Heart Disease: Is It a Lifetime or Just a 10 Year Disease?

Is heart disease a lifetime issue or is it a relatively short-term condition, say 10 years.  Think about it.  This isn't just a theoretical, rhetorical question since our answer impacts our personal decisions and patient care.  Currently, we give lip service to making lifestyle changes to improve our health and to mitigate our cardiovascular risk factors, eg blood pressure, cholesterol, sugar, tobacco use, weight, etc.

Yet when it comes down to it, everyone wants the quick solution.  The easy button.  No one wants to give up calorie dense, nutrient deficient foods.  We like our foods fried, either sweet or salty.  And no one wants to get physically active on a regular basis.  Inertia is just too great a force to overcome.

This attitude is reflected in our approach to patient care, especially cardiovascular risk assessment & management.  After all, even the two most well known heart disease risk calculators (Framingham and Reynolds Risk) only calculate 10 year risk, not lifetime risk.  Worse, we base our recommendations & decisions to treat upon your next 10 years rather than your lifetime risk for a bad outcome.

That's where this new meta-analysis of 257,384 men & women participating in 18 trials published just under 2 weeks ago in the New England Journal of Medicine comes in handy.  The authors conclude that for any combination of risk factors as noted above, while the 10 year risk of heart disease may not be all that different for the 55yo, the lifetime risk for that person with all risk factors is substantially greater than someone else with none of the risk factors, everything else being equal.

So rather than telling someone that his/her risk of a cardiovascular event is low (<10%) over the next decade, we should start considering lifetime risk, and managing their health accordingly.  Perhaps we can look across the pond and use QRISK to assess lifetime risk.  Just be prepared to enter centimeters and kilograms.  At least you don't have to learn to drive on the other side of the road!

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