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New Zealand was the first country to develop national clinical guidelines recommending that an explicit measure of absolute cardiovascular disease (CVD) risk should be the primary determinant of a decision to initiate blood pressure or lipid-lowering therapy.1 2 To facilitate the assessment of absolute CVD risk, we designed the New Zealand CVD risk charts3 which made it possible for clinicians to rapidly assess and explain a patient's risk. A patient's 5- or 10-year predicted CVD risk (a short-term measure) is now widely recommended internationally as the key clinical information to inform CVD risk-management decisions. However, 15 years after introducing the New Zealand absolute risk-based recommendations, our experience suggests that absolute risk is still not well understood by many practitioners or patients, and we believe this has been a significant barrier to the implementation of absolute CVD risk-based management. In this article, we describe the strengths and weaknesses of ‘short-term absolute CVD risk’ as a clinically useful measure and introduce a new integrated set of measures now being widely tested in New Zealand—the Heart Forecast. These measures retain the strengths of previous absolute risk-based measures while addressing their weaknesses. In our opinion and those of clinicians now using the Heart Forecast, this may represent a significant advance in absolute CVD risk communication.
Absolute and relative measures of CVD risk and the management of cardiovascular disease risk
A patient's absolute or ‘global’ CVD risk is typically calculated as their predicted probability of having a symptomatic CVD event during the subsequent 5- or 10-year period. Measures of absolute CVD risk are derived from cohort studies that estimate the simultaneous effect of multiple risk factors on CVD event rates. The main reason for estimating patients' absolute CVD risk is to determine the likely absolute benefit of interventions (eg, the estimated number of people who could be prevented from having a new CVD event over a 5- or …