Physicians' Academy for Cardiovascular Education

Development and validation of SCORE2-Diabetes, a European 10-year CVD risk model for T2DM

SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe

Literature - SCORE2-Diabetes Working Group and the ESC Cardiovascular Risk Collaboration - Eur Heart J. 2023 May 29;ehad260 [Online ahead of print]. doi: 10.1093/eurheartj/ehad260

Introduction and methods


Several CVD risk prediction models for patients with T2DM include DM-related information, such as levels of HbA1c and kidney function markers [1-4]. However, these DM-specific models have potential limitations for use in Europe, particularly as they do not reflect the wide regional variation in CVD incidence across Europe [4-6]. To address these limitations, the European Society of Cardiology has summoned an effort to extend the regionally “recalibrated” (i.e., statistically adapted) European SCORE2 10-year risk models [7].

Aim of the study

The study aim was to develop, validate, and illustrate SCORE2-Diabetes, a recalibrated prediction model to estimate the 10-year CVD risk in T2DM patients in Europe.


SCORE2-Diabetes was developed based on the original SCORE2 algorithms, which include conventional risk factors (i.e., age, sex, smoking status, systolic blood pressure (SBP), total cholesterol, and HDL-c). These models were adapted for use in T2DM patients by adding DM-related variables (i.e., age at T2DM diagnosis, HbA1c level, and creatinine-based eGFR). For this purpose, individual-participant data were extracted from 4 large-scale population datasets across 7 countries (England, Wales, Scotland, France, Germany, Italy, and the US), comprising 229,460 patients aged >40 years with T2DM but with no previous CVD (43,706 CVD events).

The derived risk models were recalibrated to 4 European risk regions, defined according to CVD mortality rates (low, moderate, high, and very high risk). External validation was performed using 4 data registries from Sweden, Spain, Malta, and Croatia, comprising 217,036 individuals (38,602 CVD events). The authors illustrated the variation in CVD risk in T2DM patients across European regions by applying the recalibrated models to data from contemporary populations in each risk region.


The primary endpoint was a composite outcome of CVD events (CV death, nonfatal MI, and nonfatal stroke).

Main results

Internal and external validations and recalibration

Illustration of CVD risk distribution in European risk regions


This study detailed the development, recalibration, and validation of SCORE2-Diabetes, an extension of the SCORE2 risk models that was tailored to predict 10-year CVD risk in patients with T2DM across 4 distinct European regions. SCORE2-Diabetes had good ability to discriminate and provide individual risk estimates for T2DM patients, taking into account their specific risk factors such as age at T2DM diagnosis, HbA1c level, and kidney function.

The authors believe their prediction model can “be used to help guide clinicians and individual patients for considering the intensity of existing treatment (such as lipid-lowering therapies), as well as additional interventions to prevent CVD (such as [SGLT2] inhibitors or [GLP-1RAs]).”


Show references

Find this article online at Eur Heart J.

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