Heart age and short-term cardiovascular disease risk metrics show differences, with younger patients frequently observed having heart age gaps exceeding 40 years despite low immediate risk, according to a recent study. 

Investigators examined the appropriateness of using heart age as a cardiovascular disease (CVD) risk metric compared with short-term absolute CVD risk in guiding preventive treatment decisions. Published in Heart, the investigators analyzed data from 371,676 patients aged 35 to 74 years enrolled in the PREDICT cohort, a New Zealand-based prospective study designed to derive and validate CVD risk prediction algorithms.

Participants’ 5-year CVD risk was calculated using published equations, whereas heart age was determined by comparing each participant's risk to a hypothetical participant with an "ideal" risk profile—nonsmoker, systolic blood pressure of 120 mmHg, and total cholesterol/high-density lipoprotein ratio of 3.5. The heart age gap, defined as the difference between heart age and chronologic age, was analyzed across age groups and risk categories.

The study found that 5-year CVD risk increased with age, approximately doubling every decade. For men, median 5-year CVD risk increased from 1.4% in those aged 35 to 44 years to 8.8% in those aged 65 to 74 years. In women, corresponding risks were lower, ranging from 0.7% to 5.1%. In contrast, heart age gaps decreased with age, halving between the youngest (35 to 44 years) and oldest (65 to 74 years) groups. For instance, in men aged 35 to 44 years with a 5-year CVD risk below 2.5%, the mean heart age gap was 3.9 years, whereas men aged 65 to 74 years with the same risk showed a mean heart age gap of –3.6 years.

Significant differences between heart age gaps and short-term CVD risk metrics were observed in the study, with younger patients showing larger heart age gaps despite low predicted short-term risk, while older patients exhibited smaller gaps despite higher short-term risk. The investigators concluded that heart age should be used primarily to encourage long-term lifestyle changes, not intended as a substitute for short-term risk when guiding pharmacologic interventions. This distinction underscored the importance of aligning treatment decisions with patients’ short-term CVD risk.

Full disclosures can be found in the published study.