Key result
Elevated 30-year PREVENT risk linked to ~2.2-fold higher ASCVD risk despite low 10-year risk.
Why the study?
The 2023 AHA PREVENT equations provide 10- and 30-year ASCVD risk assessment, but their relationship with coronary artery calcium and incident ASCVD required investigation.
Does elevated 30-year PREVENT ASCVD risk predict incident ASCVD in adults with low 10-year risk?
Cohort (n=6,747)
Yes
Does elevated 30-year PREVENT ASCVD risk predict incident ASCVD in adults with low 10-year risk?
Assessing 30-year PREVENT risk in patients with low 10-year risk identifies individuals with increased subclinical atherosclerosis and higher risk of future incident ASCVD who might benefit from earlier preventive interventions.
Answers are grounded in this paper and cite their sources.
May support 30-year PREVENT evaluation in low 10-year risk adults; leaves open whether it improves outcomes or warrants practice change.
AIMS: The 2023 American Heart Association Predicting Risk of Cardiovascular Disease (CVD) EVENTs (PREVENT) risk equations allow for 10- and 30-year atherosclerotic CVD (ASCVD) quantitative risk assessment. We investigated the relationship between PREVENT 10-year and 30-year ASCVD risk categories with coronary artery calcium (CAC) and incident ASCVD. METHODS: This analysis included participants from the Multi-Ethnic Study of Atherosclerosis with CAC measured by computed tomography and calculated PREVENT (N=6,747) risk score. Prevalent, incident, and CAC progression, as well as incident ASCVD, were compared by clinical 10-year risk categories and 30-year risk cut points based on a framework categorizing lifetime risk of ASCVD; low risk was defined as < the mean 30 year PREVENT estimate for participants without ASCVD risk factors (<11%). RESULTS: The cohort mean age was 62.2 years and was 52.8% female, and 61.5% non-White. Individuals with low 10-year PREVENT ASCVD risk (<5%) and elevated PREVENT 30-year ASCVD risk (≥11%) had a higher prevalence of CAC compared to those low-risk for both 10-year and 30-year metrics. Incident CAC followed a similar pattern. CAC progression was similar across risk thresholds for both risk equations. Individuals with low 10 -year PREVENT risk but elevated 30-year risk had a higher incidence of ASCVD events compared to those with those low by both metrics [hazard ratio 2.21; 95% confidence interval (1.62, 2.94)]. CONCLUSION: Individuals with low 10-year PREVENT ASCVD predicted risk (<5%) may benefit from 30-year ASCVD risk estimation when uncertainty remains regarding further risk stratification or initiation of preventive therapies.
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Rikhi et al. (2025) conducted a cohort in Free of baseline clinical cardiovascular disease (n=6,747). Elevated 30-year PREVENT ASCVD risk (≥11%) among those with low 10-year risk (<5%) vs. Low 10-year risk (<5%) and low 30-year risk (<11%) was evaluated on Incident ASCVD events (HR 2.21, 95% CI 1.62-2.94). Elevated 30-year PREVENT ASCVD risk (≥11%) was associated with an increased incidence of ASCVD events (HR 2.21) among individuals with low 10-year PREVENT risk (<5%) compared to those with low risk by both metrics.
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