PREVENT Equations Toolkit A Toolkit for Healthcare Professionals
Publisher’s Note PREVENT™ Equations Toolkit: A Toolkit for Clinicians is published by Ascend Media. 401 SW Ward Road, Lee’s Summit, MO 64081 © 2026 American Heart Association, Inc. a 501(c)(3) not-for-profit. All rights reserved. Unauthorized use prohibited. All references and data are current as of July 2026.
3 A Toolkit for Healthcare Professionals 4 Evaluating Cardiovascular Disease (CVD) Risk 5 Introducing the American Heart Association PREVENT™ Equations 7 Frequently Asked Questions: PREVENT Equations 8 Implementing the PREVENT Equations Into Your Workflow 9 The Importance of Shared Decision-Making 10 Guidelines at a Glance 12 Use PREVENT Equations to Guide Diagnostic Testing and Pharmacotherapy 14 Clinical Implementation of the PREVENT Equations: Example Contents
4 Evaluating Cardiovascular Disease (CVD) Risk Cardiovascular-kidney-metabolic (CKM) syndrome is a complex interplay among the cardiovascular system, metabolic risk factors and chronic kidney disease (CKD). The interaction of these risk factors affects nearly all organ systems and increases the risk for all subtypes of CVD, including stroke, coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AFib), and peripheral artery disease (PAD). The greatest clinical consequence of the increased CVD risk in CKM syndrome is premature morbidity and mortality.2 Moreover, because of the interconnectedness of CKM syndrome, many patients have combinations of these conditions, with higher mortality rates as a result.2 Diabetes is linked to a 13- to 14-year-shorter life expectancy, with earlier onset conferring greater reductions in survival.2 Stage 4 CKD with an estimated glomerular filtration rate (eGFR) 15-29 mL/min/1.73m2 is associated with >20-yearshorter life expectancy, with death resulting from CVD being a major competing risk for the development of kidney failure requiring kidney replacement therapies.2 Grade III obesity, body mass index (BMI) 40 to <45 kg/m2, is associated with an estimated 8- to 10-year reduction in median survival.2 Cardiovascular Disease Metabolic Risk Factors Chronic Kidney Disease • Dyslipidemia • CKD • Subclinical/clinical CVD An estimated 90% of adults have at least one component of CKM syndrome,1 a newly defined condition that includes: • Overweight/obesity • Prediabetes • Type 2 diabetes • Hypertension
5 A Toolkit for Healthcare Professionals Calculating Your Disease Risk: A Look Into the PREVENT Calculator WEBINAR/TUTORIAL: Introducing the American Heart Association PREVENT™ Equations To estimate CVD risk comprehensively and accurately for people without existing CVD, the American Heart Association developed the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT™) equations. Deployed in 2023, the PREVENT equations are the newest, most comprehensive risk estimation tool and the first to combine cardiovascular, kidney and metabolic health measurements to support primary prevention-focused treatment decisions. It’s important for clinicians to utilize the PREVENT equations in routine clinical practice for the primary prevention of cardiovascular disease. What Are the PREVENT Equations? The PREVENT equations are an updated approach to cardiovascular risk assessment, building on the Pooled Cohort Equations (PCE), also known as the ASCVD calculator. They were derived and validated using data from more than 6.5 million U.S. adults across multiple datasets and validated for adults aged 30 to 79 years without known CVD. Compared with prior tools, the PREVENT equations incorporate contemporary, diverse data and expanded clinical inputs, including kidney and metabolic measures. This broader approach supports more comprehensive risk assessment and better informed decisions regarding medications, lifestyle changes, and follow-up care to improve CKM health and reduce both short- and long-term CVD risk. The PREVENT equations estimate 10- and 30-year absolute risk for total CVD, atherosclerotic CVD (ASCVD), and HF. They also use lower thresholds for CVD risk, which may help identify individuals who could benefit from preventive therapies earlier.7 Target Population: The PREVENT equations are validated specifically for U.S. adults aged 30 to 79 years without established CVD, with all required clinical input values. PREVENT equations estimate 10- and 30-year absolute risk for: PREVENT-CVD (total cardiovascular disease: ASCVD + HF) PREVENT-ASCVD (atherosclerotic cardiovascular disease) PREVENT-HF (heart failure) The PREVENT calculator can also provide a “PREVENT Age” based on the 10-year PREVENT-CVD risk estimate and a risk percentile based on the 30-year PREVENT-CVD risk estimate. Accessing the PREVENT equations with the American Heart Association PREVENT™ online calculator can help inform discussions and shared decision-making with patients about cardiovascular disease risk and provide opportunities for primary CVD prevention and care optimization over the life course.3,4,5,6 PREVENT™ Online Calculator Understanding Risk Assessment: Introducing the PREVENT equations WEBINAR/TUTORIAL: Development and Validation of the American Heart Association’s PREVENT Equations AHA SCIENTIFIC STATEMENT:
