cardiology general-medicine

SMART Risk Score for Recurrent CVD

Second Manifestations of ARTerial disease (SMART) risk score. Predicts 10-year risk of recurrent cardiovascular events in patients with established atherosclerotic vascular disease.

Used in: Hypertension

Score interpretation

Low Recurrence Risk (<10% at 10 years)

→ SMART Low Risk: <10% 10-year recurrent CVD risk. Maintain statin (target LDL-C <1.8 mmol/L); antiplatelet; BP <130/80; lifestyle modification; annual review.

Moderate Recurrence Risk (10–20%)

→ SMART Moderate Risk: 10–20% 10-year recurrence risk. High-intensity statin (target LDL-C <1.4 mmol/L); optimise BP and glucose; consider PCSK9 inhibitor if LDL-C not at target; dual antiplatelet in first year post-ACS.

High Recurrence Risk (>20%)

→ SMART High Risk: >20% 10-year recurrence risk. Very high intensity therapy: LDL-C target <1.0 mmol/L; PCSK9 inhibitor if not at target; consider colchicine (COLCOT); rivaroxaban 2.5 mg BD if ACS/PAD (COMPASS); aggressive multifactorial management.

Interpretation bands for the SMART Risk Score. Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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