Ambrosio Matthew, Alebna Pamela L, Lee Terence, Friedman Alec, Chew Nicholas Ws, Burns Carolyn, Duncan Phillip, Hundley W Gregory, Kang Le, Mehta Anurag
Virginia Commonwealth University Department of Biostatistics, Richmond, VA, USA.
Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
Am J Prev Cardiol. 2025 May 18;22:101009. doi: 10.1016/j.ajpc.2025.101009. eCollection 2025 Jun.
The Pooled Cohort Equations (PCE) were created in 2013 to assess ASCVD risk in primary prevention. In 2023 the American Heart Association published the PREVENT equations to assess the risk of cardiovascular disease in primary prevention. The comparative performance of PCE and PREVENT for predicting 10-year ASCVD risk has not been evaluated in an external large-scale epidemiologic cohort.
The study population includes participants of the UK Biobank who were free of clinical cardiovascular disease. 10-year ASCVD risk was calculated using the PCE and PREVENT equations. Harrel's C-Statistics and delta C-Statistics were calculated for males and females to evaluate risk discrimination. Predicted 10-year risks were divided into deciles as well as risk groups for each equation and stratified by sex to compare predicted risk versus observed risk within each risk group, with calibration slopes calculated by decile. Sensitivity and specificity were also analyzed to assess statin eligibility.
The final cohort was 368,125 individuals ages 40-73 (mean age 56.2, 54.7 % female, 94.0 % white). The C-statistics for PCE were 0.729 (0.722-0.736) for females and 0.688 (0.683-0.693) for males; C-Statistics for PREVENT were 0.728 (0.721-0.735) for females and 0.687 (0.682-0.692) for males, with delta C-Statistics being 0.001 ( = 0.87) for females and 0.001 ( = 0.82) for males. Predicted risks were closer to observed risks for PREVENT as compared to PCE, and PREVENT tended to estimate lower risk (mean risk of 4.6 % compared to 8.3 % for PCE). PREVENT demonstrated higher specificity but lower sensitivity than PCE using the current 7.5 % risk threshold for statin eligibility, and a Youden index of 4.5 % risk was found for PREVENT.
There is no significant difference in 10-year ASCVD risk discrimination between PCE and PREVENT equations. However, the PREVENT equations demonstrate better calibration in the UK Biobank.
汇总队列方程（PCE）于2013年创建，用于评估一级预防中的动脉粥样硬化性心血管疾病（ASCVD）风险。2023年，美国心脏协会发布了PREVENT方程，以评估一级预防中的心血管疾病风险。PCE和PREVENT在预测10年ASCVD风险方面的比较性能尚未在外部大规模流行病学队列中进行评估。
研究人群包括英国生物银行中无临床心血管疾病的参与者。使用PCE和PREVENT方程计算10年ASCVD风险。计算男性和女性的Harrel's C统计量和Delta C统计量，以评估风险辨别能力。将预测的10年风险分为十分位数以及每个方程的风险组，并按性别分层，以比较每个风险组内预测风险与观察到的风险，通过十分位数计算校准斜率。还分析了敏感性和特异性，以评估他汀类药物的适用资格。
最终队列包括368,125名年龄在40 - 73岁之间的个体（平均年龄56.2岁，女性占54.7%，白人占94.0%）。PCE的C统计量女性为0.729（0.722 - 0.736），男性为0.688（0.683 - 0.693）；PREVENT的C统计量女性为0.728（0.721 - 0.735），男性为0.687（0.682 - 0.692），女性的Delta C统计量为0.001（P = 0.87），男性为0.001（P = 0.82）。与PCE相比，PREVENT预测的风险更接近观察到的风险，并且PREVENT倾向于估计较低的风险（平均风险为4.6%，而PCE为8.3%）。使用当前7.5%的他汀类药物适用风险阈值，PREVENT的特异性高于PCE，但敏感性低于PCE，并且发现PREVENT的约登指数为4.5%风险。
PCE和PREVENT方程在10年ASCVD风险辨别方面没有显著差异。然而，PREVENT方程在英国生物银行中表现出更好的校准。
