Key result
PREVENT equations lower statin recommendations by ~5 percentage points compared with PCE.
Why the study?
Does the 2026 dyslipidemia guideline using PREVENT equations alter ASCVD risk reclassification and statin recommendations compared to the 2013 PCE thresholds in MESA participants?
Cohort (n=6,098)
Does the 2026 dyslipidemia guideline using PREVENT equations alter ASCVD risk reclassification and statin recommendations compared to the 2013 PCE thresholds in MESA participants?
Applying the 2026 dyslipidemia guideline and PREVENT equations results in a modest net downward reclassification of ASCVD risk and fewer statin recommendations without a substantial increase in subsequent cardiovascular events, though CAC and risk enhancers remain important for identifying higher-risk individuals reclassified downward.
Answers are grounded in this paper and cite their sources.
Supports cautious statin de-escalation with PREVENT in select adults; leaves open whether CAC integration improves risk stratification beyond equations.
The 2026 American College of Cardiology (ACC)/American Heart Association (AHA)/Multisociety Guideline on the Management of Dyslipidemia recommends the use of the PREVENT (Predicting Risk of cardiovascular disease EVENTs) equations to predict atherosclerotic cardiovascular disease (ASCVD) risk while concurrently revising previous risk-category thresholds. The impact of these reclassifications is yet to be described. The authors characterized ASCVD reclassification and statin recommendations under the 2026 guideline, evaluated clinical events under this reclassification, and examined risk enhancement with risk enhancers and coronary artery calcium (CAC) burden. Adults (N = 6,098) from the MESA (Multi-Ethnic Study of Atherosclerosis) were assessed, comparing the Pooled Cohort Equations (PCE) and 2013 thresholds to PREVENT with 2026 thresholds. We evaluated the degree of directional reclassification, impact on statin recommendations, and risk enhancement with biomarkers and CAC burden. Over a median follow-up of 10 years, 6.0% of participants had an ASCVD event. PREVENT reclassified 16.4% to a lower and 13.1% to a higher risk category as compared to the PCE. The statin recommendation under PREVENT was 50.4% compared to 55.2% under PCE. Of those who were no longer recommended for statin use, 4.9% went on to have an event. Individuals who were reclassified downward but had elevated CAC or any risk-enhancing factors had a higher event rate. Adherence to the 2026 guideline may lead to a small net downward reclassification of predicted ASCVD risk. Statin recommendations will fall modestly, however, not accompanied by a substantial number of subsequent events. Risk enhancers and elevated CAC identify higher risk subgroups than their PREVENT risk would suggest, emphasizing their supporting role in risk prediction.
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Murphy et al. (2026) conducted a cohort in Atherosclerotic cardiovascular disease (ASCVD) risk and dyslipidemia (n=6,098). PREVENT equations with 2026 dyslipidemia guideline thresholds vs. Pooled Cohort Equations (PCE) with 2013 thresholds was evaluated on Statin recommendation and ASCVD risk reclassification. PREVENT equations with 2026 thresholds reclassified 16.4% of adults to lower and 13.1% to higher ASCVD risk, reducing statin recommendations from 55.2% under PCE to 50.4%.
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