Stjernholm Kathrine, Kerr Andrew, Poppe Katrina K, Jensen Anders Elkær, Mehta Suneela, Nielsen Jesper Bo, Jackson Rod, Wells Susan
Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Heart. 2025 Jan 29;111(4):166-171. doi: 10.1136/heartjnl-2024-324156.
Cardiovascular disease (CVD) preventive medications are recommended for patients at high short-term CVD risk. As most younger people with multiple raised CVD risk factors levels have low short-term risk, they could be falsely reassured to take no action. Heart age-the chronological age of a hypothetical person with the same short-term absolute CVD risk as the patient being assessed, but with an 'ideal' risk profile-is a complementary relative CVD risk metric developed to encourage these younger patients to make long-term lifestyle changes. However, clinicians sometimes use heart age to inform medication decisions. We assessed the appropriateness of this practice by comparing heart age and short-term CVD risk.
New Zealand primary care patients are recruited to the PREDICT cohort when their CVD risk is assessed. PREDICT is an ongoing prospective study in one-third of New Zealand general practices, designed to derive CVD risk prediction algorithms. Five-year CVD risk was calculated for 35-74-year-old PREDICT participants using published equations. Heart age was calculated using non-smoking, systolic blood pressure of 120 mm Hg and total cholesterol/high-density lipoprotein ratio of 3.5, as the 'ideal' risk profile. CVD risk and heart age gaps (difference between chronological age and heart age) were compared.
Among 371 676 PREDICT participants, 5-year CVD risk increased with age, approximately doubling every 10 years, whereas heart age gaps decreased with increasing age, approximately halving between 35 and 44-year olds and 65-74-year olds. There were 5-40-year heart age gap differences between groups with similar 5-year CVD risks, but different ages.
Short-term CVD risk and heart age are not interchangeable risk metrics. Short-term risk increases with increasing age whereas heart age gaps generally decline, with major differences between younger and older people with similar short-term risk. If heart age is used to inform medication decisions rather than encourage long-term lifestyle changes, older people at high short-term risk could be undertreated and younger people at low short-term risk could be unnecessarily medicated.
心血管疾病（CVD）预防药物适用于短期心血管疾病风险较高的患者。由于大多数具有多种心血管疾病风险因素水平升高的年轻人短期风险较低，他们可能会错误地认为无需采取行动。心脏年龄——与被评估患者具有相同短期绝对心血管疾病风险，但具有“理想”风险特征的假设个体的实际年龄——是一种补充性的相对心血管疾病风险指标，旨在鼓励这些年轻患者做出长期生活方式改变。然而，临床医生有时会使用心脏年龄来指导用药决策。我们通过比较心脏年龄和短期心血管疾病风险来评估这种做法的合理性。
新西兰初级保健患者在评估心血管疾病风险时被纳入PREDICT队列。PREDICT是一项在新西兰三分之一的全科诊所进行的正在进行的前瞻性研究，旨在推导心血管疾病风险预测算法。使用已发表的公式计算35 - 74岁PREDICT参与者的五年心血管疾病风险。心脏年龄以不吸烟、收缩压120毫米汞柱和总胆固醇/高密度脂蛋白比值3.5作为“理想”风险特征来计算。比较心血管疾病风险和心脏年龄差距（实际年龄与心脏年龄之差）。
在371676名PREDICT参与者中，五年心血管疾病风险随年龄增加，每10年大约翻倍，而心脏年龄差距随年龄增加而减小，在35至44岁和65至74岁之间大约减半。具有相似五年心血管疾病风险但年龄不同的组之间存在5至40岁的心脏年龄差距差异。
短期心血管疾病风险和心脏年龄不是可互换的风险指标。短期风险随年龄增加而增加,而心脏年龄差距通常下降，短期风险相似的年轻人和老年人之间存在重大差异。如果使用心脏年龄来指导用药决策而不是鼓励长期生活方式改变，短期风险高的老年人可能治疗不足，短期风险低的年轻人可能会不必要地用药。
