Enhanced PREVENT equations including HbA1c and UACR yielded higher 10-year CVD risk estimates than base equations in adults with HbA1c ≥9.0% (17.8% vs 11.8%) and UACR ≥300 mg/g (36.1% vs 23.4%).
Cross-Sectional (n=8,293)
Does the use of enhanced PREVENT equations including HbA1c and UACR improve 10-year CVD risk estimation compared to base PREVENT equations in adults?
The inclusion of HbA1c and UACR in the PREVENT equations provides greater individualization of CVD risk estimation in adults with diabetes, but offers little benefit in populations without diabetes.
OBJECTIVES: The 2023 Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations for 10-year cardiovascular disease (CVD) were developed by the American Heart Association to improve upon the 2013 Pooled Cohort Equations (PCEs). This study sought to compare risk reclassification using the PREVENT equations with and without the use of optional predictors of hemoglobin A1c (HbA1c) and urine albumin-creatinine ratio (UACR). RESEARCH DESIGN AND METHODS: This was a cross-sectional study of adults aged 30 to 79 years participating in the National Health and Nutrition Examination Survey 2015-2020. Ten-year CVD estimates stratified by diabetes status using the base PREVENT equations and the enhanced PREVENT equations including HbA1c and UACR were examined. RESULTS: The study included 8,293 participants (weighted mean age 51 years; 52% female; 13% with diabetes) representing 147.9 million US adults. Estimated 10-year CVD risks using the base and enhanced PREVENT equations were within 5 percentage points for 99% of adults without diabetes and 82% of adults with diabetes. Individuals with HbA1c ≥9.0% had a higher enhanced equations' mean risk of 17.8% (95% CI, 15.9%-19.7%) compared to the base equations' mean risk of 11.8% (95% CI, 10.7%-12.9%). This was mirrored with UACR, as individuals UACR ≥300 mg/g had a higher enhanced equations' mean risk at 36.1% (95% CI, 33.2%-39.1%) compared to the based equations' mean risk of 23.4% (95% CI, 20.0%-26.9%). CONCLUSIONS: Inclusion of HbA1c and UACR in the PREVENT equations provides opportunity for greater individualization of CVD risk estimation in adults with diabetes but little benefit in populations without diabetes.
Wilson et al. (2026) conducted a cross-sectional in Cardiovascular disease (n=8,293). Enhanced PREVENT equations (including HbA1c and UACR) vs. Base PREVENT equations was evaluated on 10-year cardiovascular disease risk estimates. Enhanced PREVENT equations including HbA1c and UACR yielded higher 10-year CVD risk estimates than base equations in adults with HbA1c ≥9.0% (17.8% vs 11.8%) and UACR ≥300 mg/g (36.1% vs 23.4%).