# SCORE2 10-year CVD risk

SCORE2 10-year CVD risk

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/score2`
HTML: https://magentlab.com/docs/score2
Markdown: https://magentlab.com/docs/score2.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Compute the ESC 2021 SCORE2 10-year fatal plus non-fatal CVD percent for adults aged 40-69 from sex, current smoking, systolic blood pressure, non-HDL cholesterol, and European geographic risk region.

## When to use

When an agent already has those SCORE2 2021 predictors for a person aged 40-69 without prior CVD or diabetes and needs that paper's region-calibrated 10-year CVD percent. Not a diagnosis, statin order, SCORE2-OP, SCORE2-Diabetes, or 2013 pooled-cohort equation.

## When not to use

- Not a medical device. Not a diagnosis of cardiovascular disease. Not a statin order or treatment recommendation.
- SCORE2 2021 for ages 40-69 only. Not SCORE2-OP (age 70 or older). Not SCORE2-Diabetes. Not intended for people with prior CVD or diabetes.
- Not the 2013 ACC/AHA pooled-cohort equations. Not Reynolds. european_risk_region is the paper's geographic calibration (low, moderate, high, very_high), not race or ethnicity.
- Charts display non-HDL. The published equation uses total and HDL cholesterol; magent evaluates it at the paper's HDL centering 1.3 mmol/L (TC = non-HDL + 1.3), matching the printed 50-year-old example (TC 5.5, HDL 1.3).
- Caller assigns age, sex, smoking, blood pressure, non-HDL, and European risk region. magent does not assay lipids and does not measure blood pressure.

## Formula

```
10-year fatal+non-fatal CVD % = 100*(1-exp(-exp(scale1+scale2*ln(-ln(1-uncal))))); uncal=1-S0^exp(lp); cage=(age-60)/5; csbp=(SBP-120)/20; charts display non-HDL mmol/L; equation uses TC and HDL at paper HDL centering 1.3 so TC=non-HDL+1.3, ctchol=(TC-6)/1, chdl=0; diabetes terms omitted (not SCORE2-Diabetes); men S0=0.9605 lp=0.3742*cage+0.6012*smoke+0.2777*csbp+0.1458*ctchol-0.2698*chdl-0.0755*cage*smoke-0.0255*cage*csbp-0.0281*cage*ctchol+0.0426*cage*chdl; women S0=0.9776 lp=0.4648*cage+0.7744*smoke+0.3131*csbp+0.1002*ctchol-0.2606*chdl-0.1088*cage*smoke-0.0277*cage*csbp-0.0226*cage*ctchol+0.0613*cage*chdl; region (scale1,scale2) men low (-0.5699,0.7476) moderate (-0.1565,0.8009) high (0.3207,0.9360) very_high (0.5836,0.8294); women low (-0.7380,0.7019) moderate (-0.3143,0.7701) high (0.5710,0.9369) very_high (0.9412,0.8329); SCORE2 2021 four-decimal coefficients (updated supplement Table 1); age 40-69; geographic region not race; not SCORE2-OP; not 2013 PCE
```

## Citation

[SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe](https://doi.org/10.1093/eurheartj/ehab309)
SCORE2 working group and ESC Cardiovascular risk collaboration
Eur Heart J. 2021;42(25):2439-2454
DOI: [10.1093/eurheartj/ehab309](https://doi.org/10.1093/eurheartj/ehab309)

## Worked example

### Low-risk region, male, age 50, current smoker, SBP 140, non-HDL 4.2 mmol/L (paper TC 5.5, HDL 1.3)

Given: `age=50, european_risk_region=low, non_hdl_mmol_l=4.2, sbp_mm_hg=140, sex=male, smoker=true`

1. cage=(50-60)/5=-2; csbp=(140-120)/20=1; TC=4.2+1.3=5.5; ctchol=(5.5-6)=-0.5; chdl=0; smoke=1
2. men lp = 0.2315 (diabetes terms omitted)
3. uncal = 1-0.9605^exp(lp); low-risk men scale1=-0.5699 scale2=0.7476
4. risk_10y_percent 5.9 (paper prints 5.9% for this male smoker)


