INTRODUCTION: Numerous equations to predict cardiovascular risk have been developed, but they differ in their ability to identify high-risk groups. In particular, concerns have been expressed that the Systematic Coronary Risk Evaluation (SCORE) equation may overestimate the risk of fatal myocardial infarction and stroke in certain European populations. METHODS: The SCORE guidelines were applied to a sample of 10,476 male and 11,874 female participants from the Västerbotten Intervention Program (VIP) of northern Sweden who were screened between 1990 and 1994, at the age of 40, 50, or 60 years, and followed up for at least 10 years or until death. RESULTS: The cohort experienced a total of 229 fatal cardiovascular events, 169 for men and 60 for women, during the course of follow-up, whereas 359 (266 for men and 93 for women) were predicted through application of the Swedish SCORE risk chart. CONCLUSION: Application of the SCORE guidelines resulted in substantial overestimation of the expected number of deaths from cardiovascular disease in a population from northern Sweden.