MDCalc

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.

This tool is an update to the AHA/ACC Pooled Cohort Equations previously published in 2013 and was derived and validated exclusively in US-based populations.

  • It now includes BMI, has expanded the age for which scores can be calculated, and excludes race.
  • Additionally, it includes optional variables that better define the effect of cardiovascular-kidney-metabolic (CKM) conditions.
  • Finally, it can provide risk estimates of total CVD along with subtypes including ASCVD, heart failure, coronary heart disease, and stroke.

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.

Model

Sex

years
mm Hg

Diabetes

Current smoker

mL/min/1.73 m²

Using anti-hypertensive medication

Using statins

kg/m²

Result:

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Advice
  • Risk estimates should be part of a comprehensive clinician–patient discussion in individuals at risk for CVD. 
  • 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.
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.
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