Most people are familiar with the idea of a “10-year heart risk score,” the most notable of which is the Framingham 10-year Risk Calculator. This is the number your doctor might calculate to estimate your odds of having a heart attack or stroke in the next 10 years.
However, experts are finally realizing what we have known for decades, that this short-term view is missing a big part of the story — especially for people who are younger, female or who have risk factors that don’t always show up clearly on traditional calculators (such as genetics, Lp(a), insulin resistance, obesity, or even subclinical disease).
Recently, new long-term tools, like the PREVENT calculator released by the American Heart Association, have expanded risk estimation to 30 years by addressing some of the additional risk factors we have recognized as “root causes” for years. The goal of the new risk calculators is simple: catch earlier signals of cardiovascular disease long before symptoms appear, so we can intervene earlier and more effectively. This is certainly a goal we can get behind.
Why Traditional Risk Scores Fall Short
Studies have consistently shown that nearly half of heart attacks occur in people labeled “low risk” by conventional 10-year calculators, and this is certainly what we have witnessed in our practice. That doesn’t mean the calculators are necessarily “wrong;” it means they’re designed to address short-term event risk and tend to underestimate long-term exposure to risk factors. However, these calculators are used to determine who needs treatment, and when we are only looking at short-term risk, we are missing the opportunity to prevent disease.
For example, a 42-year-old female with very high LDL (or ApoB) cholesterol may have a low estimated 10-year risk, but her lifetime risk is substantially higher and would argue for both more in-depth workup and likely early treatment. However, a clinician utilizing a 10-year risk calculator would likely be advised against these actions. When cholesterol, inflammation or blood pressure remain elevated over decades, the arterial wall quietly changes. Small problems accumulate. By the time symptoms appear, the disease is often well established, and we are stuck playing “catch up” instead of truly preventing disease.
What 30-Year Risk Assessment Adds
A 30-year calculation reflects the idea that heart disease is a slow, decades-long process. This long-term view helps us:
It also honors something we all intuitively know: a single snapshot rarely tells the whole story.
The Limitations of Risk Calculators
No risk calculator is perfect. Risk calculators are built from population data and can’t account for every nuance — family history, genetics, stress, sleep, chronic inflammation or the subtleties of metabolic health.
Long-term calculators also can’t replace clinical experience. They’re tools, not oracles. We still need to continue to do what we’ve been doing all along. We need to LOOK for disease with tools like a CIMT, CACS or CTA/Cleerly scan coupled with arterial inflammation markers. Then we have to keep looking for the source of plaque development — with personalized testing like genetics, lipoprotein(a) and advanced cholesterol testing; all in the context of a long-term partnership between patient and provider.
Short-term risk helps us prioritize, but long-term risk tells a more complete story. By looking 30 years ahead, the newer risk calculators are certainly an improvement, but the BaleDoneen Method has been incorporating these risk factors (and more) into our own assessments for decades. Utilizing all of the tools available to us, we can effectively prevent cardiovascular events in both the short and long-term.