Development and Validation of the American Heart Association's PREVENT Equations.
The American Heart Association's PREVENT equations are sex-specific, race-free cardiovascular risk models that incorporate kidney function and metabolic factors, showing good discrimination and calibration across a large, diverse US population.
Background
Primary prevention guidelines rely on multivariable equations to estimate absolute cardiovascular disease (CVD) risk, but existing equations have important limitations. The American Heart Association developed and validated the Predicting Risk of CVD EVENTs (PREVENT) equations for US adults aged 30 to 79 years without known CVD, defining the primary outcome as total CVD encompassing atherosclerotic CVD and heart failure.
Study design
The derivation sample included individual-level data from 25 datasets totaling more than 3.2 million participants between 1992 and 2017. Predictors included traditional risk factors (smoking, systolic blood pressure, cholesterol, antihypertensive or statin use, and diabetes) plus estimated glomerular filtration rate. Models were sex-specific, race-free, and adjusted for the competing risk of non-CVD death, with external validation in more than 3.3 million participants from 21 additional datasets. Optional predictors included urine albumin-to-creatinine ratio, hemoglobin A1c, and a social deprivation index.
Key findings
Across more than 6.6 million adults (mean age 53 years, 56% women), there were 211,515 incident CVD events over a mean follow-up of 4.8 years. Median external-validation C-statistics for total CVD were 0.794 in women and 0.757 in men, with calibration slopes near 1.0. Adding urine albumin-to-creatinine ratio, hemoglobin A1c, and social deprivation index together produced small but statistically significant improvements in discrimination, and calibration improved when the albumin-to-creatinine ratio was added among those with marked albuminuria.
Clinical implications
The PREVENT equations accurately predict incident CVD and its subtypes using routinely available clinical variables, including kidney function, in a contemporary and diverse population. By integrating cardiovascular-kidney-metabolic factors and removing race as a predictor, they offer a more equitable framework for absolute risk assessment to guide primary prevention, though clinical risk thresholds and implementation strategies continue to evolve.
Category
Guidelines
Source
Circulation
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