6 Plug in the Numbers: Required Clinical Inputs for the PREVENT Equations For accurate use of the PREVENT online calculator, the following clinical data is required: Sex: Male or female (based on sex assigned at birth) Age: 30 to 79 years Total cholesterol: 130-320 mg/dL HDL cholesterol: 20-100 mg/dL Systolic blood pressure: 90-200 mm Hg Diabetes status (any history of diabetes): Yes or no Smoking status (any cigarette use within the last 30 days): Yes or no Body mass index (BMI): 18.5-39.9 kg/m2 Estimated glomerular filtration rate (eGFR): 15-140 mL/min/1.73m2 Lipid-lowering medication (current use of statin medications to lower cholesterol): Yes or no Antihypertensive medication use (current use of any medication for hypertension): Yes or no Situation-Dependent PREVENT Clinical Data To further personalize risk assessment, clinicians can input the following optional data when clinically indicated and available by selecting “yes” and entering the value: Urine albumin-creatinine ratio (UACR): 0-25000 mg/g UACR is clinically indicated for people with chronic kidney disease, diabetes or hypertension. If UACR is unavailable for eligible patients, consider this a gap-closure opportunity and obtain testing before or alongside PREVENT equation use to support a more complete risk assessment. Hemoglobin A1c (HbA1c): 3-15% HbA1c is clinically indicated for people with diabetes, prediabetes, overweight or obesity, or a history of gestational diabetes. ZIP code (valid five-digit U.S. ZIP code) ZIP code is used to estimate Social Deprivation Index (SDI), a composite measure to quantify neighborhood-level socioeconomic disadvantage. Who Is Eligible for Risk Estimation Using the PREVENT Equations? Because the PREVENT equations are validated for adults aged 30 to 79 years without known CVD, do not use the PREVENT equations for adults with known or severe subclinical CVD, such as left ventricular ejection fraction <40%, coronary artery calcium ≥300, end-stage kidney disease or limited life expectancy (<1 year). Also, do not use the equations for individuals aged <30 years or >79 years, for individuals with missing required variables or out-of-range values, for those with positive genetic testing for a variant known to be pathogenic or for an inherited cardiovascular condition. *Out-of-range values should be managed as clinically indicated. Risk can still be estimated with the closest in-range value but may represent an over- or under-estimate.
7 A Toolkit for Healthcare Professionals Frequently Asked Questions: PREVENT Equations How do the PREVENT equations differ from PCE? The PREVENT equations differ from the older PCE, which was derived from historical observational research cohorts, in numerous ways. Namely, the PREVENT equations: • Were derived and validated using data from large, contemporary and diverse datasets of more than 6.5 million adults from all over the U.S. The derivation samples included electronic medical record data from patients receiving care across multiple health systems and population-based cohorts or research studies. • Include predictors for kidney and metabolic health to support a more holistic approach for screening, assessing risk and preventing CVD among patients with or at risk for CKM syndrome.8 • Incorporate additional predictors of total CVD (a composite of ASCVD and HF), including eGFR, BMI and optional fields for UACR, HbA1c and ZIP code, which are readily available in the primary care setting and through the electronic health record, to provide a more individualized picture of CKM health and clearer insights to support long-term prevention discussions with patients. • Lower the age range to 30 to begin predicting risk in younger adults, whose short-term cardiovascular risk may be low but whose long-term risk may be higher, and to capture risk emerging earlier in the life cycle and opportunities to implement CVD prevention strategies. • Provide both a 10-year and 30-year risk percentage for CVD, ASCVD, and HF to predict a patient’s short- and long-term likelihood of developing future events. • Include