QRISK3 vs ASCVD vs SCORE2: which heart risk score actually applies to you?

If you have ever plugged the same numbers into two different heart risk calculators and got two different answers, nothing went wrong. The three most widely used scores, QRISK3, the ASCVD Pooled Cohort Equations, and SCORE2, were built on different populations, for different guidelines, and they answer slightly different questions. Picking the right one matters more than the decimal place.

What each score was built to do

• QRISK3 (UK, 2017) estimates your 10-year risk of a first cardiovascular event. It was derived from millions of UK primary-care records, so it includes things most scores ignore: ethnicity, deprivation, rheumatoid arthritis, kidney disease, atrial fibrillation, and more. NICE recommends it for adults up to 84 in England and Wales.
• ASCVD Pooled Cohort Equations (US, 2013) estimate 10-year risk of a hard event: heart attack or stroke, fatal or not. They power the American ACC/AHA cholesterol guideline and use sex- and race-specific equations for adults 40 to 79.
• SCORE2 and SCORE2-OP (Europe, 2021) estimate 10-year risk of fatal and non-fatal cardiovascular disease for adults 40 to 89, and are recalibrated for four European risk regions. The ESC guideline uses them across Europe.
• AHA PREVENT (US, 2024) is the newest: it adds kidney function (eGFR) and BMI, drops race entirely, and can estimate 30-year risk and heart-failure risk as well as total CVD.

So which one should you use?

The honest rule is: use the score your country's guideline was built around. In the UK that is QRISK3. In the US it is the Pooled Cohort Equations or, increasingly, PREVENT. Across most of Europe it is SCORE2, choosing the right regional calibration. If you live in the Gulf or South Asia, none of the three was derived on your population, which is exactly why your clinician interprets the number in context rather than treating it as a verdict.

Age also decides for you. Under 40, none of the 10-year scores apply well and 30-year PREVENT or lifetime-risk framing is more useful. Over 79, QRISK3 still runs to 84 and SCORE2-OP covers 70 to 89, while the Pooled Cohort Equations stop at 79.

Why the numbers differ

A 55-year-old man can score 8% on one calculator and 12% on another because the baseline risk of the reference populations differ, the outcomes counted differ (hard events only versus all CVD), and the treatment thresholds attached to each score differ. The scores are not competing measurements of the same thing; they are calibrated estimates tied to a specific guideline's treatment triggers.

What to do with your number

A risk score is a conversation starter, not a diagnosis. Its real value is watching it move: recalculate after quitting smoking, after a blood-pressure change, after a cholesterol result. CardioTrack computes all of the published equations above on your device and saves each result to a trajectory chart so you and your clinician can see the trend rather than a single snapshot.

Use the score your national guideline was built around, and treat the output as a starting point for a clinical conversation, never as a diagnosis.