### Same male smoker in the very-high-risk region

Given: `age=50, european_risk_region=very_high, non_hdl_mmol_l=4.2, sbp_mm_hg=140, sex=male, smoker=true`

1. Same lp 0.2315; very_high men scale1=0.5836 scale2=0.8294
2. risk_10y_percent 14.0 (paper prints 14.0%)


### Low-risk region, same labs, male nonsmoker

Given: `age=50, european_risk_region=low, non_hdl_mmol_l=4.2, sbp_mm_hg=140, sex=male, smoker=false`

1. smoke=0 lowers lp to -0.5207
2. risk_10y_percent 3.4


## Also searched as

- SCORE2
- ESC 2021 cardiovascular risk
- 10-year CVD risk Europe
- European risk region SCORE2
- non-HDL cholesterol CVD
- SCORE2 age 40-69
- fatal and non-fatal CVD

## Parameters

- `age` (integer, required): Age in years (integer 40-69). SCORE2 2021 is for ages 40-69. Not SCORE2-OP (age 70 or older).
- `sex` (string, required): Sex used by the sex-specific SCORE2 2021 coefficients (female or male).
- `smoker` (boolean, required): Current cigarette smoking as assigned by the caller (true or false). magent does not take a smoking history.
- `sbp_mm_hg` (number, required): Systolic blood pressure in mm Hg (50-250). Enters as (SBP-120)/20. magent does not measure blood pressure.
- `non_hdl_mmol_l` (number, required): Non-HDL cholesterol in mmol/L (1-12). SCORE2 charts display non-HDL. The published equation uses TC and HDL at the paper HDL centering 1.3 mmol/L (TC = non-HDL + 1.3). The printed 50-year-old example is TC 5.5 and HDL 1.3 (non-HDL 4.2). magent does not assay lipids.
- `european_risk_region` (string, required): Geographic SCORE2 2021 calibration region (low, moderate, high, or very_high) as printed in that paper. Not race. Not ethnicity.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/score2`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "age": "50",
      "european_risk_region": "low",
      "non_hdl_mmol_l": "4.2",
      "sbp_mm_hg": "140",
      "sex": "male",
      "smoker": "true"
    },
    {
      "age": "50",
      "european_risk_region": "low",
      "non_hdl_mmol_l": "4.2",
      "sbp_mm_hg": "140",
      "sex": "male",
      "smoker": "true"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/score2