lipid-lowering therapy (LLT) as a clinical data input. • Exclude race as a predictor.3 Why were race-free equations adopted in the PREVENT model? The PREVENT equations were developed with clinical and social variables that holistically capture risk of cardiovascular outcomes. Since race is a social construct, and not a biological predictor, it was not included in the PREVENT equations. The inclusion of a place-based measure of social disadvantage supports more equitable approach. The PREVENT equations demonstrate high accuracy across all racial and ethnic groups, with predicted risk closely matching observed risk, eliminating the need for racespecific equations. What if patient data, such as UACR or HbA1c, is unavailable? The base PREVENT equations may still be used for risk estimation without these optional add-ons. However, consider additional testing to acquire missing optional data, such as HbA1c and UACR, to further personalize cardiovascular risk assessment. This add-on data helps ensure that clinicians screen all eligible individuals. UACR is clinically indicated for individuals with CKD, diabetes or hypertension. HbA1c is clinically indicated for individuals with diabetes, prediabetes, overweight/obesity or a history of gestational diabetes. Are the PREVENT equations applicable to patients outside the 30 to 79 age range? The PREVENT equations are only validated for adults aged 30 to 79 years who do not have a history of CVD. If any required variable, including age, is missing or out of range,the online calculator will not generate a risk estimate. For clinicians: American Heart Association PREVENT™ Equations Frequently Asked Questions. Clinicians can access this reference for common questions about PREVENT equations eligibility, inputs and interpretation. For patients: American Heart Association PREVENT™ Frequently Asked Questions for Patients. Resources for Frequently Asked Questions for Clinicians and Patients PREVENT Equations: Frequently Asked Questions WEBINAR/TUTORIAL:
8 Understanding the PREVENT 10-Year Risk Estimate The PREVENT online calculator provides a 10-year risk estimate, a practical, intuitive way to communicate a patient’s short-term likelihood of developing CVD, ASCVD or HF. The risk estimate reflects the likelihood that someone with similar risk factors will develop the specified cardiovascular outcome over the next 10 years. For example, using PREVENT-CVD, if a patient’s estimated 10-year risk of CVD is calculated to be 4.2%, approximately four out of 100 people like this patient will likely develop CVD over the next 10 years. Patient Explainer: 10-Year Risk The PREVENT equations make short-term risk easier for patients to understand. As an example, here is a patientfriendly way to explain the 10-year risk estimate to a patient with a 4.2% estimated 10-year risk of CVD: “Out of 100 people like you, with similar risk factors, approximately four will develop CVD in the next 10 years.” Understanding the PREVENT 30-Year Risk Estimate The PREVENT online calculator presents the 30-year risk estimate as a percentage, which helps communicate a patient’s long-term likelihood of developing CVD, ASCVD or HF. This risk estimate reflects the likelihood that a person with similar risk factors will develop the specified cardiovascular outcome over the next 30 years. For example, an individual with a 30-year PREVENT-CVD of 23.0% indicates that 23 out of 100 people similar to this patient will likely develop CVD in the next 30 years. The long-term view is especially powerful for younger adults — those in their 30s or early 40s whose 10-year risk may be low, but whose 30-year estimate reveals meaningful opportunities for early prevention discussions. By illustrating risk across decades, the PREVENT 30-Year Risk Estimate helps patients understand how early action today may change their future health. Patient Explainer: 30-Year Risk Here’s a patient-friendly way to explain the 30-year risk to a patient with a 23.0% estimated 30-year risk of CVD. “Out of 100 people like you, with similar risk factors, about 23 will develop CVD in the next 30 years.” PREVENT Risk Calculator for Primary Care WEBINAR/TUTORIAL: Implementing the PREVENT Equations Into Your Workflow Use the PREVENT online calculator during visits with adults aged 30 to 79 years without CVD. After inputting all required fields and, if clinically indicated, optional patient data, the PREVENT calculator will estimate 10- and 30-year risk, PREVENT risk percentile and PREVENTAge to translate risk into an intuitive concept for patients and provide an opportunity to strengthen engagement and long-term prevention planning.
