U.S. Trends in 10-Year Cardiovascular Risk Scores Over 2 Decades

The PREVENT (Predicting Risk of Cardiovascular Disease Events) equations estimate 10-year risk of total cardiovascular disease (CVD), atherosclerotic CVD (ASCVD), coronary heart disease (CHD), stroke, and heart failure (HF).

The objective of the study was to describe the trends in PREVENT-based 10-year CVD risk among U.S. adults.

We used data from the National Health and Nutrition Examination Survey (1999-2023) to estimate 10-year risk of total CVD, ASCVD, CHD, stroke, and HF among adults aged 30 to 79 years. Crude and age-standardized risk scores were calculated for each survey cycle, and orthogonal polynomial coefficients were used to test for trends across 10 continuous 2-year cycles (1999-2018) overall and according to sociodemographic characteristics.

Among 26,980 adults, 10-year CVD risk increased 24.4%, from 4.9% in 1999 to 2000 to 6.1% in 2017 to 2018 (P < 0.01). After age standardization, 10-year CVD risk remained stable at 5.4% in both periods. Age-standardized ASCVD risk declined from 3.5% to 3.3% (P = 0.04), driven by a 10% decline in CHD risk from 2.0% to 1.8% (P = 0.01), whereas stroke risk remained stable at 1.7%, and HF risk increased 7.1%, from 2.8% to 3.0% (P = 0.01). Reductions in CHD risk were more pronounced and increases in HF risk more modest among non-Hispanic White adults, those with higher educational attainment, and those with a higher income-to-poverty ratio.

Among U.S. adults, 10-year total CVD risk increased over time due to population aging. Age-adjusted total CVD risk remained stable, with declining ASCVD risk driven by reductions in CHD risk offset by rising HF risk. Socioeconomic disparities in both CHD and HF risk widened overtime.