Predicting Long-Term Risk of CVD in US Adults With the PREVENT Equations
Most adults in the U.S. have elevated long-term risks of cardiovascular disease based on findings using the PREVENT risk equations, published June 9 in JACC. Overall, the PREVENT equations performed well for risk assessment including among individuals with elevated lipoprotein(a) (Lp[a]), showing the addition of Lp(a) to the PREVENT equations may improve risk prediction according to insights from a study using data from MESA and the UK Biobank published June 4 in JAMA Cardiology.
In the first study, using data from the National Health and Nutrition Examination Survey between 2011 and 2020 on 14,184 U.S. adults aged 30 to 79 years along with the PREVENT equations, Kamil F. Faridi, MD, MSc, Harlan M. Krumholz, MD, SM, FACC, et al., examined the 10- and 30-year risks of total cardiovascular disease, atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). They also calculated age-standardized and survey-weighted risk prevalence, stratifying results by age, sex, race and ethnicity.
The study, which represents 161 million U.S. adults with and without cardiovascular disease, found the prevalence of existing cardiovascular disease was 10% overall, while it was 27% among adults 65 to 79 years old. Furthermore, there was a 20% survey-weighted prevalence of an elevated 10-year predicted risk of cardiovascular disease; only 11% were at risk for ASCVD and 13% for HF.
Looking at the 10-year risk by age groups, the prevalence was 1% for 30 to 44 years, 18% for 45 to 64 years and 66% for 65 to 79 years. The 10-year risk for cardiovascular disease, ASCVD and HF among men, Blacks and Hispanics was found to be higher because of underlying risk factors, and their mean risk for each rose moderately over time.
Regarding 30-year risk, although 67% of 30 to 59 years olds did not have cardiovascular disease, they were at increased risk for cardiovascular disease and this risk was 90% of 45 to 59 year olds; the risk of ASCVD and HF was elevated for men and Blacks.
"These findings emphasize the need for intensive efforts to prevent [cardiovascular disease] in the [U.S.]," write the authors.
"To affect long-term population health, a roadmap for the prevention of [cardiovascular disease] across the life course is needed with an emphasis on primordial and primary prevention in young adults," writes Sadiya Sana Khan, MD, FACC, in an accompanying editorial comment. "Ultimately, clinicians, patients and policy makers should consider this long-term view for optimizing prevention of [cardiovascular disease] with use of the accurate and precise long-term risk tools we now have available."
In the second study, Harpreet S. Bhatia, MD, MAS, FACC, et al., evaluated the performance of the PREVENT equations, which do not include Lp(a), among 314,783 participants from MESA and the UK Biobank who did not have cardiovascular disease but have elevated Lp(a) ≥125 nmol/L.
Ten-year observed rates were calculated for coronary heart disease (CHD), ASCVD, HF and cardiovascular disease and researchers categorized participants by risk for each outcome (low <5%, borderline 5% to <7.5%, intermediate 7.5% to <20% and high ≥20%).
Results showed that the 10-year ASCVD event rates "generally fell within the bounds of predicted risk categories regardless of Lp(a) level," but event rates were higher in participants with vs. without elevated Lp(a), with a hazard ratio of 1.30, and similar results were seen for CHD, HF and cardiovascular disease.
The authors note the addition of elevated Lp(a) values to the PREVENT equations modestly improved ASCVD risk prediction (category-free and categorical net reclassification unit 0.058 and 0.006 respectively), with the greatest improvement in borderline-risk. Moreover, when they evaluated Lp(a) continuously, they observed the greatest improvement in the low-risk category.
In an accompanying editorial comment, Donald M. Lloyd-Jones, MD, FACC, and Amit V. Khera, MD, write that, "Lp(a) is indeed a risk-enhancing, likely causal, factor for ASCVD. Its absence does not exonerate traditional risk factors, but its presence can amplify and personalize that risk and help guide clinicians and patients regarding use and intensity of preventive therapies."
Citations:
- Faridi K, Malik D, Essa M. et al. 10-year and 30-year risks of cardiovascular disease in the U.S. population. JACC. Published online June 9, 2025. 85 (23) 2239–2249. Doi: https://doi.org/10.1016/j.jacc.2025.03.546
- Bhatia H, Ambrosio M, Razavi AC, et al. AHA PREVENT equations and lipoprotein(a) for cardiovascular disease risk. JAMA Cardiol. Published online June 4, 2025. Doi: 10.1001/jamacardio.2025.1603
Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), Advanced Lipid Testing, Lipid Metabolism, Acute Heart Failure
Keywords: Coronary Artery Disease, Lipoprotein(a), Biological Specimen Banks, Heart Failure, Atherosclerosis
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