Calculator assesses 30-year heart risk for young adults

Just as saving for retirement starts early, so should protecting your heart. A new Northwestern Medicine study introduces a first-of-its-kind online calculator that uses percentiles to help younger adults forecast and understand their risk of a heart event over the next 30 years. With rates of obesity, diabetes and hypertension rising among younger Americans, the study authors say identifying long-term risk earlier could help bend the curve on future heart disease, the leading cause of death in the U.S. and worldwide.

The free tool, designed for adults aged 30 to 59, calculates a person's 30-year risk of developing heart disease using common health measures, such as blood pressure, cholesterol, smoking status, diabetes history and kidney function. After a person enters their information, the calculator displays their percentile rank among 100 peers of the same age and sex, along with a simple visual. 

The research team stresses that the tool, based on the American Heart Association's PREVENT equations, is designed to encourage discussions between patients and clinicians and is not a substitute for clinical care.

We are all used to percentiles for standardized testing or when checking our children's growth charts." 

Sadiya Khan, senior study author, the Magerstadt Professor of Cardiovascular Epidemiology, Northwestern University Feinberg School of Medicine

"But this is the first time percentiles have been translated and applied to long-term risk for heart disease. When a patient sees they are in the 90th percentile, we hope that this will serve as a wake-up call that risk starts early and prevention efforts and activities can reduce that risk and should not be put off."

The findings will be published on Monday (Nov. 17) in The Journal of the American College of Cardiology.

'Consider it like saving for retirement'

For many people in their 30s and 40s, cardiovascular issues may seem like a distant problem. But a 35-year-old with a low risk of a heart attack, stroke or heart failure in the next 10 years could still face a high risk over 30 years. Earlier analyses by Khan and colleagues found that about one in seven young U.S. adults who are low risk in the short-term over 10 years are actually at high risk over 30 years.

Khan said predicting long-term risk at a younger age could help clinicians prioritize preventive efforts for younger adults, such as behavioral modifications or earlier initiation of antihypertensive and lipid-lowering therapies.

"We don't want to wait until it is too late, and someone has had an event. Consider it like saving for retirement," she said. "We have to start now."

Khan, who recently led another study that helped adults calculate their "heart age," says turning long-term risk into percentiles serves a complementary purpose for communicating risk.

"A 30-year time horizon is difficult for most people to grasp," she said. "Therefore, we hope that being able to compare your long-term risk to others in the same age makes the information more relatable, and therefore, actionable."

"Presenting risk as percentiles can also be more helpful to motivate patients, because they see how their risk compares with peers, much like standardized tests or growth charts put these measurements in context."

Evaluating the tool on a sample of Americans

For the study, Khan's team analyzed data from nearly 8,700 U.S. adults aged 30 to 59 who were free of cardiovascular disease when they entered the National Health and Nutrition Examination Survey. Using the American Heart Association's PREVENT equations, the Northwestern scientists calculated each person's risk of developing a heart attack, heart failure or stroke over the next 30 years.

In terms of absolute risk, men had higher long-term risk than women at every age, with a median 16% risk for men versus 10% for women at age 45. However, Khan pointed out that "risk for heart disease for women catches up with time. This is why having sex-specific tools like this percentile calculator is important."

This study is titled, "Age and Sex-Specific Percentiles of 30-Year Cardiovascular Disease Risk Based on the PREVENT Equations."