• Cardiac risk factors and prevention
• Epidemiology
• Health care delivery

The iconic Framingham Heart Study paved the way for many prospective epidemiological cohort studies of cardiovascular disease (CVD) around the world, and the subsequent development of tools which can predict risk of future disease. There have been tools for a broad spectrum of outcomes from absolute CVD risk at varying time points to lifetime risk1 and vascular age.2 Multiple scores for incident CVD have been derived and validated, and adopted in consensus guidelines for use in routine practice.

However, the major burden of CVD events occurs in individuals who have already been diagnosed with recurrent disease, yet even in high-income countries, adherence and persistence to secondary prevention drugs is far from optimal.3 By comparison with incident CVD, relatively few risk prediction tools are available for clinicians to use in secondary prevention. These patients have a wide range of absolute risk for CVD. Moreover, many of the scores for this purpose have been developed in hospital populations rather than primary care, where they would arguably have more utility. …