• coronary artery disease
• cardiac risk factors and prevention

The global burden of cardiovascular disease is significant. In 2015, there were an estimated 17.9 million deaths attributable to cardiovascular disease worldwide.1 Whilst age-standardised cardiovascular disease mortality has declined over the past decade, the absolute number of deaths attributable to cardiovascular disease has risen by 12.5%.1 Reliably predicting future cardiovascular disease is therefore an important public health priority. This is especially relevant for low- and middle-income countries, which bear the majority of cardiovascular disease burden2 3 due to a high prevalence of both traditional and non-traditional cardiovascular risk factors.4 5

Numerous cardiovascular disease risk assessment models have been developed in the past five decades. The majority of these have focused on the prediction of incident cardiovascular disease in the general population.6 This is despite reports that almost half of cardiovascular disease events occur in individuals with a history of prior cardiovascular disease.7 Indeed, such patients have a 20% higher absolute risk of cardiovascular disease events than patients with no history of prior cardiovascular disease. In their Heart paper, Poppe and colleagues8 tackle in an important research gap, describing the development and validation of a cardiovascular disease risk prediction model for patients with a history of prior cardiovascular disease.

Many national guidelines do not advocate the …