Comparative evaluation of ASCVD, SCORE-2, and HEARTS risk scores in Colombian adults at risk of type 2 diabetes: stratification, concordance, and associated factors

Background The Atherosclerotic Cardiovascular Disease Risk Estimator (ASCVD), Systematic Coronary Risk Evaluation (SCORE-2), and HEARTS risk scales are commonly used to estimate cardiovascular risk (CVR); however, their applicability may vary depending on the population context. Objective This study aims to evaluate stratification, concordance, and associated clinical and social factors across three CVR scales in Colombian adults at risk of type 2 diabetes. Methods A cross-sectional study was conducted among 868 adults. CVR was categorized as low, moderate, or high based on ASCVD, SCORE-2, and HEARTS criteria. Descriptive statistics were used for categorical variables, and comparisons were made using chi-square tests. Continuous variables were analyzed using the Kruskal–Wallis test. Concordance between scales was assessed using weighted Cohen's kappa (wκ), and ordinal logistic regression was applied to identify factors associated with CVR. Results SCORE-2 classified 34.9% of participants as high cardiovascular risk, compared with 3.6% by ASCVD and 4.7% by HEARTS. Moderate agreement was observed between ASCVD and HEARTS (wκ = 0.49; p < 0.001). Living in Bogotá was associated with higher CVR according to ASCVD (OR 1.71; 95% CI: 1.28–2.30) and SCORE-2 (OR 1.74; 95% CI: 1.29–2.33). Higher education was protective in ASCVD and SCORE-2. Impaired glucose tolerance and type 2 diabetes were associated with increased CVR across all scales ( p < 0.05). Conclusion SCORE-2 classified a higher proportion of individuals as high cardiovascular risk, while ASCVD and HEARTS were more conservative. The low level of agreement between the scales highlights the need for local validation of CVR assessment tools.