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Updated: Jun 9, 2025
An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
Comparison of pooled cohort equation and PREVENT™ risk calculator for statin treatment allocation
Joseph Heaton1, Abbas Alshami2, Steven Imburgio1
1Jersey Shore University Medical Center, Department of Medicine, 1945 NJ-33, Neptune City, NJ, 07753, USA.
Insights
The PREVENT equation, a new tool for assessing cardiovascular risk, differs significantly from the older Pooled Cohort Equations (PCE). This study shows PREVENT would change hypercholesterolemia management for many patients, impacting statin therapy recommendations.
Area of Science:
- Cardiovascular disease risk assessment
- Hypercholesterolemia management
- Preventive cardiology
Background:
- Effective hypercholesterolemia management reduces mortality.
- The 2018 AHA/ACC Pooled Cohort Equations (PCE) may overestimate cardiovascular risk and be less accurate for certain racial groups.
- The new AHA PREVENT equation omits race and includes cardiometabolic factors for potentially more accurate risk assessment in diverse populations.
Purpose of the Study:
- To evaluate potential changes in hypercholesterolemia management for primary prevention.
- To compare the application of the PREVENT equation versus the PCE in a nationally representative US population.
- To assess shifts in risk stratification and statin therapy indications.
Main Methods:
- Analysis of pre-pandemic NHANES 2017-2020 data.
- Inclusion of participants aged 40-75 without prior lipid-lowering treatment.
- Risk assessment using both PCE and PREVENT equations (≥7.5% elevated risk threshold), followed by comparison of results and statin therapy indications.
Main Results:
- 81.0% of participants experienced no change in risk assessment between the two equations.
- PCE identified 18.8% of participants at elevated risk not identified by PREVENT; PREVENT identified only 0.20% not identified by PCE.
- PCE-identified moderate-intensity therapy candidates were reclassified to no therapy in 74.59% of cases; high-intensity candidates were reclassified to moderate therapy in 93.97% of cases.
Conclusions:
- The PREVENT equation significantly differs from the PCE in identifying individuals for hypercholesterolemia management.
- Adoption of the PREVENT equation would alter cardiovascular risk reduction therapy recommendations.
- Further comprehensive studies are needed to understand the long-term impact of PREVENT and reevaluate treatment thresholds.
Background And Aims:
Effective hypercholesterolemia management is linked to lower all-cause and cardiovascular mortality. The 2018 AHA/ACC guidelines recommended using the Pooled Cohort Equations (PCE) for lipid management, but these may overestimate risk and be less accurate for certain racial groups. The AHA's new PREVENT equation, which omits race and includes cardiometabolic factors, aims to provide a more accurate risk assessment for a diverse population. However, it has not yet been applied to a nationally representative US population, and implementation guidelines are still lacking. Our study aimed to evaluate potential changes in hypercholesterolemia management for primary prevention by using the PREVENT equation instead of the PCE.
Methods:
Analyzing pre-pandemic NHANES 2017-2020 data, participants aged 40-75 without prior lipid-lowering treatment or other compelling indication were identified for elevated risk (≥7.5 %) using the PCE and PREVENT equations. We assessed risk shifts and indications for statin therapy, comparing the two risk equations. NHANES guidelines with weighting were followed to obtain US nationally representative estimates.
Results:
Out of 77, 647, 807 (unweighted = 2494) participants, 81.0 % had no change in risk. The PCE flagged 18.8 % (n = 14,614,094) of participants at elevated risk not identified by PREVENT, while 0.20 % (n = 107,813) were flagged only by PREVENT. Participants identified solely by the PCE were older, with higher systolic blood pressure and increased estimated glomerular filtration rates. Indications for statin therapy were largely unchanged (81.0 %). PREVENT newly identified (0.20 %) for moderate-intensity therapy and none for high-intensity therapy. Participants qualifying for moderate intensity therapy by the PCE were reclassified to no therapy in 74.59 % of cases, while 25.41 % remained unchanged. Participants qualifying for high-intensity therapy by the PCE were reclassified to moderate therapy in 93.97 % of cases, and 6.03 % were reclassified to no therapy.
Conclusions:
The PREVENT equation notably differs in identifying hypercholesterolemia candidates compared to the PCE. Its adoption would influence cardiovascular risk reduction therapy recommendations, emphasizing the need for comprehensive studies to understand its long-term impact and reevaluate the threshold of treatment strategies for improved patient outcomes.
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