10-year cardiovascular risk is the probability of having a heart attack, a stroke or a cardiovascular death within the next ten years. In France, it is estimated with SCORE2 (ages 40–69) and SCORE2-OP (ages 70–89), two algorithms published in 2021 by the European Society of Cardiology. This figure helps you and your doctor decide how intensive prevention should be.
What is 10-year cardiovascular risk?
A 10-year cardiovascular risk of 5% means that, out of a hundred people with exactly your profile, five on average will have a cardiovascular event within ten years. It is a statistical estimate drawn from large cohorts followed over time, not an individual prediction: it places you relative to people who resemble you.
Why ten years? Because this time frame is long enough for risk factors to influence whether disease occurs, yet short enough to remain meaningful and to match the duration of the trials that validated preventive treatments. It is also the time frame used for the action thresholds in the guidelines.
This measure has a known limitation: age is its heaviest component. A 40-year-old who smokes and has high blood pressure will, mechanically, have a low 10-year risk despite significant cumulative exposure. That is why the 2021 European guidelines encourage looking at lifetime risk as well in young adults, along with the benefit of correcting risk factors early.
How do you calculate cardiovascular risk with SCORE2 and SCORE2-OP?
SCORE2 and SCORE2-OP were published in 2021 in the European Heart Journal (SCORE2 working group and ESC Cardiovascular risk collaboration, 2021; 42: 2439–2454, doi 10.1093/eurheartj/ehab309) and adopted by the European cardiovascular prevention guidelines the same year. They rely on five variables: age, sex, current smoking, systolic blood pressure and non-HDL cholesterol, that is, total cholesterol minus HDL.
| SCORE2 | SCORE2-OP | |
|---|---|---|
| Age range | 40 to 69 | 70 to 89 (OP: older persons) |
| Variables | Age, sex, smoking, systolic blood pressure, non-HDL cholesterol | The same five variables |
| What is estimated | 10-year risk of a fatal or non-fatal cardiovascular event (heart attack, stroke, cardiovascular death) | Same, taking into account the risk of death from other causes |
| Calibration | Four risk regions in Europe; France is in the low-risk region | Same |
| Publication | ESC, European Heart Journal, 2021 | ESC, European Heart Journal, 2021 |
Three points to note. SCORE2 estimates fatal and non-fatal events, whereas the former SCORE only counted deaths: the percentages cannot be compared from one version to the other. The model is calibrated by region: France belongs to the low-risk region, and those are the tables that should be used. Finally, the score does not apply to everyone: people who already have cardiovascular disease, diabetes, chronic kidney disease or familial hypercholesterolemia are classified at high or very high risk from the outset by the 2021 European guidelines, without going through the calculation. A version dedicated to type 2 diabetes was published later.
In practice, your doctor has the tables or a calculator; you need a recent blood pressure reading and a lipid panel, detailed in what a comprehensive blood test includes. The resulting figure is only a starting point, which your doctor adjusts using the factors the score cannot see.
What are the 7 cardiovascular risk factors?
The frequently cited list of “7 risk factors” brings together three factors you cannot act on (age, male sex and family history) and four modifiable factors: smoking, high blood pressure, high cholesterol and diabetes. Depending on the source, excess weight, physical inactivity and diet are added, and the count varies.
A risk factor increases the likelihood of developing a disease without making it certain. These factors act mainly through atherosclerosis (the gradual buildup of plaque in the artery walls) and they compound one another: two moderate factors often weigh more than a single severe one.
| Non-modifiable factors | Major modifiable factors | Additional factors and “modifiers” |
|---|---|---|
| Age | Smoking (including secondhand smoke) | Overweight and obesity, especially abdominal |
| Male sex (the gap with women narrows after menopause) | High blood pressure | Sedentary lifestyle and physical inactivity |
| Family history of early cardiovascular events | High cholesterol (LDL, non-HDL) | Unbalanced diet, alcohol |
| Diabetes, prediabetes | Chronic stress, sleep disorders, social deprivation, chronic inflammatory diseases, kidney disease |
The 2021 European guidelines call the items in the third column “risk modifiers”: although they are not part of the formula, they may lead the doctor to reclassify a person whose score is close to a threshold. That is why the calculation should not be done alone in front of a screen. The blood parameters that feed the score are reviewed in blood biomarkers.
What is the risk scale: low, high, very high?
The European guidelines classify 10-year risk into three levels, “low to moderate,” “high” and “very high,” with thresholds that depend on age: the younger you are, the lower the alert threshold, because the same percentage reflects greater exposure when it is reached early. The values below, generally used for SCORE2 and SCORE2-OP, must be confirmed before publication.
| Age range | Low to moderate | High | Very high |
|---|---|---|---|
| Under 50 | below 2.5% | 2.5% to less than 7.5% | 7.5% or more |
| 50 to 69 | below 5% | 5% to less than 10% | 10% or more |
| 70 and over (SCORE2-OP) | below 7.5% | 7.5% to less than 15% | 15% or more |
These categories change the intensity of the prevention offered: at low to moderate risk, the focus is on lifestyle habits; at high or very high risk, treatment for blood pressure or cholesterol may be considered, with LDL cholesterol targets that are lower the higher the risk. These targets are reference points for the discussion with your doctor, not goals to set for yourself on your own; we do not give figures for them here.
What does the prevention check-up at ages 45–50 do about your cardiovascular risk?
