The PREVENT score showed better calibration (P/O 1.21 vs 1.57) and improved risk classification (NRI 0.19) for ASCVD over the WHO score in 11,077 Latin American adults.
Does the PREVENT risk score improve ASCVD risk prediction compared to the WHO risk score in a diverse Latin American cohort?
The PREVENT risk score provides better calibration and risk classification for ASCVD events compared to the WHO score in a diverse Latin American cohort.
Absolute Event Rate: 0% vs 0%
Abstract Background Traditional cardiovascular risk prediction models systematically overestimate the risk of atherosclerotic cardiovascular disease (ASCVD) in diverse populations from low- and middle-income countries (LMICs). The recently developed PREVENT risk score incorporates additional risk factors, which could enhance risk assessment across diverse populations, but requires explicit evaluation in LMIC settings before broad adoption. Purpose To evaluate the predictive performance of the PREVENT risk score in the largest Latin American community-based cohort and compare it with the 2019 World Health Organization (WHO) cardiovascular risk score, the current best performing risk score that was explicitly validated for these settings. Methods This study included all participants from the prospective ELSA-Brasil cohort without ASCVD at baseline who were followed for adjudicated cardiovascular events, including fatal and non-fatal myocardial infarction and stroke. The mean predicted ASCVD risk was compared with the observed event rates across baseline risk quintiles. Model discrimination was evaluated using the area under the receiver operating characteristic (AUC) curve, while calibration was assessed through predicted-to-observed (P/O) risk ratios. To quantify improvements in risk classification, we calculated the net reclassification index (NRI) for PREVENT over the WHO score. We examined performance across sex and race groups. Results A total of 11,077 individuals (mean age 52.1 ± 8.1 years, 55.3% female) were included, who had 157 adjudicated ASCVD events over five years of follow-up. The PREVENT score demonstrated a model discrimination of AUC 0.76 95% CI: 0.72–0.80), similar to the WHO score (0.75 0.71–0.78). However, PREVENT was better calibrated for ASCVD risk, with a P/O ratio of 1.21 (95% CI: 1.07–1.51) compared with 1.57 (95% CI: 1.31–2.46) for the WHO score, with similar better calibration across subgroups of sex and race (Figure 1). PREVENT also improved risk classification, correctly reclassifying 30.3% of individuals who experienced an event into a higher-risk category while appropriately reclassifying 15.3% of non-events (Figure 2) (NRI 0.19), with a similar performance in men (events upclassified 29.6% & non-events downclassified 19.5%, NRI 0.18) and women (31.9%, 12.0%, NRI 0.24), Black/Mixed race (37.0%, 16.5%, NRI 0.28), and White (24.2%, 16.5%, NRI 0.11) individuals. Conclusions The risk of ASCVD predicted by PREVENT was more closely aligned with the observed events compared with the WHO score in a large, diverse, community-based cohort from Latin America. PREVENT enhanced risk classification in populations where traditional risk scores have historically underperformed, including women and Black/Mixed-race individuals, mitigating risk overestimation in low-risk groups while improving the identification of high-risk individuals.Figure 1 Figure 2
Pedroso et al. (Sat,) reported a other. The PREVENT score showed better calibration (P/O 1.21 vs 1.57) and improved risk classification (NRI 0.19) for ASCVD over the WHO score in 11,077 Latin American adults.