Table 2 Why caution should be used when linking heart age to medication

• Practice variation: Heart age results may be younger, the same or older than current age for the same risk factors, depending on the CVD risk model and ideal risk factor thresholds used to calculate heart age; so it is important for doctors to understand the assumptions behind these calculators in order to avoid unwarranted practice variation.

• Uninformed decision making: Patients cannot understand the chance of benefiting from preventive CVD medications such as statins and blood pressure lowering drugs without knowing the baseline absolute risk; so the relationship between heart age, absolute risk and recommended medication thresholds needs to be explained to enable informed decision making.

• Over-treatment: Using heart age to decide on the need for drugs will lead to treatment of people who are very unlikely to experience a CVD event in the next 5-10 years; so treatment decisions should be made on the basis of absolute risk and not heart age.