Lee Ming-Sum, Onwuzurike James, Wu Yi-Lin, Palmer-Toy Darryl E, An Jaejin, Chen Wansu
Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
JAMA Netw Open. 2025 Sep 2;8(9):e2532164. doi: 10.1001/jamanetworkopen.2025.32164.
The Predicting Risk of Cardiovascular Disease Events (PREVENT) equations are an updated model developed to improve on the Pooled Cohort Equation (PCE) for estimating 10-year atherosclerotic cardiovascular disease (ASCVD) risk. These equations facilitate patient-clinician discussions on initiating statin therapy and are used to estimate risk without treatment. However, statin exposure during follow-up was not fully accounted for in the development of these equations.
To assess the performance of the PCE and PREVENT equations in estimating ASCVD, accounting for statin exposure during follow-up.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults from an integrated health care system with 10-year follow-up data. Adults without diabetes or ASCVD were identified in 2013 and followed-up through December 31, 2023, with analyses performed in January 2025.
The primary outcome was incident ASCVD. Estimated risks from PCE and PREVENT equations were compared with observed risks, with discrimination assessed via C statistics. The performance of these equations was evaluated in patient populations stratified by statin exposure during follow-up.
Among 193 885 adults (median [IQR] age, 55 [48-63] years; 113 400 [58.5%] women), 6528 experienced an ASCVD event. The C statistic was 0.725 (95% CI, 0.719-0.731) for PCE and 0.723 (95% CI, 0.716-0.729) for PREVENT. In the overall population, regardless of statin exposure, the observed 10-year ASCVD risk was lower than estimated by PCE: 3.6% for individuals with estimated risk of 5% to less than 7.5%, 4.5% for those with estimated risk of 7.5% to less than 10%, and 8.0% for those with estimated risk of 10% or greater. The observed risk more closely aligned with the estimated risk from PREVENT: 5.2% for individuals with estimated risk of 5% to 7.5%, 8.1% for those with estimated risk 7.5% to less than 10%, and 11.6% for those with estimated risk of 10% or greater. In contrast, among patients not exposed to statin therapy during follow-up, PREVENT underestimated risk: observed risk was 8.2% for individuals with estimated risk of 5% to less than 7.5%, and 13.5% for those with estimated risk of 7.5% to less than 10%, while PCE-estimated risk more closely approximated the observed risk.
In this retrospective cohort study, the PREVENT model underestimated risk in patients not treated with statins, whereas the PCE estimates more closely reflected what a patient's risk would be without statin therapy.
心血管疾病事件预测（PREVENT）方程是一个经过更新的模型，旨在改进汇总队列方程（PCE）以估计10年动脉粥样硬化性心血管疾病（ASCVD）风险。这些方程有助于医患之间关于启动他汀类药物治疗的讨论，并用于估计未经治疗时的风险。然而，这些方程的开发过程中并未充分考虑随访期间他汀类药物的暴露情况。
评估PCE和PREVENT方程在估计ASCVD方面的性能，并考虑随访期间他汀类药物的暴露情况。
设计、设置和参与者：这项回顾性队列研究纳入了来自综合医疗保健系统且有10年随访数据的成年人。2013年识别出无糖尿病或ASCVD的成年人，并随访至2023年12月31日，于2025年1月进行分析。
主要结局是发生ASCVD。将PCE和PREVENT方程估计的风险与观察到的风险进行比较，并通过C统计量评估区分度。在根据随访期间他汀类药物暴露情况分层的患者群体中评估这些方程的性能。
在193885名成年人中（年龄中位数[四分位间距]为55[48 - 63]岁；113400名[58.5%]为女性），6528人发生了ASCVD事件。PCE的C统计量为0.725（95%置信区间，0.719 - 0.731），PREVENT的C统计量为0.723（95%置信区间，0.716 - 0.729）。在总体人群中，无论他汀类药物暴露情况如何，观察到的10年ASCVD风险均低于PCE估计值：估计风险为5%至低于7.5%的个体为3.6%，估计风险为7.5%至低于10%的个体为4.5%，估计风险为10%或更高的个体为8.0%。观察到的风险与PREVENT估计的风险更为接近：估计风险为5%至7.5%的个体为5.2%，估计风险为7.5%至低于10%的个体为8.1%，估计风险为10%或更高的个体为11.6%。相比之下，在随访期间未接受他汀类药物治疗的患者中，PREVENT低估了风险：估计风险为5%至低于7.5%的个体观察到的风险为8.2%，估计风险为7.5%至低于10%的个体为13.5%，而PCE估计的风险更接近观察到的风险。
在这项回顾性队列研究中，PREVENT模型低估了未接受他汀类药物治疗患者的风险，而PCE估计值更能准确反映患者在未接受他汀类药物治疗时的风险。
