Thirty-Year Atherosclerotic Cardiovascular Disease Risk Among US Adults Aged 30 to 59 Years

The 2023 Predicting Risk of Cardiovascular Disease Events equations estimate 30-year atherosclerotic cardiovascular disease (ASCVD) risk for adults aged 30 to 59 years to inform preventative treatment decisions. We aimed to characterize 30-year ASCVD risk in the eligible US population.

We examined adults aged 30 to 59 without known ASCVD who participated in the National Health and Nutrition Examination Survey, 2017 to March 2020 cycle. Using survey weighting to generate nationally representative estimates with 95% CIs, we described 10-year and 30-year ASCVD risk and risk factor control. We then estimated the absolute risk reduction of statin use in populations at high 30-year risk (≥20%.

The cohort included 3229 participants without known ASCVD (mean [SD] age, 44.6 [8.8] years; 49.8% women), representative of 101.9 million (95% CI, 92.2-111.6) US adults. The mean estimated 10-year ASCVD risk was 2.0% (95% CI, 1.9%-2.1%), and the mean 30-year risk was 9.7% (95% CI, 9.4%-10.1%). Of the 9% of the population with high estimated 30-year ASCVD risk, 32.4% (95% CI, 24.0%-40.7%) reported statin use. Most adults with high 30-year ASCVD risk had multiple uncontrolled risk factors, including elevated blood pressure (70.8% [95% CI, 62.4%-79.2%]), obesity (59.9% [95% CI, 52.6%-67.2%]), and elevated total cholesterol (56.2% [95% CI, 45.5%-66.9%]). Expanding primary prevention statins to adults with high 30-year ASCVD risk would change recommendations for 2.5 million (95% CI, 1.9-3.2) adults not currently receiving statins, with an average number needed to treat over 10 years to prevent 1 ASCVD event of 78.3 (95% CI, 74.6-82.0).

Use of the Predicting Risk of Cardiovascular Disease Events 30-year ASCVD risk equations would identify a population of US adults with low 10-year but high 30-year risk who may warrant enhanced primary prevention strategies.