The prevention check-up offered between ages 45 and 50 inclusive by French National Health Insurance (Assurance Maladie) is a 30- to 45-minute consultation, fully covered (100%) with no upfront payment, and preventing cardiovascular disease is one of its official themes. It does not include a blood draw, but it identifies lifestyle-related risk factors and results in a Personalized Prevention Plan (PPP), which is sent to your regular doctor (médecin traitant) unless you object.
The check-up takes place in three steps. A self-assessment questionnaire, completed before the appointment in Mon espace santé (France’s personal digital health record) or on paper, reviews smoking, alcohol, diet, physical activity, sleep, stress and medical history. The consultation with the professional (doctor, nurse, pharmacist or midwife) lets you choose one or two priority topics together. The Personalized Prevention Plan sets concrete goals and, if needed, refers you to your regular doctor for a blood pressure reading, a lipid panel and a blood sugar test: the data still missing to calculate SCORE2.
In our view, this is the right time to raise the question: around 45, risk factors have often been in place for years but are still reversible, and the 10-year figure becomes informative. The process, screenings and preparation are detailed in the prevention check-up at ages 45–50, and the program in the prevention check-up.
What can metabolomics add to standard scores?
Scores such as SCORE2 rely on a handful of variables; nuclear magnetic resonance (NMR) metabolomics adds dozens from a single blood sample: lipoproteins detailed by class and size, fatty acids, amino acids, and markers of inflammation and energy metabolism. It does not replace the reference score; it documents what the score sums up in a single non-HDL cholesterol figure.
The reference panel quantifies 249 metabolic biomarkers. It was characterized in 118,461 participants from the UK Biobank cohort (Julkunen et al., Nature Communications, 2023). In the same cohort, Buergel et al. (Nature Medicine, 2022) showed that a metabolomic profile improves 10-year prediction of 24 diseases, including several cardiovascular diseases, when added to standard risk factors. These results, obtained at the scale of a research population, do not mean that a metabolomic profile is “more accurate” than a properly calculated SCORE2 for any given person, and to date no guideline incorporates it into risk calculation.
What it can offer at this stage: a finer reading of lipid and inflammatory metabolism when the score is intermediate, and a baseline for tracking the changes you make. The technique, its limitations and its uses are presented in NMR metabolomics.
How can you lower your cardiovascular risk?
Six levers have proven their effect on the occurrence of cardiovascular events: quitting smoking, regular physical activity, a Mediterranean-style diet, controlling blood pressure, lowering LDL cholesterol when indicated, and preventing or properly controlling diabetes. What follows describes these levers, not a treatment: treatment is something to discuss with your doctor.
Quit smoking
For smokers, this is the most powerful and fastest lever: the cardiovascular benefit starts within the first months after quitting and continues over time. Nicotine replacement therapy is covered with a prescription, and support (Tabac info service, France’s national smoking cessation service, or a tobacco cessation specialist) increases the chances of success.
Move more, sit less
Physical activity acts on blood pressure, cholesterol, blood sugar and weight all at once. The World Health Organization’s guidelines, adopted in France, call for moderate endurance activity each week, muscle strengthening and less sitting time.
Eat Mediterranean
A diet rich in vegetables, fruit, legumes, whole grains, olive oil, nuts and fish, and low in processed meats, salt and ultra-processed foods, reduced cardiovascular events in a large randomized trial. Cutting down on salt and limiting alcohol have a direct effect on blood pressure.
Know and control your blood pressure
High blood pressure cannot be felt: a measurement at the doctor’s office, confirmed by home monitoring, is the only way to detect it. When lifestyle changes are not enough, treatment is discussed with your doctor based on your overall risk level.
Cholesterol and diabetes: screen, then decide together
The lipid panel and fasting blood sugar feed the score and detect early diabetes. Depending on the result and your risk category, your doctor will suggest simple monitoring, stronger lifestyle measures or treatment. Sleep, stress and weight, which affect all the previous factors, are part of the same discussion.
Key takeaways
- 10-year cardiovascular risk is a statistical probability of a heart attack, stroke or cardiovascular death within the decade; it places your profile, it does not predict your fate.
- SCORE2 (ages 40–69) and SCORE2-OP (ages 70–89), published by the ESC in 2021, estimate it from age, sex, smoking, systolic blood pressure and non-HDL cholesterol; France uses the tables for the low-risk region.
- High-risk thresholds are lower before age 50; the doctor adjusts the result using factors the score ignores (family history, weight, inactivity, diabetes, kidney disease).
- The prevention check-up at ages 45–50, fully covered (100%), is the natural time to raise the question and get a prescription for the necessary tests.
- Smoking, physical activity, a Mediterranean diet, blood pressure, cholesterol and diabetes are the six proven levers; metabolomics can refine the picture, but it does not replace the score.
What Sokrate lets you do
Sokrate provides a service built into the prevention check-up that is fully covered (100%) by French National Health Insurance, with no upfront payment. The Sokrate 360 adaptive questionnaire, completed online before your appointment, explores nine dimensions of your health, including smoking, physical activity, diet and family history; a doctor signs your Personalized Prevention Plan and, unless you object, sends it to your regular doctor, who is responsible for calculating SCORE2 and making treatment decisions. A metabolomics panel of 249 biomarkers can complement this pathway, in agreement with your doctor. Join the waitlist.