Individuals with low 10-year PREVENT ASCVD risk (<5%) but elevated 30-year risk (≥11%) had a higher incidence of ASCVD events compared to those low by both metrics (HR 2.21; 95% CI 1.62-2.94).
Cohort (n=6,747)
Does elevated 30-year PREVENT ASCVD risk identify higher risk of coronary artery calcium and incident ASCVD among individuals with low 10-year PREVENT risk?
Among individuals with low 10-year PREVENT ASCVD risk, an elevated 30-year risk identifies a subgroup with higher prevalence of coronary artery calcium and a 2.2-fold higher risk of incident ASCVD events.
Effect estimate: HR 2.21 (95% CI 1.62, 2.94)
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.
Rikhi et al. (Sat,) conducted a cohort in Atherosclerotic cardiovascular disease (n=6,747). Elevated PREVENT 30-year ASCVD risk (≥11%) and low 10-year risk (<5%) vs. Low PREVENT 30-year ASCVD risk (<11%) and low 10-year risk (<5%) was evaluated on Incident ASCVD events (HR 2.21, 95% CI 1.62, 2.94). Individuals with low 10-year PREVENT ASCVD risk (<5%) but elevated 30-year risk (≥11%) had a higher incidence of ASCVD events compared to those low by both metrics (HR 2.21; 95% CI 1.62-2.94).