Vascular Age Versus Cardiovascular Risk: Clarifying Concepts

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

“…age, sex, blood pressure, cholesterol, smoking and diabetes status) to estimate an individual’s risk of CVD, which is then compared to a defined ‘ideal’ [ 11 ]. A heart age that is older than current age indicates elevated but modifiable risk, even if the absolute risk of a CVD event in the next 5-10 years is low [ 5 , 11 , 12 ]. For example, the New Zealand Heart Foundation (NZHF) assesses absolute risk in the next 5 years, and compares this to the age at which a person would reach the same absolute risk result if they did not smoke, had systolic blood pressure of 120 mmHg and total/HDL cholesterol ratio of 4 [ 11 ].…”

“…There are two distinct, and complementary, ways to manage CVD risk: lifestyle change to improve diet and physical activity, and medication to lower blood pressure and cholesterol. Motivating patients with CVD risk factors to change their lifestyle is important at any age, and this is where the heart age concept has been promoted as a potentially useful tool [ 5 , 11 , 12 ]. For example, a 25-year-old obese smoker needs to be motivated to give up smoking and improve their diet and exercise.…”

“…It can be challenging to communicate CVD risk to patients [ 12 , 29 ]. Heart age has been promoted as a potentially useful way to explain lifetime CVD risk, particularly for younger people who need to change their lifestyle but are at low risk of a CVD event in the next few years [ 5 , 11 ].…”

“…Other risk format suggestions in the cardiovascular literature include relative risk, lifetime risk and percentiles [ 12 ], but they all have the same problem as heart age: they do not enable patients to make an informed choice about medication benefits and harms based on current research evidence. The 2016 European guidelines make a clearer distinction between absolute risk for medication and heart age for lifestyle, stating directly: “both risk age and lifetime risk are closer to relative than absolute risk, and none provides an evidence base for drug treatment decisions” [ 27 ].…”

Clinical Perspective on Antihypertensive Drug Treatment in Adults With Grade 1 Hypertension and Low-to-Moderate Cardiovascular Risk: An International Expert Consultation

“…64,65 New variants of the relative CVR are a) vascular age or risk age 9,83,84 , b) the age and gender total CVR percentile 83 and c) long-term (eg lifetime) risk approach 28 . There is no consensus about relative CVR thresholds of low, moderate, and high risk.…”