Key result
SCORE2 classifies more patients as high ASCVD risk than HellenicSCORE II+ despite similar moderate plaque discrimination.
Why the study?
European guidelines recommend SCORE2 for ASCVD risk classification, but an updated model, HellenicSCORE II+, was developed for the Greek population, prompting a comparison of their ability to detect preclinical carotid atherosclerosis.
Does the SCORE2 algorithm compare favorably to the HellenicSCORE II+ algorithm in detecting preclinical carotid atherosclerosis in a middle-aged Greek population without ASCVD?
Cross-Sectional (n=965)
Yes
Does the SCORE2 algorithm compare favorably to the HellenicSCORE II+ algorithm in detecting preclinical carotid atherosclerosis in a middle-aged Greek population without ASCVD?
Both SCORE2 and HellenicSCORE II+ algorithms show only moderate discrimination for detecting preclinical carotid atherosclerosis, highlighting the potential need for carotid imaging to refine ASCVD risk assessment.
Moderate discrimination by both scores warrants caution in relying on them alone for ASCVD risk stratification in Greeks without disease; leaves open whether carotid imaging refines classification.
BACKGROUND AND AIM: Current European guidelines for primary atherosclerotic cardiovascular disease (ASCVD) prevention recommend using Systematic Coronary Risk Evaluation 2 (SCORE2) algorithms for risk classification and decision-making. For the Greek population, an updated model - HellenicSCORE II+ - has been developed. This cross-sectional study compared SCORE2 versus HellenicSCORE II+ in detecting preclinical carotid atherosclerosis. METHODS: Middle-aged (40-69 years) individuals from the general population without ASCVD, were invited to participate on a voluntary basis in screening programs in 3 municipalities of Attica, Greece (2023-2025). Handheld carotid ultrasonography was performed and carotid plaque score (CPS) was calculated by summing points allocated to the number/height of plaques. RESULTS: A total of 965 individuals were analyzed [mean age 57.1±8.0 (SD) years, men 43.2%, body mass index 27.6±4.7 kg/m CONCLUSIONS: SCORE2 classified a higher proportion of participants as high/very-high ASCVD risk compared with HellenicSCORE II+. Both models demonstrated moderate discrimination for detecting carotid plaque burden, highlighting the need for carotid imaging in refining ASCVD risk.
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Κόλλιας et al. (2026) conducted a cross-sectional in preclinical carotid atherosclerosis (n=965). SCORE2 algorithm vs. HellenicSCORE II+ algorithm was evaluated on detecting preclinical carotid atherosclerosis. SCORE2 classified a higher proportion of participants as high/very-high ASCVD risk compared with HellenicSCORE II+, with both models showing moderate discrimination for carotid plaque burden.
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