Impact of PREVENT Cardiovascular Risk Equations on Statin Eligibility by Subgroup and Risk Thresholds: A Cross-Sectional Study

Abstract Background Replacing the pooled cohort equations (PCEs) with the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations for atherosclerotic cardiovascular disease (ASCVD) risk is projected to reduce statin eligibility, prompting discussion of lowering the risk threshold used with PREVENT. The potential impact on statin eligibility in different subgroups is unknown. Objective To assess the impact of replacing PCEs with PREVENT equations on statin eligibility for a real-world population of primary care patients, incorporating social deprivation index (SDI) and lowering the ASCVD risk thresholds for statin eligibility. Design Cross-sectional analysis comparing 10-year ASCVD risk scores and statin eligibility using the PCEs and PREVENT equations within a primary care population. Subgroup analyses were conducted by age, sex, and race. Risk thresholds for statin eligibility were varied to assess the effect on eligibility. Participants Adult patients who visited a Vanderbilt primary care clinic in 2023. Main Measures Estimated 10-year ASCVD risk and proportion of patients eligible for statin therapy using the PCEs vs. PREVENT equations. Key Results In 50,123 patients, the mean 10-year ASCVD risk was significantly lower with PREVENT compared to the PCEs (3.6 vs. 7.5, p < 0.0001). In 36,430 patients not on statins, PREVENT reduced statin eligibility by 78.2%, with the largest reductions in women (82.6%), patients aged 40–49 (97.8%), and Black patients (81.2%). Lowering the statin eligibility threshold from 7.5 to 3% led to a 27.5% overall increase in eligibility rather than 78.2% reduction. However, gaps between subgroups expanded, and younger and Black patients retained relative reductions in eligibility (e.g., 4.7% decrease in statin eligibility among Black patients compared to a 32.7% increase among White patients). Conclusions In a real-world primary care population, replacing the PCEs with the PREVENT equations would significantly reduce statin eligibility at the 7.5% threshold. Lowering the risk threshold would increase overall eligibility but disproportionately affect eligibility within certain subgroups.