Relationship between 10- and 30-year PREVENT Risk Scores with Coronary Artery Calcium and Incident Atherosclerotic...

The 2023 American Heart Association Predicting Risk of Cardiovascular Disease (CVD) EVENTs (PREVENT) risk equations allow for 10- and 30-year atherosclerotic CVD (ASCVD) quantitative risk assessment. We investigated the relationship between PREVENT 10-year and 30-year ASCVD risk categories with coronary artery calcium (CAC) and incident ASCVD.

This analysis included participants from the Multi-Ethnic Study of Atherosclerosis with CAC measured by computed tomography and calculated PREVENT (N=6,747) risk score. Prevalent, incident, and CAC progression, as well as incident ASCVD, were compared by clinical 10-year risk categories and 30-year risk cut points based on a framework categorizing lifetime risk of ASCVD; low risk was defined as < the mean 30 year PREVENT estimate for participants without ASCVD risk factors (<11%).

The cohort mean age was 62.2 years and was 52.8% female, and 61.5% non-White. Individuals with low 10-year PREVENT ASCVD risk (<5%) and elevated PREVENT 30-year ASCVD risk (≥11%) had a higher prevalence of CAC compared to those low-risk for both 10-year and 30-year metrics. Incident CAC followed a similar pattern. CAC progression was similar across risk thresholds for both risk equations. Individuals with low 10 -year PREVENT risk but elevated 30-year risk had a higher incidence of ASCVD events compared to those with those low by both metrics [hazard ratio 2.21; 95% confidence interval (1.62, 2.94)].

Individuals with low 10-year PREVENT ASCVD predicted risk (<5%) may benefit from 30-year ASCVD risk estimation when uncertainty remains regarding further risk stratification or initiation of preventive therapies.