Predicting Risk of Cardiovascular Disease EVENTs (PREVENT™)
Predicts 10- and 30-year risk of CVD and CVD subtypes in patients aged 30-79 without known CVD.
Optional variables include urine albumin-creatinine ratio (uACR), HbA1c, and social deprivation index (SDI; US ZIP code-based).
- If you are using only one optional variable, select that model for use.
- If you have all optional variables, select the “Full” model.
- If you do not have any optional variables, select “Base” model.
BMI is used to estimate heart failure risk; if the patient’s BMI falls outside the studied range, this tool will not produce a heart failure risk estimate but will still generate estimates for all other cardiovascular subtypes.
Use in adults aged 30–79 years without known atherosclerotic cardiovascular disease (ASCVD) to estimate their 10- and 30-year risk of total cardiovascular disease (CVD), ASCVD, heart failure, coronary artery disease (CAD), and stroke.
Clinical Advice
- Use results to support shared decision-making around cardiovascular prevention strategies.
- Risk estimates should be interpreted in the context of:
- Patient comorbidities (e.g., diabetes, CKD, obesity).
- Risk-enhancing factors (e.g., family history, lipoprotein(a), inflammatory conditions, coronary artery calcium score).
- Patient preferences.
- Treatment goals.
- Consider both 10-year and 30-year risk, particularly in younger patients, where long-term risk may better inform early preventive strategies.
- As predicted risk increases, the intensity of lifestyle counseling and therapeutic intervention should increase accordingly.
- In general, lipid-lowering therapy is now recommended in individuals with a ≥3% 10-year ASCVD risk estimate.
- Ensure management of modifiable risk factors (e.g., lipids, blood pressure, glycemia, smoking) regardless of calculated risk.
- Reassess risk over time as clinical status and risk factors change.
- Evaluate for secondary causes of dyslipidemia or elevated CVD risk when appropriate.
Management
PRIMARY PREVENTION
The 2026 ACC/AHA Guideline uses the following risk categories and recommended primary prevention measures (based on 10-year ASCVD risk):
- Low (<3% risk):
- Health behavior counseling.
- If LDL-C 160–189 mg/dL or 30-year ASCVD risk is ≥10%, consider moderate-intensity statin therapy.
- Borderline (3% to <5% risk):
- Health behavior counseling.
- Engage in risk-benefit discussion about pharmacotherapy; consider risk enhancers to personalize the decision.
- If moderate-intensity statin therapy is initiated, target a ≥30% LDL-C reduction with a goal of LDL-C <100 mg/dL and non-HDL-C <130 mg/dL.
- If shared decision-making does not produce a clear treatment path, consider CAC assessment.
- Intermediate (5% to <10% risk):
- Health behavior counseling.
- Start moderate- to high-intensity statin therapy, targeting a ≥30% LDL-C reduction with a goal of LDL-C <100 mg/dL and non-HDL-C <130 mg/dL.
- If uncertainty remains regarding whether to initiate therapy or its appropriate intensity, consider CAC assessment.
- High (≥10% risk):
- Health behavior counseling.
- Start high-intensity statin therapy, targeting a ≥50% LDL-C reduction with a goal of LDL-C <70 mg/dL and non-HDL-C <100 mg/dL.
- If goals are not achieved on maximally tolerated statin therapy, additional therapies (e.g., ezetimibe, PCSK9 inhibitors, bempedoic acid) may be necessary.
The following groups should receive lipid-lowering therapy regardless of calculated risk:
- Established clinical ASCVD.
- LDL-C ≥190 mg/dL.
- Aged 40–75 with diabetes, chronic kidney disease stage 3 or higher, or HIV on stable combination antiretroviral therapy.
HYPERTENSION
The 2025 AHA/ACC Guideline recommends the following hypertension management (based on 10-year total CVD risk):
- BP ≥130/80 mmHg:
- Treat if risk estimate ≥7.5%, or if clinical CVD, diabetes, or CKD is present.
- If risk estimate is <7.5%, try lifestyle modification for 3–6 months first; start medication if BP remains elevated.
- BP ≥140/90 mmHg: Treat all adults regardless of CVD risk estimate.
Additional Information
Model Notes
The minimum uACR value accepted by the model is 0.1mg/g. If your laboratory reports a value lower than this, enter 0.1mg/g.
BMI is only used as a predictor for the heart failure risk calculation. Per study authors, the indicated range (with max allowed value of 39.9) was chosen based on past work in the Pooled Cohort Equations to Prevent Heart Failure (PCP-HF) study.
Due to the use of age as a time scale, 30-year risk may be overestimated.