You can access the SCORE2 risk estimation tool here:
1. HeartScore by the European Society of Cardiology (ESC)
This is the official interactive tool using the latest SCORE2 algorithm. It calculates the 10-year risk of fatal and non-fatal cardiovascular events. Best option.
2. MDCalc. (very easy to use)
3. U-Prevent
Additional Notes:
• SCORE2 is designed for Europe and requires selecting the correct risk region (low, moderate, high, or very high).
• It is intended for people aged 40–69 years without previous cardiovascular disease or diabetes.
• There are also versions for older adults (SCORE2-OP) and people with diabetes (SCORE2-Diabetes).
Recommendation: Start with the official HeartScore tool or use MDCalc for a quick calculation. Both are free to use.
"Designed for Europe" means the SCORE2 risk estimation tool was statistically developed and calibrated using large European population datasets. This makes its predictions more accurate for European countries by reflecting the actual cardiovascular disease rates observed there.
Why does that matter? Cardiovascular disease rates differ between regions because of:
• Genetics
• Diet and lifestyle patterns (e.g., Mediterranean diet in Southern Europe)
• Smoking rates and physical activity levels
• Healthcare systems and treatment of risk factors
• Socioeconomic and environmental factors
Because of these differences, the same set of risk factors (age, sex, blood pressure, cholesterol, smoking) can translate into different actual risks depending on where you live.
How SCORE2 handles regional differences
The tool divides Europe into four risk regions (low, moderate, high, and very high). For identical risk factors, a person in a high-risk region (e.g., Eastern Europe) will receive a higher predicted risk than someone in a low-risk region (e.g., Spain or Italy).
The United States uses its own calibrated tools (such as the ASCVD Pooled Cohort Equations or the PREVENT calculator), which are based on American data. Using a European tool on an American (or vice versa) can lead to over- or under-estimation of true risk.
Bottom line: “Designed for Europe” simply means the calculator is fine-tuned to European population data for better accuracy in that context. It is not because people are fundamentally different, but because populations have different average disease patterns and lifestyles.
U.S. and European cardiovascular risk tools often deliver noticeably different results for the same person. Real-world evidence shows clear differences:
• In multiple studies, SCORE2 (European) frequently classifies more people into higher risk categories compared to US tools.
• The older US Pooled Cohort Equations (PCE / ASCVD calculator) often estimates higher risk than newer tools.
• The newer US PREVENT calculator usually gives the lowest risk estimates among the three.
Examples from studies:
• SCORE2 often puts more patients into “high/very high risk” than ASCVD/PCE, sometimes doubling the proportion classified as high risk.
• PREVENT reclassifies many people downward compared to the older PCE — sometimes moving 38% of people from above 5% risk to below 5%.
Why the differences occur:
• Different source populations (European vs. American cohorts)
• Different endpoints (SCORE2 focuses on fatal + non-fatal heart attack/stroke; PREVENT includes heart failure too)
• Different risk factor weighting and regional calibration
• Updates over time (newer tools like PREVENT tend to predict lower risks than older ones because actual heart disease rates have declined)
Bottom line: The same individual can easily get a 10-year risk of 3% on one calculator and 7% on another. This is why doctors are advised to use the tool calibrated for their region (SCORE2 in Europe, PREVENT or PCE in the US) and not mix them freely. Clinical judgment, additional tests (like coronary calcium scoring), and shared decision-making remain important when results are borderline.
The results of this Keto vs Mediterranean diet study are largely applicable to the USA.
• The core findings are physiological: both diets produced similar weight loss, fat mass reduction, blood pressure improvement, and metabolic benefits over 3 months. These biological responses (calorie deficit → weight/fat loss → lower BP and better metabolism) occur in humans regardless of continent.
• The participants had typical Western profiles: overweight/obese adults with high-normal or Grade 1 hypertension and low-to-moderate cardiovascular risk — a very common group in the United States.
• Both ketogenic and Mediterranean-style diets are widely studied and used in the US. Many American trials show similar short-term benefits for both approaches.
Important limitations / caveats for US readers:
• The study used SCORE2 (European risk calculator). A US patient with identical risk factors might get a different risk percentage on the American PREVENT or ASCVD calculator.
• The Mediterranean diet in the study was specifically low-sodium, high-potassium — which aligns well with US DASH-style recommendations.
• The ketogenic diet was low-calorie and high-protein (not the classic very-high-fat version), making it more comparable to US versions.
• It was a small Italian pilot study (n=26, only 3 months). Results may vary with larger, longer US-based trials that include more diverse ethnic backgrounds (African American, Hispanic, Asian populations), where average responses can differ slightly.
Bottom line:
You can reasonably apply the main message to the USA. Both a well-formulated low-calorie Keto diet and a low-calorie Mediterranean diet can be effective for weight loss and blood pressure reduction in overweight/obese people with mildly elevated BP. The key driver appears to be weight and fat loss, not the specific diet type.
Seems to me the common factor here is “low-calorie.”
Stop putting too much stuff in your mouth and good things will happen.
No,no,no. Not another diet. I wanna pill so I can still eat Little Debbie’s, and Twinkies.
I lost 40lbs and keep it off with the “paleo” diet. Lots of fish and veggies and eggs. I can’t digest mammalian meat so it is a challenge but not too bad. If I had to pick a “diet” I’m going with the Mediterranean diet. I love that food.
Retatrutide will be the Fountain Of Youth!
Good to know.
I’ve tried both and keto is just easier.
For me, the Med Diet is just a pain, too much prep.
Too many ingredients.
But whatever works well is the best plan for you.
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