31
Table 11. Salient Features of the American Heart
Association PREVENT™* Equations
8. Demonstrate similar risk discrimination (C statistics) as the pooled cohort equations
for prediction of ASCVD events.
9. Provide significantly and substantially more accurate risk estimates (improved
calibration) for ASCVD than the pooled cohort equations, overall and in all
demographic subgroups. In general, risk estimates from PREVENT-ASCVD
equations tend to be 40% to 50% lower than 10-year risk estimates from the pooled
cohort equations for the same risk factor profile.
* For the purposes of risk assessment in decision-making for LLT, the PREVENT-ASCVD
equations version should be used to predict hard ASCVD outcomes and assist the patient-
clinician risk/benefit discussion.
†
Fatal or nonfatal stroke, nonfatal MI, or CHD death. is does not include
revascularizations performed without antecedent clinical events, given wide variation in
practice patterns.
Adapted with permission from Khan et al. Copyright © 2023 American Heart Association, Inc.
ASCVD indicates atherosclerotic cardiovascular disease; BMI, body mass index; CVD,
cardiovascular disease; CHD, coronary heart disease; CKD, chronic kidney disease; eGFR,
estimated glomerular filtration rate; HDL-C, high-density lipoprotein-cholesterol; HF, heart
failure; LLT, lipid-lowering therapy; and MI, myocardial infarction.
Rationale to start LLT in patients at borderline (3% to <5%),
intermediate (5% to <10%), and high (≥10%) predicted 10-y risk
Estimates from contemporary PREVENT-ASCVD equations ~40%–50%
lower than older PCE
Similar numbers of US adults recommended to consider statin therapy
using PCE ≥5% or PREVENT-ASCVD ≥3% 10-y risk
Net benefit (benefit > potential harm) for statin therapy ≥3% 10-y event
rate in primary prevention RCTs
Figure 3. Rationale for New 10-Year Risk Thresholds in
Lipid-Lowering Therapy Using PREVENT-ASCVD
ASCVD indicates atherosclerotic cardiovascular disease; LLT, lipid-lowering therapy; PCE, pooled
cohort equations; RCTs, randomized controlled trials; and US, United States.
Adapted from Khan et al and Khan et al.
(cont'd)
