30
Management
4.2.3.2. PREVENT-ASCVD Equations
COR LOE
Recommendation
1 B-NR
1. In adults aged 30 to 79 years without ASCVD or subclinical
atherosclerosis and with an LDL-C level between 70 and
189 mg/dL (1.8–4.9 mmol/L), the PREVENT-ASCVD
equations should be used to estimate 10-year ASCVD risk,
with categorization as having low (<3%), borderline (3% to
<5%), intermediate (5% to <10%), or high (≥10%) 10-year
estimated ASCVD risk.
Table 11. Salient Features of the American Heart
Association PREVENT™* Equations
The PREVENT equations:
1. Included a large, contemporary, representative sample of U.S. adults for derivation
(N ~3.3 million) and external validation (N ~3.3 million).
2. Lower limit to begin risk prediction to age 30 years (through 79 years).
3. Provide sex-specific equations; race/ethnicity is not a variable that added predictive
value to the equations and provides estimates adjusted for competing risk of non-
CVD death.
4. Provide a base model for risk prediction that includes commonly available risk factor
measures: age, sex, blood pressure, total and HDL-C, diabetes status, tobacco use,
kidney function (eGFR), statin use, and antihypertensive medication use (and BMI
for heart failure prediction).
5. Provide optional models with additional inputs, if known/measured, of hemoglobin
A1c (to capture glycemic status), urinary albumin/creatinine ratio (for proteinuria
and CKD), and zip code (to represent social deprivation index and acknowledge
social determinants of cardiovascular risk). These factors are not necessary to
generate risk estimates, but they may enhance risk prediction if available.
6. Predict 10-year and 30-year outcomes.
7. Predict risk for hard ASCVD
†
(relevant for LLT decisions), HF, and total CVD
(ASCVD plus HF; relevant for blood pressure-lowering therapy decisions).
