Murphy Brittany Saldivar, Hershey M Sims, Huang Shi, Nam Yunbi, Post Wendy S, McClelland Robyn L, DeFilippis Andrew P
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
JACC Adv. 2025 May 26;4(6 Pt 1):101825. doi: 10.1016/j.jacadv.2025.101825.
In 2023, the American Heart Association developed the PREVENT (Predicting Risk of CVD Events) equations to estimate risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF).
Assess the comparative performance of PREVENT-ASCVD vs current guideline-recommended Pooled Cohort Equations (PCE). Evaluate the performance of the PREVENT-HF risk algorithm.
In 6,098 individuals from the MESA (Multi-Ethnic Study of Atherosclerosis) cohort, we calculated baseline PCE, and PREVENT predicted 10-year ASCVD event percentages, observed event percentages at 10 years, discordance between observed and expected percentages, discrimination using Harrell's C index, and calibration using mean absolute error.
Observed ASCVD event rate (6.0%) was closer to the predicted PREVENT event rate (5.7%) than the PCE (10.8%). PREVENT was more accurate in women than men (3.3% vs -11.6% discordance between observed and PREVENT predicted ASCVD), nonsmokers compared to smokers (2.4% vs -37.0% discordance), chronic kidney disease stages 3/4 (discordance 3.2%), and those with high social deprivation scores (discordance -5.0%). Forty-two percent of this cohort would be re-classified to a lower ASCVD risk category using the PREVENT equation vs the PCE. PREVENT-HF overestimates HF events by 2.1%, a relative risk overestimation of 62.6%.
PREVENT-ASCVD equations demonstrated a more accurate ASCVD risk-prediction stratification than the PCE. PREVENT performs best in women, nonsmokers, those with a greater degree of renal dysfunction, social deprivation, and Black individuals. PREVENT-HF overestimates risk of incident HF in a Multi-Ethnic Study of Atherosclerosis.
2023年，美国心脏协会制定了PREVENT（预测心血管疾病事件风险）方程，以估计动脉粥样硬化性心血管疾病（ASCVD）和心力衰竭（HF）的风险。
评估PREVENT-ASCVD与当前指南推荐的合并队列方程（PCE）的比较性能。评估PREVENT-HF风险算法的性能。
在动脉粥样硬化多族裔研究（MESA）队列的6098名个体中，我们计算了基线PCE以及PREVENT预测的10年ASCVD事件百分比、10年观察到的事件百分比、观察到的与预期百分比之间的不一致性、使用Harrell C指数的辨别力以及使用平均绝对误差的校准。
观察到的ASCVD事件发生率（6.0%）比PCE（10.8%）更接近预测的PREVENT事件发生率（5.7%）。PREVENT在女性中比男性更准确（观察到的与PREVENT预测的ASCVD之间的不一致性为3.3%对-11.6%），在不吸烟者与吸烟者相比（不一致性为2.4%对-37.0%）、慢性肾脏病3/4期（不一致性3.2%）以及社会剥夺得分高的人群（不一致性-5.0%）中更准确。与PCE相比，使用PREVENT方程，该队列中有42%的人将被重新分类到较低的ASCVD风险类别。PREVENT-HF高估HF事件2.1%，相对风险高估62.6%。
PREVENT-ASCVD方程显示出比PCE更准确的ASCVD风险预测分层。PREVENT在女性、不吸烟者、肾功能不全程度较高者、社会剥夺人群和黑人个体中表现最佳。在动脉粥样硬化多族裔研究中，PREVENT-HF高估了新发HF的风险。
