Heart disease is the leading cause of death in the United States, and in Europe cardiovascular disease accounted for up to 47 percent of deaths in 2012. It has been estimated that up to 40 percent of the general population underestimates their risk of cardiovascular disease, with women exhibiting more of this “optimistic bias” than men. The World Health Organization estimates that up to 80 percent of cardiovascular disease-related premature deaths could be avoided if healthier habits in diet, exercise, and smoking were adopted. Yet the public health challenge remains: how to communicate risks of heart disease in a way that can produce behavior changes that lead to reduced cardiovascular risk.
Recently an online tool called Heart Age (www.heartage.me) was developed to communicate risk for cardiovascular disease in a novel, easy-to-understand way. Rather than communicating the risk in conventional ways, this short survey of health factors related to risk of cardiovascular disease assesses risk, which is then communicated as your “heart age.” The heart age uses the normal, modifiable risk factors of someone at a given age as a baseline. The heart age given to an individual using this tool then indicates the impact of various risk factors compared to what is normal for an individual of that age. For example, if a 65-year-old female has more risk factors than an average female her age, she would have a heart age of over 65 years. The risk factors measured by Heart Age are age, gender, height, weight, waist circumference, family medical history of heart problems, cholesterol, blood pressure, and diabetes.
The effectiveness of this Heart Age tool was compared to that of conventional medical advice, as well as a traditional percentage risk-based tool for communicating cardiovascular disease risk factors. The group receiving conventional health advice was given recommendations common to an annual health checkup, including general guidelines on a healthy lifestyle. The traditional tool for communicating heart disease risk examined here was the Framingham Heart Study risk score, which gives a patient the probability of developing a cardiovascular event in the next 10 years. (Both the Framingham risk score and heart age are based on the same patient data.) In this study, 3,153 adults were randomly assigned to one of these three interventions, and 12 months after receiving the intervention, each group’s risk scores were compared.
At the start of the study, the following measurements were obtained for all participants: weight, height, waist circumference, self-reports of physical activity, blood pressure and blood levels of cholesterol, glucose, and triglycerides. These measurements were then also taken one year later.
Those participants who were only given conventional health advice had increased blood pressure, glucose, cholesterol, and triglyceride levels when they were measured a year later. This group also gained weight during that period, and had increased rates of smoking, due to relapses of ex-smokers. Overall, men in this group had greater increased risk from baseline than women. By contrast, both the Framingham risk score group and the Heart Age group had decreased blood pressure, glucose, cholesterol, and triglyceride levels compared to one year earlier. Both of these groups also showed weight loss and a decrease in the number of smokers during this period.
Comparing the two intervention groups, the Heart Age group consistently showed greater improvements than the group given the Framingham risk score. For the Framingham group, men showed greater improvement than women, but no gender differences were observed in the Heart Age group. Looking at the three groups in terms of their heart ages, the conventional health advice group’s heart age increased by 1.2 years after one year, the Framingham risk score group’s heart age decreased by 0.3 years, and the Heart Age group showed a decrease of 1.5 years.
Taken together, this research suggests that Heart Age’s simplicity and use of concepts familiar to the general population make it a more effective intervention tool for communicating the cardiovascular risks associated with modifiable behavior. Learning about cardiovascular risk framed as heart age not only prevented the deterioration seen in the conventional health advice group, but it also led to an improvement in measured heart age over baseline that was significantly greater than the improvement from learning about the risk framed as a risk of a heart event in 10 years.
This data shows that presenting risks in clear, easy-to-understand ways not only impacts intention to change unhealthy habits, but also changes behaviors in ways that lead to a measureable decrease in the risk of heart disease. Not only does this make Heart Age a valuable health education tool, but it also suggests the importance of finding ways of presenting health-related data in ways that are meaningful and motivating for the target audience.
Lopez-Gonzalez AA, Aguilo A, Frontera M, et al. Effectiveness of the Heart Age tool for improving modifiable cardiovascular risk factors in a Southern European population: a randomized trial. European Journal of Preventive Cardiology. (2014). DOI: 10.1177/2047487313518479