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/score2",
  "items": [
    {
      "age": 50,
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "SCORE2 working group and ESC Cardiovascular risk collaboration",
        "doi": "10.1093/eurheartj/ehab309",
        "id": "score2-2021",
        "pmid": "34120177",
        "source": "Eur Heart J. 2021;42(25):2439-2454",
        "title": "SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe"
      },
      "formula": "score2",
      "formula_expression": "10-year fatal+non-fatal CVD % = 100*(1-exp(-exp(scale1+scale2*ln(-ln(1-uncal))))); uncal=1-S0^exp(lp); cage=(age-60)/5; csbp=(SBP-120)/20; charts display non-HDL mmol/L; equation uses TC and HDL at paper HDL centering 1.3 so TC=non-HDL+1.3, ctchol=(TC-6)/1, chdl=0; diabetes terms omitted (not SCORE2-Diabetes); men S0=0.9605 lp=0.3742*cage+0.6012*smoke+0.2777*csbp+0.1458*ctchol-0.2698*chdl-0.0755*cage*smoke-0.0255*cage*csbp-0.0281*cage*ctchol+0.0426*cage*chdl; women S0=0.9776 lp=0.4648*cage+0.7744*smoke+0.3131*csbp+0.1002*ctchol-0.2606*chdl-0.1088*cage*smoke-0.0277*cage*csbp-0.0226*cage*ctchol+0.0613*cage*chdl; region (scale1,scale2) men low (-0.5699,0.7476) moderate (-0.1565,0.8009) high (0.3207,0.9360) very_high (0.5836,0.8294); women low (-0.7380,0.7019) moderate (-0.3143,0.7701) high (0.5710,0.9369) very_high (0.9412,0.8329); SCORE2 2021 four-decimal coefficients (updated supplement Table 1); age 40-69; geographic region not race; not SCORE2-OP; not 2013 PCE",
      "sex": "male",
      "linear_predictor": 0.2315,
      "sbp_mm_hg": 140.0,
      "smoker": true,
      "risk_10y_percent": 5.9,
      "european_risk_region": "low",
      "hdl_mmol_l": 1.3,
      "non_hdl_mmol_l": 4.2,
      "total_cholesterol_mmol_l": 5.5
    },
    {
      "age": 50,
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "SCORE2 working group and ESC Cardiovascular risk collaboration",
        "doi": "10.1093/eurheartj/ehab309",
        "id": "score2-2021",
        "pmid": "34120177",
        "source": "Eur Heart J. 2021;42(25):2439-2454",
        "title": "SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe"
      },
      "formula": "score2",
      "formula_expression": "10-year fatal+non-fatal CVD % = 100*(1-exp(-exp(scale1+scale2*ln(-ln(1-uncal))))); uncal=1-S0^exp(lp); cage=(age-60)/5; csbp=(SBP-120)/20; charts display non-HDL mmol/L; equation uses TC and HDL at paper HDL centering 1.3 so TC=non-HDL+1.3, ctchol=(TC-6)/1, chdl=0; diabetes terms omitted (not SCORE2-Diabetes); men S0=0.9605 lp=0.3742*cage+0.6012*smoke+0.2777*csbp+0.1458*ctchol-0.2698*chdl-0.0755*cage*smoke-0.0255*cage*csbp-0.0281*cage*ctchol+0.0426*cage*chdl; women S0=0.9776 lp=0.4648*cage+0.7744*smoke+0.3131*csbp+0.1002*ctchol-0.2606*chdl-0.1088*cage*smoke-0.0277*cage*csbp-0.0226*cage*ctchol+0.0613*cage*chdl; region (scale1,scale2) men low (-0.5699,0.7476) moderate (-0.1565,0.8009) high (0.3207,0.9360) very_high (0.5836,0.8294); women low (-0.7380,0.7019) moderate (-0.3143,0.7701) high (0.5710,0.9369) very_high (0.9412,0.8329); SCORE2 2021 four-decimal coefficients (updated supplement Table 1); age 40-69; geographic region not race; not SCORE2-OP; not 2013 PCE",
      "sex": "male",
      "linear_predictor": 0.2315,
      "sbp_mm_hg": 140.0,
      "smoker": true,
      "risk_10y_percent": 5.9,
      "european_risk_region": "low",
      "hdl_mmol_l": 1.3,
      "non_hdl_mmol_l": 4.2,
      "total_cholesterol_mmol_l": 5.5
    }
  ]
}
```

## Response fields

- `formula` (string): score2
- `formula_expression` (string): SCORE2 2021 sex-specific coefficients and region scale1/scale2
- `age` (integer): Age in years used (40-69)
- `sex` (string): female or male used
- `smoker` (boolean): Caller-assigned current smoking used
- `sbp_mm_hg` (number): Systolic BP used, mm Hg
- `non_hdl_mmol_l` (number): Non-HDL cholesterol used, mmol/L
- `total_cholesterol_mmol_l` (number): TC used as non-HDL + 1.3 mmol/L (paper HDL centering)
- `hdl_mmol_l` (number): HDL used, always 1.3 mmol/L (paper centering / printed example)
- `european_risk_region` (string): Geographic calibration region used
- `linear_predictor` (number): Sex-specific linear predictor lp, 4 decimals
- `risk_10y_percent` (number): Calibrated 10-year fatal+non-fatal CVD risk percent, 1 decimal
- `citation` (object): SCORE2 working group Eur Heart J 2021 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "age": 50,
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "SCORE2 working group and ESC Cardiovascular risk collaboration",
    "doi": "10.1093/eurheartj/ehab309",
    "id": "score2-2021",
    "pmid": "34120177",
    "source": "Eur Heart J. 2021;42(25):2439-2454",
    "title": "SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe"
  },
  "formula": "score2",
  "formula_expression": "10-year fatal+non-fatal CVD % = 100*(1-exp(-exp(scale1+scale2*ln(-ln(1-uncal))))); uncal=1-S0^exp(lp); cage=(age-60)/5; csbp=(SBP-120)/20; charts display non-HDL mmol/L; equation uses TC and HDL at paper HDL centering 1.3 so TC=non-HDL+1.3, ctchol=(TC-6)/1, chdl=0; diabetes terms omitted (not SCORE2-Diabetes); men S0=0.9605 lp=0.3742*cage+0.6012*smoke+0.2777*csbp+0.1458*ctchol-0.2698*chdl-0.0755*cage*smoke-0.0255*cage*csbp-0.0281*cage*ctchol+0.0426*cage*chdl; women S0=0.9776 lp=0.4648*cage+0.7744*smoke+0.3131*csbp+0.1002*ctchol-0.2606*chdl-0.1088*cage*smoke-0.0277*cage*csbp-0.0226*cage*ctchol+0.0613*cage*chdl; region (scale1,scale2) men low (-0.5699,0.7476) moderate (-0.1565,0.8009) high (0.3207,0.9360) very_high (0.5836,0.8294); women low (-0.7380,0.7019) moderate (-0.3143,0.7701) high (0.5710,0.9369) very_high (0.9412,0.8329); SCORE2 2021 four-decimal coefficients (updated supplement Table 1); age 40-69; geographic region not race; not SCORE2-OP; not 2013 PCE",
  "sex": "male",
  "linear_predictor": 0.2315,
  "sbp_mm_hg": 140.0,
  "smoker": true,
  "risk_10y_percent": 5.9,
  "european_risk_region": "low",
  "hdl_mmol_l": 1.3,
  "non_hdl_mmol_l": 4.2,
  "total_cholesterol_mmol_l": 5.5
}
```