A Toolkit for Healthcare Professionals 9 Understanding Estimated PREVENT-Age The PREVENT online calculator provides an estimated PREVENT-Age, a “risk age” or “heart age” that translates a patient’s predicted cardiovascular risk into an equivalent age based on the PREVENT-CVD equations. Patient Explainer: Interpreting PREVENT-Age When the PREVENT-Age is greater than the patient’s actual age, it suggests a higher-than-expected predicted CVD risk relative to peers of the same age. When the PREVENT-Age is less than the patient’s actual age, it suggests a more favorable cardiovascular risk profile relative to peers of the same age. For example, if a 45-year-old female has an estimated PREVENT-Age of 61 years, her predicted cardiovascular risk is higher than expected for her chronological age and greater than that of peers of the same age. PREVENT-Age offers a simple, motivating concept that patients can grasp instantly. It has the potential to drive behavior change because it translates complex risk into something that feels personal, relatable and real. Understanding the 30-Year PREVENT-CVD Percentile The PREVENT online calculator also provides age and sex-specific percentiles for 30-year PREVENT-CVD risk. Percentiles compare a person’s predicted long-term CVD risk with that of others of the same age and sex in a nationally representative population. As an example, a 45-year-old female with a 30-year PREVENT-CVD risk of 23.0% would place her at the 93rd percentile, indicating that her estimated long-term CVD risk is higher than about 93 out of 100 age- and sex-matched peers. The Importance of Shared Decision-Making The PREVENT equations are an opportunity to provide more precise risk stratification and personalized guidance for patients. Shared decision-making can help personalize treatment recommendations, enabling patients to become champions of their own care. As you incorporate the PREVENT equations into your practice, consider each patient individually, including riskenhancing factors that aren’t included in the equations but that may be clinically important. Here are additional ways to use PREVENT risk estimates in shared decision-making conversations to help patients understand their risk and take steps to reduce it. Use relatable analogies. If your patient is a teacher, you might say, for example: “Based on your results, your chance of developing cardiovascular disease is estimated to be 10.8% over the next 10 years. Think of it like recognizing when a student may need extra support before a small challenge becomes a bigger problem. In the same way, starting treatment now can help prevent future heart and blood vessel problems. I recommend a statin, a medication that can lower cholesterol levels and help protect your heart and circulation over time.” Shared Decision-Making Steps 1 Ask permission to begin sensitive conversations with patients. 2 Assess your patient’s health factors and expectations. 3 Advise patients on treatment options specific to their individual needs and perspectives. 4 Agree and support patients through shared goal setting and decision-making. 5 Assist patients in developing an action plan. 6 Arrange for follow-up care support. See page 10 for additional Shared Decision-Making resources.
10 Guidelines at a Glance By combining comprehensive, meaningful and clinically relevant outputs, the PREVENT equations empower health care professionals and patients with clearer insight into their cardiovascular risk and, importantly, the potential to change it. Use the PREVENT equations to estimate short- and long-term CVD risk and support clinician-patient discussions about prevention strategies and current guideline-directed treatment strategies. Whenever possible or available, include the following specific guideline-based prevention strategies when discussing the PREVENT equations during management visits. Cardiovascular-Kidney-Metabolic Syndrome Screening and Prevention The PREVENT equations can be used to identify high-risk individuals, including younger adults, at earlier stages of CKM syndrome. The conceptual framework for risk-based prevention of cardiovascular disease, integrating risk assessment with the PREVENT equations and CKM syndrome staging is detailed in the Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association.3 CKM syndrome is classified by a staging construct, which helps guide treatment. Components of CKM syndrome screening, including blood pressure, lipids, BMI, HbA1c, eGFR and UACR as clinically indicated, can inform the calculation of