Should heart age calculators be used alongside absolute cardiovascular disease risk assessment?

Abstract

BackgroundNational estimates of ‘heart age’ by government health organisations in the US, UK and China show most people have an older heart age than current age. While most heart age calculators are promoted as a communication tool for lifestyle change, they may also be used to justify medication when clinical guidelines advocate their use alongside absolute risk assessment. However, only those at high absolute risk of a heart attack or stroke are likely to benefit from medication, and it is not always clear how heart age relates to absolute risk. This article aims to: 1) explain how heart age calculation methods relate to absolute risk guidelines; 2) summarise research investigating whether heart age improves risk communication; and 3) discuss implications for the use of medication and shared decision making in clinical practice.Main bodyThere is a large and growing number of heart age models and online calculators, but the clinical meaning of an older heart age result is highly variable. An older heart age result may indicate low, moderate or high absolute risk of a heart attack or stroke in the next 5-10 years, and the same individual may receive a younger or older heart age result depending on which calculator is used. Heart age may help doctors convey the need to change lifestyle, but it cannot help patients make an informed choice about medication to reduce CVD risk.ConclusionInteractive heart age tools may be helpful as a communication tool to initiate lifestyle change to reduce risk factors. However, absolute risk should be used instead of heart age to enable informed decision making about medication, to avoid unnecessary treatment of low risk people. Evidence-based decision aids that improve patient understanding of absolute risk should be considered as alternatives to heart age calculators for lifestyle and medication decisions.

Riesgo cardiovascular en mujeres en edad fértil mediante el Score de Framingham, 2018

“…(17,18) El análisis conjunto de estos datos en un individuo es el indicador para establecer la necesidad de medicación y de desarrollar hábitos de vida saludables. (19)…”

Future directions in cardiovascular disease risk prediction

“…30 There is increasing interest in 'heart age' calculators, which have been promoted around the world including in Australia, New Zealand and the UK. 31 While there are claims that giving patients an 'older' heart age can motivate them to change their lifestyles, a review of biological age formats found no evidence that this is more effective than absolute risk formats. 32 Anecdotally, New Zealand GPs find this to be a useful communication tool to get people interested in their CVD risk and lifestyle change, but absolute risk must be used when considering medication.…”

Is the NHS ‘Heart Age Test’ too much medicine?

“…Heart age is an ill-defined measure of risk, relative to others of the same age, sex, and ethnicity with optimal risk factor levels. 4,11 As it is not a measure of absolute risk, it is not helpful for medication decisions. 5,11 7.…”

“…4,11 As it is not a measure of absolute risk, it is not helpful for medication decisions. 5,11 7. There should be evidence from highquality RCTs that screening is effective in reducing mortality or morbidity.…”

“…13 The Heart Age Test provides no information about who should use it, recommends cholesterol and blood pressure testing for everyone who does not enter values for these, and provides no information about the potential benefits, harms, and costs of having these additional tests done and of taking any medication that might subsequently be offered. 11 It is therefore not possible to make an informed choice about using it. 14 Furthermore, the Heart Age Test may confuse people when heart age and absolute risk are contradicting (for example, low risk but heart age higher than own age), and convey conflicting messages about the person's risk and the need for medication.…”