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Estimate 10-year CVD risk

(SCORE2)

Apparently healthy personsa

AND

Stop smoking, lifestyle recommendations and SBP <160 mmHg (Class I) STEP 1

Consider risk modifiers, lifetime CVD risk and treatment benefitb,

patient preferences

Estimate 10-year CVD risk

(SCORE2) Estimate 10-year CVD risk

(SCORE2-OP)

Age 50 – 69 years sr a e y 0 7 ≥ e g A sr a e y 0 5 < e g A b

No additional prevention

goals

SBP <140 to 130 mmHg if tolerated (Class I) SBP <140 to 130 mmHg

if tolerated (Class I) LDL-C <2.6 mmol/L (<100 mg/dL)

(Class IIb)

<2.5% ≥7.5% % 5 1 ≥ % 5.7 < % 5.7 < o t 5.2 7.5 to <15%

Consider risk modifiers, lifetime treatment benefitb, comorbidities, frailty, polypharmacy, patient preferences

No additional prevention

goals

AND

No additional prevention

goals

LDL-C <2.6 mmol/L (<100 mg/dL)

(Class IIa)

For specific risk factor management in patients ≥70 years, please see Section 4

STEP 2

10-year CVD risk (SCORE2) Lifetime CVD risk and treatment benefitb Comorbidities, frailty Patient preferences

Intensified treatment based on:

SBP <130 mmHg if tolerated (Class I) LDL-C (Class IIa)

High risk <1.8 mmol/L (<70 mg/dL) Very high risk

<1.4 mmol/L (<55 mg/dL)

AND

STEP 2 Consider risk modifiers,

lifetime CVD risk

patient preferences

No additional prevention

goals

<5% ≥10% 5 to <10%

and treatment benefitb,

Figure 6 Flow chart of cardiovascular disease risk and risk factor treatment in apparently healthy persons. ASCVD = atherosclerotic cardiovascular disease; CKD = chronic kidney disease; CVD = cardiovascular disease; DM = diabetes mellitus; ESC = European Society of Cardiology; FH = familial hypercholesterolaemia; LDL-C = low-density lipoprotein cholesterol; LIFE-CVD = LIFEtime-perspective CardioVascular Disease; SBP = systolic blood pressure; SCORE2 = Systematic Coronary Risk Estimation 2; SCORE2-OP = Systematic Coronary Risk Estimation 2-Older Persons. Solid lines represent default options for the majority of people. Dotted lines represent alternative choices for some, depending on the patient-specific characteristics and conditions indicated in the boxes. Ultimate treatment goals for SBP (<130 mmHg) and LDL-C (according to level of risk) according to the respective ESC Guidelines are to be pursued as indicated. The stepwise approach has to be applied as a whole: after STEP 1, considering proceeding to the intensified goals of STEP 2 is mandatory. Risk scores are available in the ESC CVD Risk Calculator app for mobile devices (https://www.escardio.org/Education/ESC- Prevention-of-CVD-Programme/Risk-assessment/esc-cvd-risk-calculation-app) and at websites such as https://www.u-prevent.com. aDoes not include patients with CVD, DM, CKD, or FH. bThe LIFE-CVD model for estimating lifetime CVD risk and treatment benefit is calibrated for low- and moderaterisk regions (see Box 1). Downloaded from academic.oup.com/eurheartj/article/42/34/3227/6358713 by guest on 07 October 2026