INTRODUCTION
The NHS ‘Heart Age Test’ has expanded cardiovascular disease (CVD) risk assessment in the UK to include younger people (<40 years). Public Health England’s (PHE) Healthy Heart campaign, launched in September 2018, encourages all adults aged >30 years to do the test, stating: ‘Having a heart age older than your chronological age means that you are at a higher risk of having a heart attack or stroke.’ But does older heart age really mean high risk? The calculator will give you an older age if at least one CVD risk factor is higher than the level set as ‘optimal’; but this does not necessarily mean you are at high risk of a CVD event in the next 10 years. Is there evidence to support PHE’s promotion of the Heart Age Test? To find out, we evaluated the Heart Age Test according to PHE’s own UK National Screening Committee (UK NSC) criteria. This analysis suggests heart age is not a good screening test.
EVALUATING PHE’S HEART AGE TEST
1. The condition should be an important health problem as judged by its frequency and/or severity
CVD is an important health problem. The rate of death from CVD has declined throughout the UK in the last 3 decades,1 but CVD remains the leading cause of death in males and second leading cause of death in females, with around 160 000 people in the UK dying from CVD every year.
2. There should be a simple, safe, precise, and validated screening test
Though the Heart Age Test calculator is simple and physically safe to use, it is not precise or validated. Heart age is estimated from the lifetime risk of CVD, relative to people of the same age, sex, and ethnicity who have ‘optimal’ risk factor levels (for example, non-smoker, systolic blood pressure <120 mmHg).2 The authors of the last update of the National Institute for Health and Care Excellence guidelines on CVD risk assessment in 2014 found insufficient evidence to recommend lifetime …
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