cardiovascular health assessments may need to start sooner than age 40, according to experts at the British Cardiovascular Society Annual Conference 2025. Rather of focusing on 10-year projections, assessments should focus on lifetime risk, they said.

“We are looking at cardiovascular risk assessment far too late,” said Beverley Bostock, a Queen’s nurse and president-elect of the Primary Care Cardiovascular Society (PCCS).

Bostock introduced a conference session titled ’25 is the new 40: shifting the focus to lifetime risk.’

Preventive Cardiology in NHS Strategy

Derek Connolly, a consultant cardiologist in private practice in Birmingham, expressed hope that this approach would be supported in England’s 10 Year Health Plan for the NHS.

“There is going to be an enormous emphasis, we think, going forward, on preventive cardiology – and it’s about time that that was the case,” he said.

Connolly noted that the team behind the plan is focused on prevention and has analyzed the potential benefits of lifestyle interventions.

By addressing modifiable risk factors earlier, “they’ve worked out that if we do a lot of these things, not only do we save lives, but we save money, and we keep people in work and paying taxes,” he said.

“There is going to be an enormous emphasis,we think,going forward,on preventive cardiology – and it’s about time that that was the case.”

The Rising Burden of CVD

Recent data in the European Journal of Preventative Cardiology,highlighted at the conference,projected a 90% increase in global cardiovascular disease (CVD) prevalence over the next 25 years.

CVD-related deaths are expected to rise from 20.5 million in 2025 to 35.6 million in 2050 – a 73.4% increase in crude mortality.

Current NHS Risk Assessments

Currently, the NHS assesses 10-year CVD risk from age 40, repeating the assessment every 5 years until age 74. This is typically measured using the cardiovascular risk score (QRISK 2). Though, QRISK 3 and QRISK lifetime offer greater predictive power.

“CVD risk is predicated around a lifetime exposure to risk factors,” said Jim Moore, a recently retired GP with a special interest in cardiovascular medicine. “Just modest changes in those risk factors – your lipid profile or blood pressure – can, we certainly know independently, and in combination, improve your outcomes.”

Moore, a past president of the PCCS, suggested that 10-year calculators may underestimate risk in those under 40, even when significant risk factors are present. He argued that lifetime calculators could be “persuasive” tools in patient consultations, helping to steer discussions towards lifestyle changes.

He emphasized the need for a holistic approach, noting that it is “something that we really do not see routinely happening in my area within primary care.”

The Case for earlier Screening

Scott Murray, a consultant cardiologist at University Hospitals of Liverpool Group, advocated for assessing CV risk in people under 40.

He stated that modern lifestyles, marked by sedentary behavior, poor dietary habits, and increasing stress, contribute to rising CVD in younger populations. “We’re seeing more obesity, insulin resistancedyslipidaemia, and hypertension“, Murray said.

“I like to think of it a bit like this: so, you’ve got your genetic predisposition – genetics loads the gun, and your environment pulls the trigger.”

Murray proposed age 25 as a potential “sweet spot” for screening, citing a “lifestyle transition at age 25 into more independent adulthood, more able to perhaps think about family responsibilities.”

he added that at age 25, most people have finished puberty and reached physiological maturity, and data suggests that starting CVD screening at this age would be cost-effective.

Though, he acknowledged potential difficulties in engaging 25-year-olds, given the challenges in reaching targets for over-40s with NHS health checks.

Targeted Strategies

Laura Ormesher, a National Institute for Health and Care Research academic clinical lecturer at the University of Manchester, suggested that pregnancy could be an ideal time to educate younger women about lifestyle-related CVD risk.

“We certainly know that adverse pregnancy outcomes increase the risk of cardiovascular disease, and I think we’ve got to make the most of that prospect during the pregnancy,” she said.

She added that the postnatal period is a time when many women feel “empowered to try and improve their long-term health for their child and their family.”

Dr Sundhya Raman, a lifestyle physician, supported a targeted strategy, acknowledging that worldwide health checks from age 25 might be too enterprising.

“Maybe we need to target the higher risk individuals with strong family histories of raised BMI,” she said.

“There is great potential for when you educate one person, you educate a family, you educate a community,” Raman added.