## Errors

- HTTP 400 `invalid_age`: age must be an integer from 18 to 120 Returned before settlement; you are not charged.
- HTTP 400 `invalid_sex`: sex must be female or male Returned before settlement; you are not charged.
- HTTP 400 `invalid_systolic_bp`: systolic_mm_hg or systolic_bp_mm_hg must be a number from 50 to 250. Returned before settlement; you are not charged.
- HTTP 400 `invalid_score2_region`: european_risk_region must be low, moderate, high, or very_high as printed in SCORE2 2021 (geographic calibration, not race). Returned before settlement; you are not charged.
- HTTP 400 `invalid_score2`: SCORE2 2021 inputs must match that paper's age 40-69, sex, smoking, systolic BP, non-HDL cholesterol, and European risk region. Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Reynolds Risk Score](https://magentlab.com/docs/reynolds) — Compute the Ridker JAMA 2007 Reynolds Risk Score 10-year CVD percent for women using clinically simplified Model B (age, SBP, hsCRP, total cholesterol, HDL-C, HbA1c if diabetic, current smoking, and parental MI before age 60).
- [Framingham CHD](https://magentlab.com/docs/framingham-chd) — Sum Wilson 1998 sex-specific total-cholesterol point sheets (age, TC, HDL, JNC-V blood pressure, diabetes, smoking) and return the published 10-year CHD percent.
- [NAFCS](https://magentlab.com/docs/nafcs) — Sum Hegele 2025 Table 3 NAFCS item points (age or early HTG onset, BMI, abdominal pain or pancreatitis, secondary factors, fasting TG, TG/TC ratio, apo B, and three published interactions) and return the 0–100 score plus ≥60 definite classical FCS and ≥45 very likely classical FCS flags. Not a diagnosis or genetic test.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.