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.

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.

Model

Optional variables include urine albumin-creatinine ratio (uACR), HbA1c, and social deprivation index (SDI; ZIP code). Use the base model if no optional variables are available, the corresponding single-variable model if one is available, and the full model if all are available.

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
  • 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.
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