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CVD prevention must target those with high lifetime risk

New calculator determines true heart age

Jo Carlowe

Wednesday, 26 March 2014

Getting patients to understand their true heart age is key to staving off the “worldwide epidemic” of cardiovascular disease (CVD).

This is the consensus of 11 UK professional societies and charitable organisations, who have today published their recommendations in the journal Heart.

The Joint British Societies’ consensus recommendations emphasise the importance of putting patients in the driving seat and starting preventive action early on, using a new method of risk assessment - the JBS3 risk calculator.

The JBS3 risk calculator helps work out a person’s true heart age. It does this by using current familial and lifestyle risk factors to predict how many more years that individual can expect to live before s/he has a heart attack/stroke compared with someone without these particular factors - if no corrective action is taken.

So, for example, a 35-year-old woman smoker, with a systolic blood pressure of 160 mm Hg and a total cholesterol of 7 mmol/l, plus a family history of premature CVD, would have a true heart age of 47 and expect to survive to the age of 71 without having a heart attack/stroke. Her 10 year risk would be less than 2%.

But if this woman quit smoking, cut her total cholesterol to 4 mmol/l and her systolic blood pressure to 130 mm Hg, her heart age would fall to 30. She could expect to live to the age of 85 before having a heart attack/stroke and more than halve her 10 year risk to less than 0.25%.

Heart disease deaths have almost halved over the past 40-50 years, particularly in high income countries, thanks largely to the identification of the common risk factors involved and national public health initiatives, say the authors.

But “despite impressive progress, there is much still to be achieved in the prevention and management of cardiovascular care, with no room for complacency.”

The experts describe CVD as “by far and away the leading cause of deaths worldwide”. They describe it as “rampant” in low and middle income countries and warn that the surge in obesity and diabetes threatens to overturn the steady decline made in CVD prevalence.

The new recommendations extend the current focus of preventive treatment from targeting only those at high short-term (within the next 10 years) risk of a heart attack/stroke to those whose familial and lifestyle factors at a younger age indicate a low short-term risk, but a high lifetime risk.

The approach is based on the growing body of evidence showing that there is a long build-up (pre-clinical phase) to CVD, and that most heart attacks and strokes occur in people who are in the “intermediate” risk category.

“Most surveys suggest that the majority of the public underestimate their lifetime risk of developing and dying of CVD, considering cancer to be a greater threat despite robust evidence to the contrary,” say the authors.

The JBS3 risk calculator will be a pivotal component of the NHS Health Check programme in England aimed at 40-74 year olds, but is not intended to prompt blanket prescribing of statins and other heart health drugs, say the authors.

“It is important to emphasise that, for the majority, the strong message will be the potential gains from an early and sustained change to a healthier lifestyle rather than prescription of drugs,” they emphasise.

Lifestyle changes include quitting smoking, adopting a healthy diet, and boosting the amount of regular exercise while curbing sedentary activity.

“Acute cardiovascular care is expensive and with life expectancy continuing to rise, the prevalence of CVD continues to increase,” write the authors. “The lifesaving gains made through national investment in acute cardiovascular care over more than a decade now need to be complemented by a modern and integrated approach to cardiovascular prevention,” they conclude. 

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