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Impact of lipid-lowering treatment on the performance of SCORE2 algorithms in detecting high-risk individuals

Anastasios Kollias1, Konstantinos G Kyriakoulis1, Aikaterini Komnianou1

  • 1Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.

Nutrition, Metabolism, and Cardiovascular Diseases : NMCD
|June 13, 2026
PubMed

Insights

Lipid-lowering therapy slightly impacts the Systematic Coronary Risk Evaluation 2 (SCORE2) calculation. Adjusting SCORE2 for treatment improves its ability to identify individuals at high cardiovascular risk.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Pharmacotherapy

Background:

  • Current guidelines advise against using Systematic Coronary Risk Evaluation 2 (SCORE2) risk algorithms in patients undergoing lipid-lowering therapy.
  • This study addresses the impact of lipid-lowering treatment on SCORE2 calculations and its effectiveness in identifying high-risk individuals.

Purpose of the Study:

  • To investigate the effect of lipid-lowering treatment on SCORE2 risk algorithm calculations.
  • To evaluate the performance of SCORE2 in detecting high-risk individuals when adjusted for lipid-lowering therapy.

Main Methods:

  • Analysis of 417 middle-aged individuals treated for dyslipidemia without established cardiovascular disease, diabetes, or chronic kidney disease.
  • SCORE2 algorithms were calculated using both measured and adjusted lipid levels to account for lipid-lowering therapy.
  • Comparison of risk classifications and agreement with carotid plaque scores between standard and adjusted SCORE2.

Main Results:

  • Adjusted-SCORE2 values were significantly higher than standard SCORE2 (6.6% vs. 5.4%, P<0.05).
  • The adjusted-SCORE2 reclassified a greater proportion of individuals into high-risk categories (16.8% vs. 6.7%).
  • Agreement between standard and adjusted SCORE2 was substantial (weighted kappa 0.73), but adjustments improved risk detection.

Conclusions:

  • Lipid-lowering treatment has a modest effect on SCORE2 calculation.
  • Adjusting SCORE2 for lipid-lowering therapy enhances its stability and accuracy in identifying high-risk individuals.
  • The findings suggest a need to consider treatment status when applying SCORE2 in clinical practice.
Abstract

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