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July 5, 2026Scientific ReportsOpen Access

External validation of American heart association predicting risk of cardiovascular disease EVENTs (PREVENT) equations in a Chinese population

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Why the study?

The applicability of the AHA PREVENT equations to the Chinese population, particularly within specific age cohorts, remained unevaluated.

Does the AHA PREVENT equation accurately predict CVD risk in a middle-aged and elderly Chinese population?

Population

10,068 participants aged ≥ 45 years in China

Comparison

PREVENT equations vs China-PAR

Design

Retrospective cohort study

Key result

The PREVENT equations exhibited poor discrimination for predicting cardiovascular disease in a Chinese population, with an AUC of 0.61 in males and 0.62 in females, despite higher scores being significantly associated with increased CVD risk.

Authors

WFWan-Qiu FanYHYiwen HuCYChun-Yu Yu

Discussion

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Overview

Supports PREVENT evaluation for CVD risk stratification; hypothesis-generating and requires prospective validation before practice change.

Key Points

  • This study aims to validate the AHA PREVENT equations for predicting cardiovascular disease (CVD) risk in a Chinese population.
  • Analyzed data from 10,068 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study (CHARLS)
  • Evaluated CVD risk using univariate and multivariate logistic regression, ROC curves, and calibration analysis
  • Compared PREVENT scores with China-PAR for predicting CVD risk using AUC and Delong test.
  • Each 1% increase in PREVENT scores correlates with a higher risk of CVD (OR for males: 1.05, 95% CI 1.04-1.07; females: OR 1.06, 95% CI 1.05-1.07)
  • AUC for CVD prediction was 0.61 for males and 0.62 for females, indicating low predictive performance
  • PREVENT showed better discrimination than China-PAR (AUC: 0.52, P < 0.001), but overall net benefit was marginal.

Study Design

Type

Cohort (n=10,068)

Multicenter

Yes

Structured PICO

Does the AHA PREVENT equation accurately predict CVD risk in a middle-aged and elderly Chinese population?

P
Population
10,068 middle-aged and elderly Chinese adults aged 45 to 79 years without baseline cardiovascular disease were followed for 7 years to externally validate the PREVENT risk equations.
E
Exposure
American Heart Association (AHA) Predicting Risk of Cardiovascular Disease Events (PREVENT) equations
C
Comparator
China-PAR risk prediction model
O
Outcome
Cardiovascular disease (CVD), including heart disease and strokecomposite

Main Result

Odds Ratio: 1.05 (95% CI 1.04–1.07)

The AHA PREVENT equations exhibit reduced discrimination for CVD prediction in middle-aged and elderly Chinese individuals compared to US populations, suggesting the need for statistical recalibration before clinical application.

Limitations

  • Family history of ASCVD was unavailable in the CHARLS cohort, preventing the evaluation of the China-PAR model in males.
  • Tracking data from wave 5 (2020) was not utilized due to simplified handling during the COVID-19 pandemic, which could introduce information bias.
  • Retrospective study design.

Cite This Study

Fan et al. (2026) conducted a cohort in Cardiovascular disease (n=10,068). PREVENT equations was evaluated on Cardiovascular disease (CVD) events, including heart disease and stroke (OR 1.05, 95% CI 1.04-1.07). The PREVENT equations exhibited poor discrimination for predicting cardiovascular disease in a Chinese population, with an AUC of 0.61 in males and 0.62 in females, despite higher scores being significantly associated with increased CVD risk.

synapsesocial.com/papers/6a49f36ff5d1d45b287ff90ehttps://doi.org/10.1038/s41598-026-60494-x
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