A new systematic analysis of the American Heart Association’s Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations provides insight into how age and combinations of cardiovascular risk factors translate into clinically meaningful estimates of cardiovascular disease risk.
The PREVENT equations, developed in 2023, estimate 10-year and 30-year risk of total cardiovascular disease (CVD), defined as a composite of atherosclerotic cardiovascular disease and heart failure. Although the models incorporate a broader range of predictors, their complexity has made them more difficult to interpret in clinical practice.
To clarify their use, investigators conducted a systematic evaluation using hypothetical patient profiles aged 30 to 79 years. Individual and combined risk factors were varied while others were held constant at population averages.
The analysis showed that 10-year CVD risk increases substantially with age, even among patients with average risk profiles. Among females, estimated risk ranged from 0.3% at age 30 years to 17.4% at age 79 years; among males, it ranged from 0.7% to 22.8%. Clinically relevant thresholds were reached later in life for patients with average risk factors, exceeding 7.5% at age 68 years in females and 63 years in males.
The presence of high-risk conditions markedly accelerated risk. Investigators reported that “a hypothetical person with stage 3 chronic kidney disease (CKD) and diabetes would exceed the 10-year risk threshold of ≥7.5% with the PREVENT [cardiovascular disease] equations at age 43 years if female and at age 36 years if male.”
The findings highlight the importance of risk factor clustering, particularly conditions related to cardiovascular-kidney-metabolic health.
“Even at younger ages, there is substantial heterogeneity in [cardiovascular disease] risk estimates,” the authors wrote, noting that kidney function, glycemic control, and social risk factors can significantly influence predictions.
The study also examined long-term risk projections. Using the 30-year PREVENT equations, estimated risk ranged from 2.5% to 20.5% in females and 4.8% to 26.5% in males with average risk factors, substantially higher than corresponding 10-year estimates. These findings suggest that long-term risk assessment may be particularly useful in younger patients who appear to be at low short-term risk.
The authors noted that the PREVENT equations incorporate optional predictors such as urine albumin-creatinine ratio, hemoglobin A1c, and the Social Deprivation Index, enabling more individualized risk estimation. These measures may also prompt clinicians to screen for these factors when indicated and optimize treatment.
“These results can support clinicians and patients in the interpretability of the PREVENT equations and can inform clinician-patient discussions on preventive efforts,” the investigators concluded.
The study was limited by its use of hypothetical patient scenarios, which may not fully reflect real-world combinations of risk factors.
Donald M. Lloyd-Jones reported employment with the American Heart Association. Josef Coresh reported a relationship with Healthy.io Ltd that includes consulting or advisory roles and equity ownership. All other authors reported no disclosures.
