A NEW study has demonstrated that heart age and short-term cardiovascular risk are distinctly different measures of risk and using heart age to inform treatment decisions could result in both under- and over-treatment of patients.
Heart age is a relative risk metric that represents the chronological age of a person with the same cardiovascular risk as the individual but with an ideal risk profile. It is designed to encourage long-term lifestyle changes, particularly in younger patients with multiple risk factors but low short-term risk. In contrast, predicted short-term cardiovascular risk provides an absolute measure, commonly used to determine immediate need for preventive medications. Despite their distinct purposes, these measures are sometimes used interchangeably in clinical practice, which this study suggests may lead to inappropriate treatment decisions.
The study utilised data from over 370,000 patients aged 35–74 enrolled in New Zealand’s PREDICT cohort, which assesses cardiovascular disease (CVD) risk in primary care. Five-year CVD risk was calculated using established equations, and heart age was determined based on an idealised non-smoking profile with optimal blood pressure and cholesterol levels. Results showed that while short-term CVD risk doubled approximately every 10 years, heart age gaps (the difference between a patient’s heart age and chronological age) decreased significantly with age, halving between younger (35–44 years) and older (65–74 years) groups. Crucially, the study highlighted a 5–40-year variation in heart age gaps among patients with similar short-term CVD risks but differing ages.
The findings underscore that short-term cardiovascular risk and heart age are not interchangeable metrics. Short-term risk rises significantly with age, while heart age gaps tend to narrow. Relying on heart age to guide medication decisions could result in undertreatment for older patients at high short-term risk, while younger patients at low short-term risk might be unnecessarily prescribed preventive medications. These results have important implications for clinical practice, emphasising that heart age should be used to motivate lifestyle changes rather than determine immediate pharmacological interventions. Future clinical guidelines should differentiate the use of these two risk measures to ensure appropriate management of cardiovascular disease risk.
Katrina Thornber, EMJ
Reference
Stjernholm K et al. Age-stratified comparison of heart age and predicted cardiovascular risk in 370 000 primary care patients. Heart (British Cardiac Society). 2024;10:heartjnl-2024.
