Cumulative CVD risk to age 85 was ~28% in women, 40% in men, but short-term risk was low in young adults, suggesting treatment should prioritize high short-term risk.
Does long-term cardiovascular risk prediction provide better clinical utility for initiating preventive treatment compared to short-term risk prediction in adults without CVD?
Long-term CVD risk prediction to age 85 is similar across baseline ages, challenging its utility for initiating preventive treatment in younger adults compared to short-term risk assessment.
Abstract Background Many international treatment guidelines for primary prevention of cardiovascular disease (CVD) recommend considering long-term risk alongside short-term risk in younger adults, who may have low short-term but high long-term risk. Purpose By describing the distribution of CVD risk over different risk prediction time-windows for younger and older people, we sought to assess the rationale for promoting long-term rather than short-term risk calculators in clinical practice. Methods De-identified individual-level linkage of multiple administrative health datasets in Aotearoa New Zealand established a cohort of nearly all New Zealanders without CVD aged 25 – 84 years on 1 January 2014, with 5 years follow-up for hospitalisations and deaths. Cumulative CVD risk until age 85 years was calculated using sex-specific lifetime risk prediction equations derived from demographics, disease history and medications. The CVD risk prediction time-windows ranged from 55 years for 30-year-olds to 5 years for 80-year-olds. Results During 11,229,001 person-years of follow-up, 2,387,403 people had 80,650 first CVD events. At each year of age, predicted risk increased consistently as the prediction time-window increased. Among 30-year-old women, median (IQR) CVD risk was 0.1% (0.1, 0.2) over 5 years, 5% (4, 9) over 35 years and 29% (26, 38) over 55 years. Among 50-year-old women, CVD risk was 0.9% (0.8, 1.8) over 5 years, 7% (6, 11) over 20 years and 28% (25, 36) over 35 years. Similar patterns were observed for men. Cumulative CVD risk to age 85 years was approximately 28% for all women and 40% for all men, irrespective of the baseline age of risk prediction. In contrast, risk over the same prediction time-window varied markedly by baseline age: 10-year risk was 0.3% (0.2, 0.7) for 30-year-old women vs. 15% (12, 19) for 70-year-old women. Conclusions Younger and older people had very similar predicted risk of a first CVD event to age 85, however the majority of events occurred at older ages. As medications reduce most preventable events within approximately 5 years of initiation, these findings challenge the clinical utility of long-term risk prediction to initiate treatment, particularly for younger adults, as their predicted CVD risks can take decades to exceed reasonable treatment thresholds. Given the challenges of medication adherence and potential side effects, it may be more appropriate to prioritise treatment when short-term risk becomes sufficiently high to warrant intervention.
Liang et al. (2025) studied this question. Cumulative CVD risk to age 85 was ~28% in women, 40% in men, but short-term risk was low in young adults, suggesting treatment should prioritize high short-term risk.