The concept of vascular or biological age in risk prediction should be credited to Scott Grundy, who originally wrote up this concept in 20011 and incorporated this into practice guidelines via the National Cholesterol Education Program 2004 update.2 The original concept, was that coronary artery calcium (CAC) scores, by demonstrating the vascular age of the patient, should replace chronological age as a better surrogate of risk and atherosclerosis. Conceptually, this made a lot of sense as age is used as an atherosclerosis surrogate for cardiovascular (CV) risk in the risk stratification tools. That CAC is better than age is intuitive, as CAC is a better measure of coronary plaque burden, and thus a direct risk marker for CV disease events. Grundy concluded that ‘the …