PREVENT: AHAs New Risk Calculator Incorporates CKM Health

The American Heart Association (AHA) has unveiled a new heart disease risk calculator that aims to estimate an individual’s long-term risk for cardiovascular disease (CVD).

The new Predicting Risk of CVD Events (PREVENT) calculator is the first risk calculator that combines measures of cardiovascular, kidney, and metabolic health to estimate risk for CVD.

It follows an AHA presidential advisory and scientific statement published last month formally defining cardiovascular-kidney-metabolic (CKM) syndrome, as reported by | Medscape Cardiology.

The PREVENT calculator also “starts earlier and goes longer” than the pooled cohort equations (PCE), Sadiya Khan, MD, MSc, chair of the statement writing committee, told | Medscape Cardiology.

PREVENT is for use in adults aged 30-79 years and estimates the 10- and 30-year risk of total CVD including, for the first time, heart failure. The PCE were designed to assess 10-year risk of only myocardial infarction and stroke and only in adults aged 40 to 79 years.

“The new PREVENT equations are important for doctors because they allow us to start conversations earlier and more comprehensively and accurately calculate risk for our patients,” said Khan, preventive cardiologist at Northwestern Medicine and associate professor at Northwestern University Feinberg School of Medicine in Chicago.

“We want to support clinicians in starting these conversations around optimizing CKM health earlier and begin to engage in discussions on ways to optimize health,” Khan added.

The AHA scientific statement on the PREVENT calculator, with Khan as lead author, was published online November 10 in Circulation, with an accompanying article that describes development and validation of the tool. 

Going Beyond the PCE

The new calculator was developed using health information from more than 6 million adults from diverse racial and ethnic, socioeconomic, and geographic backgrounds.

In addition to blood pressure and cholesterol levels, the PREVENT equations allow for inclusion of hemoglobin A1c, if necessary, to monitor metabolic health.

It also includes estimated glomerular filtration rate (eGFR), a measure of kidney function, and allows for use of albumin excretion to monitor kidney disease to further individualize risk assessment and help inform personalized treatment options.

The new calculator also asks about tobacco use and use of medications for CVD risk factors, factors in age and sex, and removes race from the risk calculations.

“The inclusion of race in risk prediction may imply that differences by race are not modifiable and may reify race as a biological construct, which may worsen health disparities. Therefore, it was decided a priori not to include race as a predictor in the development of PREVENT,” the writing group says.

They emphasize that the PREVENT calculator has similar accuracy among varied racial and ethnic groups.

The equations also include an option to use the Social Deprivation Index, which incorporates measures of adverse social determinants of health such as education, poverty, unemployment, and factors based on a person’s environment.

The PREVENT equations are a “critical first step” toward including CKM health and social factors in risk prediction for CVD, Khan said in a news release.

“We are working on finalizing the online tool and should be available soon — hopefully in a few weeks,” Khan told | Medscape Cardiology.

Knowledge Gaps

The scientific statement lists several knowledge gaps and areas for more research. These include:

  • Incorporating “net benefit” to identify the expected benefit of treatment recommendations based on an individual’s level of risk.

  • Collecting more data from people of diverse race and ethnic backgrounds to better represent the increasing diversity in the United States. The number of Hispanic and Asian people included in the PREVENT datasets is lower than national estimates in the general US population, so risk estimations in these populations may be less precise.

  • Expanding the collection, reporting, and standardization of social determinants of health data, such as individual information rather than neighborhood information.

  • Expanding risk assessment and prevention to earlier in life (childhood and/or adolescence) and in key life periods, such as during the peripartum period, since adverse pregnancy outcomes are associated with increased CVD risk.

  • Investigating whether predicting adverse kidney outcomes, particularly among people with and without type 2 diabetes, may further optimize cardiovascular risk prediction.

The scientific statement was prepared by the volunteer writing group on behalf of the AHA. Khan reports no relevant financial relationships.

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