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ASCVD Risk Estimates Using the PREVENT Equations
Quick Takes
- Using the PREVENT equations was associated with reduced ASCVD risk estimates across age, sex, and racial groups compared with the pooled cohort equations.
- Based on PREVENT equations, 17.3 million adults who were previously recommended primary prevention statin therapy would no longer meet eligibility for statin therapy.
- Currently, the majority of adults eligible for receiving statin therapy based on PREVENT equations did not report statin use.
Study Questions:
How do the national estimates of 10-year atherosclerotic cardiovascular disease (ASCVD) risk using the 2013 pooled cohort equations (PCEs) compare to the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations regarding recommendations for statin in primary prevention?
Methods:
The present analysis used data from the National Health and Nutrition Examination Survey (2017 to March 2020), including adults aged 40-75 years. Adults were defined as eligible for primary prevention statin use based on the 2019 ACC/AHA guideline on the primary prevention of CVD. Data were weighted to be nationally representative and were analyzed from December 27, 2023, to January 31, 2024. The primary outcome of interest was 10-year ASCVD risk and eligibility for primary prevention statin therapy.
Results:
This cross-sectional study included 3,785 US adults (mean [standard deviation] age, 55.7 [9.7] years; 52.5% women). Participants with known ASCVD were excluded. 20.7% of the participants reported current statin use. The mean estimated 10-year ASCVD risk was 8.0% (95% confidence interval [CI], 7.6%-8.4%) using the PCEs and 4.3% (95% CI, 4.1%-4.5%) using the PREVENT equations. Across all age, sex, and racial subgroups, compared with the PCEs, the mean estimated 10-year ASCVD risk was lower using the PREVENT equations, with the largest difference for Black adults (10.9% [95% CI, 10.1%-11.7%] vs. 5.1% [95% CI, 4.7%-5.4%]) and individuals aged 70-75 years (22.8% [95% CI, 21.6%-24.1%] vs. 10.2% [95% CI, 9.6%-10.8%]).
The use of the PREVENT equations could reduce the number of adults meeting the criteria for primary prevention statin therapy from 45.4 million (95% CI, 40.3-50.4 million) to 28.3 million (95% CI, 25.2-31.4 million) compared to the PCEs. This translated into an estimated 17.3 million (95% CI, 14.8-19.7 million) adults who recommended statins based on the PCEs who would no longer be recommended statins based on PREVENT equations. Based on the PREVENT equations, 44.1% (95% CI, 38.6%-49.5%) of adults eligible for primary prevention statin therapy reported currently taking statins, equating to 15.8 million (95% CI, 13.4-18.2 million) individuals eligible for primary prevention statins who reported not taking statins.
Conclusions:
The authors conclude that data from this cross-sectional study found that use of the PREVENT equations was associated with fewer US adults being eligible for primary prevention statin therapy.
Perspective:
On a population level, using different risk scores results in significant differences in statin eligibility for primary prevention. Using additional data sources and patient-shared decisions will assist providers in a patient-live discussion of statin eligibility.
Clinical Topics: Prevention
Keywords: Atherosclerosis, Heart Disease Risk Factors, Primary Prevention
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