could overestimate (or underestimate) risk in populations other than the US population; therefore it is important to assess your patients using the most appropriate risk scoring system for them14.

The JBS “HeartAge” risk calculator

The JBS3 “HeartAge” risk calculator is an easy to use tool, intended for use by GPs and other HCPs with their patients15. Different to the other scoring systems mentioned above, this risk calculator has been developed to estimate the lifetime risk of developing a cardiovascular event in healthy people (with no established CVD), by calculating their “Heart Age”. Heart Age can differ from the chronological age, depending on the presence and severity of modifiable risk factors that lead to CVD15.

Heart Age gives patients a better understanding of their CVD risk over their lifetime and the benefits that may be achieved by sustained long-term reduction of CVD risk factors through diet and lifestyle changes, and/or drug therapies, if necessary. To find out more information about the JBS3 “HeartAge” risk calculator, please see the Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease JBS315.

Test your knowledge
Which of these risk estimation tools can predict a person’s lifetime risk of developing a cardiovascular event?
  1. Systemic Coronary Risk Estimation (SCORE)
  2. Joint British Societies (JBS) "HeartAge" risk calculator
  3. Framingham score system
Check your answer