Age-neutral guidelines for the primary prevention of cardiovascular disease

Use of common guidelines for primary prevention of cardiovascular events based on 10-year risk results in undertreatment of younger individuals, especially women, since age and sex are major determinants of global risk. Women in their late 40s have a 10-year risk lower than the 10% threshold used for cholesterol-lowering treatment even in the presence of marked elevations of blood pressure or cholesterol. Removal of age from risk algorithms and use of lifetime global risk to treat individuals according to the degree of their modifiable risk factors rather than demographics has been proposed. Initiation of therapy at younger ages, aiming at "primordial" prevention of atherosclerotic disease rather than focusing on cardiovascular events, will result in saving more quality-adjusted life-years. Generic medications can be obtained at an affordable cost, and concerns about long-term safety and efficacy can be tested in a clinical trial of younger individuals at low 10-year risk but high lifetime risk.