the PREVENT equations. CKM syndrome screening can help identify patients at higher risk of developing cardiovascular disease, such as those with CKM syndrome stage 3 with a CVD risk estimate of greater than or equal to 20%, providing an opportunity to intensify prevention efforts.3 Lipid-Lowering Therapy (LLT) The 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines addresses the evaluation, management and monitoring of Use patient-friendly visual aids and shared decision-making support tools. This graphic, for example, can help explain CKM syndrome. Follow the 6As for best communication practices to provide patient-centered care for healthy lifestyle changes at every visit: Ask, Assess, Advise, Agree, Assist and Arrange. Promote a heart-healthy lifestyle by reviewing the American Heart Association’s Life’s Essential 8™ with patients and the need for lifestyle adjustments in eating habits, level of physical activity, smoking cessation, weight management, sleep, controlling cholesterol, blood pressure and blood sugar. Visual aids can help drive messages home. Encourage patients to use the American Heart Association’s Life’s Essential 8™ My Life Check calculator, which provides a health score that offers positive reinforcement and shows improvement in real time as they implement lifestyle changes. The American Heart Association’s Life’s Essential 8 Fact Sheet for Patients outlines the easy steps they can take for a healthier lifestyle. Helpful Tools to Guide Shared Decision-Making:
11 A Toolkit for Healthcare Professionals individuals with dyslipidemias, including high blood cholesterol, hypertriglyceridemia and elevated lipoprotein(a).9 Considerations for LLT • The guideline recommends using PREVENT-ASCVD 10-year and 30-year risk estimates to guide lipid-lowering therapy (LLT) decisions in adults aged 30 to 79 years with LDL-C 70 to 189 mg/dL and no history of ASCVD. Moderate-intensity statin therapy is reasonable for those with borderline 10-year ASCVD risk (3% to <5%) and for selected adults aged 30 to 59 years with low 10-year risk (<3%) but LDL-C 160 to 189 mg/dL or 30-year ASCVD risk ≥10%; at least moderate-intensity statin therapy is recommended for intermediate 10-year risk (5% to <10%), high-intensity statin therapy for high 10-year risk (≥10%) and maximally tolerated statin therapy for individuals with LDL-C ≥190 mg/dL regardless of estimated risk.9 • Use ASCVD risk and the degree of LDL-C lowering achieved to guide LLT. Adults at borderline or intermediate risk should achieve a 30% to 49% LDL-C reduction, with greater LDL-C lowering at the higher end of risk. Adults at high risk should achieve at least a 50% LDL-C reduction, with additional LDL-C lowering as needed to reach guideline-recommended goals. If LDL-C goals are not achieved on maximally tolerated statin therapy in adults who are at high risk, adding ezetimibe is reasonable and, when appropriate, a PCSK9 inhibitor or bempedoic acid may be considered.9 • LDL-lowering is recommended for primary prevention in adults aged 40 to 75 with diabetes, chronic kidney disease stage 3 or 4 or human immunodeficiency virus, regardless of LDL-C level. After age 75 years, LDL-C-lowering pharmacotherapy can be considered alongside lifestyle interventions to reduce ASCVD risk9 • In patients with persistently elevated triglycerides (TG), statin therapy remains the foundation as an adjunct to lifestyle intervention to reduce ASCVD risk. Treatment to prevent pancreatitis may also include TG-lowering therapies, especially in individuals with TG levels ≥1000 mg/dL (11.3 mmol/L).9 Blood Pressure Management The 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines integrates the PREVENT equations to refine treatment thresholds.10 The guideline recommends using the PREVENT-CVD outcome-specific equation to estimate 10-year risk of total CVD to inform management decisions for Stage 1 hypertension (systolic blood pressure [SBP] 130-139 mm Hg or diastolic blood pressure [DBP] 80-89 mm Hg) among adults without known CVD, diabetes or CKD. Considerations for Antihypertensive Therapy • Initiating medication therapy to lower blood pressure in addition to lifestyle interventions is recommended for all adults with average blood pressure ≥140/90 mm Hg and/or for selected adults with average blood pressure ≥130/80 mm Hg who have clinical CVD, previous stroke, diabetes, chronic kidney disease or increased 10-year predicted cardiovascular risk of ≥7.5% as defined by the PREVENT-CVD. • For adults with average blood pressure ≥130/80 mm Hg and at