New Online Tool Calculates Percentiles for 30-Year Cardiovascular Disease Risk in Younger Adults

Northwestern University researchers have developed the first percentile-based tool for communicating 30-year cardiovascular disease (CVD) risk to younger adults, aiming to improve risk perception and support earlier preventive interventions.1

The free online calculator, based on the American Heart Association's PREVENT equations, displays patients' absolute 30-year risk of CVD alongside their percentile rank among age- and sex-matched peers. The tool was developed using data from 8686 US adults aged 30 to 59 years from the National Health and Nutrition Examination Survey (NHANES) 2011 to March 2020.1

The research, published in the Journal of the American College of Cardiology, found that men had consistently higher 30-year CVD risk than women across all age groups. At age 45 years, the median 30-year CVD risk was 16.2% for men compared with 9.9% for women. At the 75th percentile, risk was 21.2% for men and 14.7% for women at that age.1

"We are all used to percentiles for standardized testing or when checking our children's growth charts," senior author Sadiya S. Khan, MD, MSc, the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine, said in a press release. "But this is the first time percentiles have been translated and applied to long-term risk for heart disease. When a patient sees they are in the 90th percentile, we hope that this will serve as a wake-up call that risk starts early and prevention efforts and activities can reduce that risk and should not be put off."2

The percentile approach may help address a key challenge in cardiovascular prevention: younger adults typically have low 10-year absolute risk due to the influence of age in prediction equations, even when their long-term risk is substantial. Previous research by Khan and colleagues demonstrated that approximately 1 in 7 US adults aged 30 to 59 years who are at low 10-year risk remain at high 30-year CVD risk.1,3

The calculator incorporates standard clinical measurements including systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, estimated glomerular filtration rate, diabetes status, current smoking status, and use of antihypertensive medications or statins. For heart failure risk prediction, the tool additionally includes body mass index.1

"A 30-year time horizon is difficult for most people to grasp," Khan said. "Therefore, we hope that being able to compare your long-term risk to others in the same age makes the information more relatable, and therefore, actionable."2

The study population represented approximately 91 million US adults, with a mean age of 44.8 years among women and 44.2 years among men. The median 30-year CVD risk in the overall sample was 13.1%. Participants at higher risk percentiles demonstrated greater prevalence of cardiovascular risk factors. Among those in the top quartile (≥75th percentile), diabetes prevalence was 28.6% in women and 29.7% in men, compared with 0% and less than 0.1%, respectively, in the lowest quartile.1

The investigators calculated age- and sex-specific percentiles using rolling windows of ±5 years to ensure adequate sample stability. The online tool provides visual representation of percentile rankings using a 100-square icon array, with shading to indicate relative risk levels among peers.1

The research team emphasized that the percentile tool is designed to complement, not replace, absolute risk assessment and clinical judgment. "Presenting risk as percentiles can also be more helpful to motivate patients, because they see how their risk compares with peers, much like standardized tests or growth charts put these measurements in context," Khan added in the press release.2

The authors noted that prospective clinical trials are needed to evaluate whether percentile-based risk communication improves risk perception, supports shared decision making, or influences clinical outcomes compared with traditional absolute risk communication alone.1

The online calculator is available at no cost and can be accessed through Northwestern University's Khan Lab website.2

References:

1. Krishnan V, Huang X, Zhang S, et al. Age and sex-specific percentiles of 30-year cardiovascular disease risk based on the PREVENT equations. J Am Coll Cardiol. Published online November 17, 2025. doi:10.1016/j.jacc.2025.09.1509
2. New ‘heart percentile’ calculator helps young adults grasp their long-term risk. News release. Northwestern University. November 17, 2025. Accessed November 18, 2025. https://news.northwestern.edu/stories/2025/11/new-heart-percentile-calculator-helps-young-adults-grasp-their-long-term-risk?fj=1
3. Krishnan V, Huang X, Perak AM, et al. Discordance of 10- and 30-year predicted risk for cardiovascular disease in US adults. JAMA. 2025;333:1828-1831. doi:10.1001/jama.2025.2868