Lifetime Risk

Concept of lifetime risk in the JBS3 Report

A major focus of the JBS3 report is the idea of estimating cardiovascular disease (CVD) risk over a lifetime to help inform prevention strategies with lifestyle changes (interventions) and, where necessary, drug therapy. JBS3 includes estimation of the widely used 10-year risk estimation, as previously recommended in JBS2, but now extends this to include CVD risk over a lifetime, linked to our JBS3 risk calculator. By only using short term risk estimates, which are heavily dependent on age and gender, younger subjects and women tend to be overlooked even if they have substantially elevated risk factors that can be changed (such as smoking), and are consequently at high lifetime risk. Evidence shows that early lifestyle interventions and, where necessary, drug treatment can decrease or slow down CVD and thereby the risk of future CVD events, such as heart attack or stroke. This change to ‘lifetime risk’ represents an opportunity for investment in future cardiovascular health.

CVD appears to be related to long-term and combined exposure to risk factors (such as smoking and having high blood pressure). There is an opportunity to change CVD progression in an individual by earlier intervention on risk factors. CVD risk over lifetime can be estimated and takes into account both risk from CVD and competing diseases such as cancer. As with 10-year risk levels, lifetime risk estimates represent the average figures taken from studying large groups of people; so caution should be applied in their use with individual patients. Nevertheless, lifetime risk is a novel way of communicating risk to individuals in a clinical setting, such as a GP surgery.

While the concept of a Lifetime risk approach may still be relatively new for the medical community, it has been applied by the insurance industry for many years to determine appropriate levels of insurance premiums. They have long understood that disease and death caused by CVD risk factors increases with the length of exposure and that the benefits gained from interventions depend on the age that the intervention begins (whether it is through lifestyle or drug therapy).

Lifetime risk measurement should be used in addition to the estimate of 10-year risk. It is not intended primarily as a guide for GPs to decide upon drug initiation but as a way to show an individual the lifetime consequences from their current lifestyle/risk factors and the substantial opportunity to reduce/delay future CVD events by early appropriate lifestyle changes and drug treatments.

Lifetime risk approach in JBS3 risk calculator

Who to use the JBS3 Risk Calculator with?