Validation and improvements in cardiovascular risk estimation

The assessment and refinement of cardiovascular risk prediction models remains a crucial area of research in preventive cardiology. In this issue of the European Journal of Preventive Cardiology, several studies provide valuable insights into improving cardiovascular risk estimation, focusing on validation, recalibration, and the integration of new criteria to enhance predictive accuracy. The traditional prediction timing for cardiovascular disease (CVD) risk estimation is generally 10 years, but there is increasing interest in shorter horizons to facilitate timely intervention. Liang et al.1 from New Zealand compared 5-year and 10-year CVD risk predictions in their study ‘Comparing 5-year and 10-year predicted CVD risks in Aotearoa New Zealand: national data linkage study of 1.7 million adults’. The median predicted 10-year CVD risk [3.8%; InterQuartile Range (IQR): 1.7–9.6] was ∼2.5 times higher than the median predicted 5-year risk (1.6%; IQR: 0.7–4.1). Despite this difference, both the 5-year and 10-year risk prediction models classified largely the same individuals as high risk, with 95% of participants in the top quintile of predicted 5-year CVD risk also appearing in the top quintile of predicted 10-year risk. As a result, a greater proportion of individuals met the commonly recommended treatment criteria (≥5% for 5-year risk or ≥10% for 10-year risk) when assessed using the 10-year period compared with the 5-year risk equations, due to the systematically higher predicted risk over the longer horizon (Figure 1).