Key result
Current 10-year CV risk thresholds miss ~95% of adults aged 30-44 experiencing incident vascular events.
Why the study?
Increasing stroke and cancer incidence at younger ages prompted proposals to reduce the starting age of primary care health checks from 40 to 30 years, but potential barriers to the success of this strategy were unclear.
Does the proposed earlier primary care health check with a 10-year CV risk threshold of 10% identify individuals aged 30-44 years who will have an incident vascular event?
Observational (n=211)
No
Does the proposed earlier primary care health check with a 10-year CV risk threshold of 10% identify individuals aged 30-44 years who will have an incident vascular event?
The vast majority of young adults suffering premature vascular events have 10-year cardiovascular risk scores well below the current 10% treatment threshold, highlighting the limitations of short-term risk prediction for early prevention.
Should not change practice based on 10-year risk thresholds alone in adults aged 30-44; leaves open whether earlier checks or alternative thresholds reduce events.
Background Incidence of stroke and certain cancers is increasing at younger ages in many high-income countries, prompting healthcare systems to consider how best to improve prevention, such as earlier primary care health checks. We assessed potential barriers to the success of the current proposal in England to reduce the starting age of the 5-yearly NHS health check from 40 to 30 years. Methods In a prospective population-based study (Oxford Vascular Study; 1/4/2002–31/3/23) of 94 567 people in a subpopulation of Oxfordshire, UK, we assessed all participants with incident acute vascular events occurring at age 30–44 years and determined the proportion of those who would have qualified for active risk management were they to have had the proposed new health check prior to their event (i.e. premorbid QRISK3-10-year absolute CV-risk ≥ 10%). We also assessed CV-risk relative to age-specific ‘ideal’ risk (QRISK3-Relative Risk (RR) score, predicted “healthy-heart-age”) and number of risk factors above recommended target. Results During 433,797 person-years of ascertainment, 217 individuals aged 30–44 years had an incident vascular event (crude incidence rate 50/100 000 person years). Of these, 155 would have been eligible for an earlier health check. The median 10-year predicted CV risk in this group was only 2.5% (IQR = 1.1–4.8%), with 148 (95%) falling below the 10% threshold for active risk management. The median 10-year risk among the 49 women was 1.1% (IQR 0.5–2.2%), with none having a predicted risk above the 10% threshold. Yet, the mean predicted “healthy heart age” gap was 9 years(SD = 7), and 137(88%) had at least one treatable risk factor above target level. Conclusions The majority of vascular events at age 30–44 years occur in individuals with treatable risk factors above target level, yet the vast majority had falsely reassuring premorbid 10-year CV risks that were well below the 10% threshold for treatment, potentially undermining the effectiveness of earlier primary care health checks.
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Scott et al. (2026) conducted an observational in Incident acute vascular events (n=211). Proposed earlier NHS health check (QRISK3 assessment) was evaluated on Proportion of patients eligible for active risk management (premorbid QRISK3 10-year absolute CV-risk ≥ 10%). Among 155 adults aged 30-44 years with incident vascular events eligible for an earlier health check, 95% had a falsely reassuring premorbid 10-year cardiovascular risk below the 10% threshold for treatment.
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