![]() NZHF de- scribes the risk category as mild and below the medi- cation threshold based on absolute risk, while the NHS calculator suggests that both cholesterol and blood pressure medication may be needed, even though the absolute risk is low in both cases. Both the heart age and absolute risk numbers vary due to different underlying models, but the key issue to note for this paper is how "older heart age" is related to medication recommendations. She would receive an older heart age estimate on both the NZHF (64) and NHS (60) websites, but a low absolute risk result of 4% over 5 years or 5% over 10 years. For example, Case 1 is a 57 year old non-smoking woman with elevated cholesterol but 'ideal' blood pressure, body mass index (BMI) in the healthy range, and no other risk factors. The examples in Table 1 show how people with isolated risk factors but low absolute risk would receive different heart age results and medication information depending on whether they use the NZHF or NHS calculator. ![]() demonstrate this, we entered real patients' risk fac- tor values from a previous study of the NZHF calculator into the 2017 version of the NHS calculator. Heart age may help doctors to con- vey the need for lifestyle change at any level of absolute risk, but it cannot help patients. In this context a shared decision making approach is particularly important, which requires clear communication about the absolute risk of a CVD event, and the absolute benefit of medication. Not everyone will think it is worth the cost, inconvenience and side effects to reduce their individual risk from 10% to 8% (see Fig. For example, 100 asymptomatic people with a 10-year absolute risk of 10% would need to take statins for 10 years in order to prevent 2 CVD events the other 98 people would not benefit (90 would not have an event and 8 would have an event despite treatment). To make an informed decision about medication, patients need to understand their base- line absolute risk, because the probability of preventing CVD with treatment is directly proportional to this. However, discussions about medication need to be based on absolute risk rather than heart age, because the likelihood of benefit depends on the likelihood of risk. the research suggests that heart age is a more emotionally engaging format for communicating CVD risk to patients, and visual heart age formats may improve risk factor management compared to standard care involving verbal explanations of absolute risk.
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