SCORE2 versus HellenicSCORE II+ algorithms in detecting preclinical carotid atherosclerosis in a middle-aged general...

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 with HellenicSCORE II+ in detecting preclinical carotid atherosclerosis.

Middle-aged (40-69 years) individuals from the general population without ASCVD were invited to participate voluntarily 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.

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/m², smokers 27.8%, diabetes 7%, antihypertensive/lipid-lowering drug treatment 41.6%/46.5%, respectively, SCORE2 5.2 ± 3.4%, HellenicSCORE II+ 3.7 ± 2.4%]. Participants classified as low-moderate/high/very-high ASCVD risk were 50.9%/43.3%/5.8% according to SCORE2, 74.4%/23%/2.6% with HellenicSCORE II+ and 55.6%/36.4%/8% with CPS. The agreement between SCORE2 and HellenicSCORE II+ was 67.2% (kappa 0.37, P < 0.01), whereas agreement between CPS and SCORE2/HellenicSCORE II+ was 57.6%/56.2% (kappa 0.24/0.13, P < 0.01 for each, P < 0.01 for comparison). Receiver operating characteristic curve analysis demonstrated similar discrimination of SCORE2/HellenicSCORE II+ for detecting carotid atherosclerosis (AUC, 0.74; 95% confidence interval, 0.71-0.78, and AUC, 0.71; 95% confidence interval, 0.68-0.74, respectively; P = NS for comparison).

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 to refine ASCVD risk.