建议使用欧洲系统冠状动脉风险评估 2 (SCORE2) 和 SCORE2-老年人 (OP) 模型来识别 10 年心血管疾病 (CVD) 高风险的个体。需要对临床效用进行独立验证和评估。评估低风险 SCORE2 和 SCORE2-OP 的区分、校准和临床效用。在 40-69 岁 (SCORE2) 和 70-79 岁 (SCORE2-OP) 的个体中进行验证，无来自欧洲癌症前瞻性调查 (EPIC)-诺福克前瞻性人群研究的基线 CVD 或糖尿病。我们将 10 年 CVD 风险估计值与观察到的结果（心血管死亡率、非致命性心肌梗塞和中风）进行了比较。对于 SCORE2，19,560 名个体（57% 女性）的 10 年 CVD 风险估计值为 3.7%（95% 置信区间（95% 置信区间） CI) 3.6-3.7) 对比观察值 3.8% (95% CI 3.6-4.1)（观察值 (O)/预期 (E) 比率 1.0 (95% CI 1.0-1.1)。曲线下面积 (AUC) 为 0.75（ 95% CI 0.74-0.77)，男性风险低估 (O/E 1.4 (95% CI 1.3-1.6))，女性风险高估 (O/E 0.7 (95% CI 0.6-0.8)。决策曲线分析 ( DCA）显示出临床益处。SCORE2-OP 对 3,113 名个体（58% 女性）进行的 10 年 CVD 事件预测为 10.2%（95% CI 10.1-10.3），而观察值为 15.3%（95% CI 14.0-16.5）（O/E）比率 1.6 (95% CI 1.5-1.7))。AUC 为 0.63 (95% CI 0.60-0.65)，低估了不同性别和风险范围的风险。DCA 的临床获益有限。在英国人群队列中，SCORE2 低-风险模型显示出公平的区分和校准，对于预防性治疗启动决策具有临床益处。相比之下，在 70-79 岁的个体中，SCORE2-OP 表现出较差的辨别能力、低估了两性的风险以及有限的临床效用。© 作者 2023。由牛津大学出版社代表欧洲心脏病学会出版。

The European Systematic Coronary Risk Evaluation 2 (SCORE2) and SCORE2-Older Persons (OP) models are recommended to identify individuals at high 10-year risk for cardiovascular disease (CVD). Independent validation and assessment of clinical utility is needed.To assess discrimination, calibration and clinical utility of low-risk SCORE2 and SCORE2-OP.Validation in individuals aged 40-69 years (SCORE2) and 70-79 years (SCORE2-OP) without baseline CVD or diabetes from the European Prospective Investigation of Cancer (EPIC)-Norfolk prospective population study. We compared 10-year CVD risk estimates with observed outcomes (cardiovascular mortality, non-fatal myocardial infarction and stroke).For SCORE2, 19,560 individuals (57% women) had 10-year CVD risk estimates of 3.7% (95% confidence interval (CI) 3.6-3.7) versus observed 3.8% (95% CI 3.6-4.1) (observed (O)/expected (E) ratio 1.0 (95% CI 1.0-1.1). The area under the curve (AUC) was 0.75 (95% CI 0.74-0.77), with underestimation of risk in men (O/E 1.4 (95% CI 1.3-1.6)) and overestimation in women (O/E 0.7 (95% CI 0.6-0.8). Decision curve analysis (DCA) showed clinical benefit. SCORE2-OP in 3,113 individuals (58% women) predicted 10-year CVD events in 10.2% (95% CI 10.1-10.3) versus observed 15.3% (95% CI 14.0-16.5) (O/E ratio 1.6 (95% CI 1.5-1.7)). The AUC was 0.63 (95% CI 0.60-0.65) with underestimation of risk across sex and risk ranges. DCA showed limited clinical benefit.In a UK population cohort, the SCORE2 low-risk model showed fair discrimination and calibration, with clinical benefit for preventive treatment initiation decisions. In contrast, in individuals aged 70-79 years, SCORE2-OP demonstrated poor discrimination, underestimated risk in both sexes, and limited clinical utility.© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.