Review of Predicting Risk of Cardiovascular Disease EVENTs (PREVENT)

The PREVENT equations are contemporary risk prediction models developed to estimate 10- and 30-year risk of total cardiovascular disease (CVD), atherosclerotic cardiovascular disease (ASCVD), heart failure, coronary artery disease, and stroke in adults without established CVD (primary prevention). Derived from large, diverse US populations, PREVENT incorporates traditional risk factors along with kidney function and optional cardiovascular-kidney-metabolic (CKM) variables to improve individualized risk assessment. Compared with the prior Pooled Cohort Equations, PREVENT demonstrates improved calibration and broader applicability, including prediction of heart failure risk. These equations are now incorporated into recent US prevention guidelines to support risk-based primary prevention strategies, including lipid-lowering decisions using PREVENT-ASCVD risk and antihypertensive treatment decisions using PREVENT-total CVD risk. PREVENT generally yields lower estimated ASCVD risk than the prior Pooled Cohort Equations, likely reflecting improved calibration in contemporary populations. However, the downstream impact on treatment eligibility and the optimal treatment thresholds for PREVENT-based risk estimates remain areas of ongoing study.