SCORE2 charts assign a different risk category than the underlying model in a large portion of Polish primary care patients

To compare the estimates provided by the SCORE2/SCORE2-OP charts with the estimates obtained by using SCORE2 and SCORE2-OP risk model equations. Patients were recruited from 16 major Polish administrative regions proportionally to the number of inhabitants through primary care practices. Patients with risk parameters exceeding permitted values and with comorbidities putting them in the very high-risk category were excluded, and a total of 6,621 patients were studied in this analysis. Each eligible patient was assigned SCORE2/SCORE2-OP risk estimate and category using the SCORE2 chart and the equations for high-risk countries provided in the original SCORE2/SCORE2-OP papers. Compared to the underlying model estimate, SCORE2 chart estimate was ≥20% higher for a total of 2,164 (32.7%) patients and 20% lower for a total of 382 (5.6%) patients; the assigned risks differed significantly between (p<0.0001; Wilcoxon rank test). It was also found that SCORE2 charts assigned 1,277 (19.3%) patients to a higher risk category and 122 (1.8%) patients to a lower category (p<0.001; McNemar-Bowker test). A clear saw-tooth pattern was observed in the difference between equation and chart estimate at different values of systolic blood pressure, age, and non-HDL and a clear bias towards risk overestimation at higher HDL concentrations was also noted for the charts. SCORE2/SCORE2-OP charts tend to overestimate cardiovascular risk relative to the core risk models. The use of calculators that directly apply the model might help to determine more accurately the indications for blood pressure- and lipid-lowering therapies.