Introduction

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.