a lower 10-year cardiovascular disease risk defined by PREVENT-CVD of <7.5%, initiating medication therapy to lower blood pressure is recommended if average blood pressure remains ≥130/80 mm Hg after an initial three- to six-month trial of lifestyle modification. • For adults with Stage 2 hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg), antihypertensive therapy is recommended regardless of estimated PREVENT-CVD risk. Heart Failure (HF) Management For management decisions about HF prevention therapies, the PREVENT-HF equations may help inform clinician-patient discussions. For further guidance on management of heart failure beyond the CKM framework, clinicians should continue to follow current recommendations for HF prevention from The 2026 AHA/ ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-KidneyMetabolic Syndrome: A Report of the American College of Cardiology/ American Heart Association Joint Committee on Clinical Practice Guidelines. • Cardiac biomarker assessment (natriuretic peptides and/or high-sensitivity troponin) can be considered in those with CKM syndrome who are at increased 10-year predicted HF risk (PREVENT-HF ≥5%)
12 Use PREVENT Equations to Guide Diagnostic Testing and Pharmacotherapy While working in tandem with patients aged 30 to 79 to arrive at an informed treatment decision for primary prevention of cardiovascular disease, consider these important recommendations: PREVENT-CVD, PREVENT-ASCVD and PREVENT-HF Use the “CPR” Model: Step 1 Calculate patient baseline 10-year risk for PREVENT-CVD, PREVENT-ASCVD, and PREVENT-HF. Step 2 Personalize the estimated risk by considering 30-year ASCVD risk and ASCVD risk enhancers for patients at low risk (<3%) and borderline risk (3 to <5%) with PREVENT-ASCVD. For patients at lower risk (<7.5%) and increased risk (7.5 to <20%) with PREVENT-CVD, consider their 30-year CVD risk and CKM risk enhancers. Step 3 Possibly Reclassify a patient’s risk estimate with selective use of cardiac biomarker testing followed by transthoracic echocardiogram (TTE) if indicated, or CAC scoring, and Reassess treatment recommendations as needed.2,9 PREVENT-CVD • Use the PREVENT equations to inform CKM syndrome staging. Begin by evaluating CKM risk factors, then calculate CVD risk with the PREVENT-CVD equations. A 10-year PREVENT-CVD estimated ≥20% is defined as a risk equivalent to CKM syndrome Stage 3. Intensify CKM therapies as indicated.11 • For patients with lower (<7.5%) risk, consider 30-year PREVENT-CVD risk and CKM risk enhancers. • When 10-year predicted CVD risk using PREVENT-CVD is increased (7.5% to <20%), cardioprotective therapy, such as sodium-glucose cotransporter-2 inhibitors (SGLT2i) and/or glucagon-like peptide-1 (GLP-1)-based therapies should be initiated for patients with CKM syndrome Stage 2-3 with type 2 diabetes.11,2 • For patients with increased (≥7.5%) PREVENT-CVD risk, initiating intensive blood pressure-lowering drug therapy is recommended for BP ≥130/80 mm Hg.11,2 The PREVENT equations use a 7.5% 10-year total CVD risk threshold to guide treatment decisions for antihypertensive therapy, which is lower than the PCE (10-year ASCVD risk ≥10%).2 • For patients with high (≥20%) PREVENT-CVD risk, intensify CKM therapies as indicated.11 • Apolipoprotein B (ApoB) testing is reasonable to improve risk assessment and guide therapy once LDL-C and nonHDL-C goals are met, particularly in those with elevated triglycerides (TG) (>150 mg/dL), diabetes or low achieved LDL-C (<70 mg/dL). ApoB measurement helps identify adults with residual elevated lipoprotein-related risk that may be underestimated by the standard profile alone and may be useful in the diagnosis of specific lipid and lipoprotein disorders.9 PREVENT-ASCVD • Personalize risk assessment by considering 30-year ASCVD risk and ASCVD risk enhancers for patients at low risk (<3%) and borderline risk (3 to <5%).2 • For patients at low risk, consider moderate intensity lipidlowering therapy if LDL-C is 160-189 mg/dL or 30-year risk is ≥10% (ages 30 to 59).11 • Consider coronary artery calcium (CAC) scoring when treatment remains uncertain for patients with borderline risk (3 to <5%). CAC scoring in men at least 40 years of age and women at least 45 years of age can improve risk assessment and guide LDL-C and non-HDL-C goals. Both the absolute amount of CAC and the corresponding standardized percentile (currently based on age, sex and race) have prognostic importance and help to reclassify risk in adults.9 Consider moderate intensity lipid-lowering therapy if additional risk enhancers are present.11 • When 10-year predicted ASCVD risk using PREVENT-ASCVD Top Take-Home Messages for Clinicians Using the PREVENT- ASCVD Equations AHA RESOURCE: Top Take-Home Messages for Clinicians: CKM Syndrome AHA RESOURCE:
