. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SCORE2 models allow consideration of sex- specific cardiovascular disease risks by region Steven Hageman 1 , Lisa Pennells 2 , Francisco Ojeda 3 , Stephen Kaptoge 2 , Jannick Dorresteijn 1 , and Emanuele Di Angelantonio 2 *; for the SCORE2 working group and ESC Cardiovascular Risk Collaboration † 1 Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Netherlands; 2 Cardiovascular Epidemiology Unit, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK; and 3 University Heart & Vascular Center, Hamburg, Germany This commentary refers to ‘SCORE2 risk prediction algo- rithms: new models to estimate 10-year risk of cardiovascu- lar disease in Europe’, by the SCORE2 working group and European Society of Cardiology (ESC) Cardiovascular Risk Collaboration, https://doi.org/10.1093/eurheartj/ehab309 and the discussion piece ‘A sex-specific prediction model is not enough to achieve equality for women in preventative cardiovascular medicine’, by D.M. Kimenai et al., https://doi. org/10.1093/eurheartj/759. SCORE2 is a risk algorithm developed to estimate 10-year cardiovas- cular disease (CVD) risk in men and women from four different risk regions of Europe, 1 which is now recommended for use by the 2021 ESC Guidelines on cardiovascular disease prevention in clinical prac- tice. 2 We agree with Kimenai et al. 3 on the need for consideration of sex differences in cardiovascular disease risk in both basic, clinical and translational research and prevention guidelines. Indeed, our devel- opment of the SCORE2 algorithm recognized this, with all steps of model development performed separately for each sex. This has resulted in accurate and externally validated prediction algorithms for both men and women, with further research validation and clinic- al application facilitated by different translational tools already pro- vided (or in progress), including: easy-to-use risk charts (main paper Figure 3), and the statistical software program—score2risk—(https:// www.phpc.cam.ac.uk/ceu/erfc/programs/ ). Furthermore, all relevant sex-specific model parameters were included in the Supplementary materials, in particular: Supplementary Table 7 (for beta coefficients and baseline hazards) and Supplementary Methods Table 3 (for recalibration scales). 1 We do, however, recognize the relevance of making all model parameters available to a greater precision in order to facilitate appropriate usage. Therefore, we have included with this comment an additional table of sex-specific model coefficients and recalibration scales (Table 1) rounded to four decimal places. To make these parameters as easily accessible as possible, these tables have been included in the updated version of the article supplement. * Corresponding author. Email: ed303@medschl.cam.ac.uk † The members of the SCORE2 working group and ESC Cardiovascular Risk Collaboration are available in https://doi.org/10.1093/eurheartj/ehab309. DISCUSSION FORUM https://doi.org/10.1093/eurheartj/ehab761 European Heart Journal (2022) 43, 241–242 Published on behalf of the European Society of Cardiology. All rights reserved. V C The Author(s) 2021. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article/43/3/241/6433491 by guest on 17 July 2022