Calculating CVD risk up to ages 80 and 95 yields the highest gains in CVD-free life years (≈62,700) versus 30-year (42,333) and 10-year (46,254) risk models.
Do long-term CVD risk definitions (up to age 80 or 95) improve the identification of individuals who benefit most from preventive treatment compared to 10-year or 30-year risk models in individuals aged 35-70 without CVD or diabetes?
Calculating CVD risk up to ages 80 and 95 is less age-driven than 30-year or 10-year risk models and identifies individuals who would gain more CVD-free life years from preventive treatment.
Abstract Background The 2021 European Society of Cardiology prevention guidelines recommend using risk prediction models to identify individuals at high cardiovascular disease (CVD) risk who are most likely to benefit from preventive treatment. Since short-term risk assessment is largely age-driven, long-term risk models are recommended to be used alongside traditional 10-year risk models to support treatment decisions among younger individuals. However, there is large heterogeneity in what long-term risk actually means across the currently available tools. For example, the US-recommended PREVENT model estimates 30-year risk, while the European LIFE-CVD2 model calculates risk until 80 years. Purpose The aim of this study was to evaluate which of the currently used definitions of long-term CVD risk (risk until age 80, age 95, or 30-year risk) would most effectively identify apparently healthy individuals benefitting the most from prevention on the long term (i.e. largest expected CVD event reduction and gain in CVD-free life years). Methods 486,926 individuals aged 35-70 years without CVD and diabetes mellitus from a large Dutch population-based database (2007-2024) were studied. Using the LIFE-CVD2 model, individual long-term risks were estimated based on different risk definitions: risk until age 80, risk until age 95, and 30-year risk, compared to using 10-year risk for reference. Treatment eligibility for a risk certain definition was defined as being in the top decile of predicted risk for the respective definition, for those individuals the effect of lifelong 10 mm Hg blood pressure reduction was evaluated. The predicted gain in CVD-free life expectancy and the reduction in CVD events were compared across the four treatment strategies. Results The 30-year risk estimate exhibited a similar age pattern to the 10-year risk estimate, classifying the majority of the oldest age group as high risk (Figure 1). In contrast, the risk estimates extending to age 80 and 95 demonstrated a more evenly distributed classification across different age groups. Similarly, the 30-year risk estimate identified largely the same individuals as the 10-year risk estimate, with a 53% overlap, whereas risk estimates up to ages 80 and 95 identified a more distinct set of individuals (Figure 2). The predicted gain in CVD-free life years was highest for treatment strategies based on risk estimates up to ages 80 and 95, yielding 62,707 and 62,753 years, respectively. By comparison, the 30-year and 10-year risk models resulted in lower gains of 42,333 and 46,254 CVD-free life years, respectively. Conclusion(s) The definition of long-term risk has a major impact on which individuals are classified as high-risk. Calculating CVD risk up to ages 80 and 95 is a less age-driven approach than the 30-year risk and has the potential to prevent much more CVD events on the long term.
Bijkerk et al. (2025) studied this question. Calculating CVD risk up to ages 80 and 95 yields the highest gains in CVD-free life years (≈62,700) versus 30-year (42,333) and 10-year (46,254) risk models.