Hellenic J Cardiol. 2026 Jun 5:S1109-9666(26)00114-4. doi: 10.1016/j.hjc.2026.05.006. Online ahead of print.
ABSTRACT
BACKGROUND AND AIM: 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 versus HellenicSCORE II+ in detecting preclinical carotid atherosclerosis.
METHODS: Middle-aged (40-69 years) individuals from the general population without ASCVD, were invited to participate on a voluntary basis 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.
RESULTS: 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 between CPS and SCORE2/HellenicSCORE II+ 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 intervals 0.71-0.78 and 0.71, 0.68-0.74 respectively, P=NS for comparison).
CONCLUSIONS: 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 in refining ASCVD risk.
PMID:42250873 | DOI:10.1016/j.hjc.2026.05.006