Most guidelines on cardiovascular disease prevention recommend the use of algorithms for absolute risk prediction to identify subjects at elevated cardiovascular risk (e.g. Framingham, SCORE, QRISK).
Given the dominant effect of age on the estimated absolute risk, these models have however shown to be limited in terms of identifying younger persons at relatively high relative risk but low absolute risk. In this respect, the development of alternative formulations of risk assessment have recently received much attention such as the concepts of vascular or heart age and lifetime risk estimation, a measure of the cumulative risk of developing a disease during the remainder of an person’s life.
Hippisley-Cox et al. successfully developed and validated new QRISK equations based on routinely collected data from 3.6 million primary care patients from general practices all over England and Wales to obtain individualised estimates of lifetime risk of cardiovascular disease accounting for established risk factors, ethnicity, social deprivation and comorbidity.
This lifetime risk approach may be more intuitive for both patients and clinicians. However, although the QRISK lifetime model identified more young people (and more men) being at high risk in comparison with the 10-year QRISK2 model, it remains unclear whether early medical intervention in people with a high lifetime risk but low 10-year risk would have a greater clinical benefit than later intervention.
The web-based lifetime risk calculator is available at
www.qrisk.org/lifetime and is free for non-commercial research, educational and personal use.