13 A Toolkit for Healthcare Professionals is intermediate (3% to <10%), consider CAC scoring to evaluate for subclinical atherosclerosis in the setting of treatment uncertainty.2, 11 • LLT for primary prevention of ASCVD is reasonable for adults with a 10-year PREVENT-ASCVD risk estimate of 3% to <5%, and is recommended for those at 5% to <10%, after a clinician-patient discussion.2,9 • Consider LLT when 10-year predicted ASCVD risk using PREVENT-ASCVD is 3% to <5% after evaluating risk enhancers, 30-year ASCVD risk or CAC scoring in select individuals when there is treatment uncertainty.11 • Initiate LLT when 10-year predicted ASCVD risk using PREVENT-ASCVD is high (≥10%).11 • Measure lipoprotein(a) at least once to identify patients at higher risk of ASCVD. It’s considered a risk-enhancing factor at levels ≥125 nmol/L (50 mg/dL), which is associated with about a 1.4-fold increase in ASCVD risk, and values ≥250 nmol/L (100 mg/dL) are associated with ≥2-fold higher estimated risk. The presence of elevated Lp(a) should indicate more intensive LDL-C lowering and management of other risk factors.9 PREVENT-HF Consider cardiac biomarker testing, such as B-type natriuretic peptide (BNP), N-terminal pro b-type natriuretic peptide (NT-proBNP) or high-sensitivity cardiac troponin (hs-cTn) and/or transthoracic echocardiogram (TTE) when 10-year predicted HF risk using PREVENT-HF is increased (≥5%) and use preventive therapies as indicated.11 For patients with pre-HF as indicated by biomarker/TTE, use lifestyle modification and coordinated care to intensify preventive therapies as indicated.2 Use of Predicted Risk and Expected Benefit to Guide Decision-Making in Cardiovascular-KidneyMetabolic Syndrome for the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology AHA SCIENTIFIC STATEMENT: Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology | Hypertension AHA SCIENTIFIC STATEMENT:
14 Clinical Implementation of the PREVENT Equations Example: How can you integrate the PREVENT equations into your workflow? Here is an example of a patient for whom LLT would be appropriate when using the PREVENT equations: Patient: 58-year-old woman Medical History: • Hypertension treated with lisinopril • Type 2 diabetes • BMI: 33 kg/m² • No prior cardiovascular disease • Nonsmoker • No chronic kidney disease Clinical Data: • Total cholesterol: 220 mg/dL • HDL cholesterol: 45 mg/dL • LDL cholesterol: 145 mg/dL • Systolic blood pressure: 138 mm Hg (treated) • Hemoglobin A1c: 7.4% • Estimated glomerular filtration rate (eGFR): 92 mL/min/1.73m2 PREVENT Risk Assessment Using the PREVENT equations, the patient’s estimated 10-year risk of ASCVD is 8.3%, placing her in an intermediate risk category. Clinical Interpretation A 10-year ASCVD risk above 7.5% suggests a meaningful likelihood of developing a cardiovascular event over the next decade. Given her: • Elevated LDL cholesterol (145 mg/dL) • Diabetes • Hypertension • Obesity • Intermediate PREVENT-estimated cardiovascular risk Initiating lipid-lowering therapy is recommended as part of a comprehensive risk-reduction strategy. Example Patient Discussion “Based on your health information, your chance of developing a problem in your heart or blood vessels over the next 10 years is 8.3%. That means out of 100 people like you, with similar risk factors, approximately 8 will likely develop ASCVD in the next 10 years. Much of this risk is related to factors we can address, including your cholesterol level. Starting a cholesterol-lowering medication, such as a statin, can help lower your risk and reduce the likelihood of future heart disease, stroke or heart failure.” The PREVENT equations are intended to support clinicianpatient discussions by estimating overall CVD risk in addition to ASCVD and HF. LLT should still be guided by current cholesterol management guidelines, incorporating: • LDL-C level • Presence of diabetes • Age • Overall PREVENT-estimated risk • Patient preferences and shared decision-making This type of patient is a good example because the PREVENT equations identify intermediate cardiovascular risk driven by traditional risk factors as well as obesity and diabetes, helping to inform a conversation about the potential benefit of LLT. Integration of PREVENT equations into the electronic health record systems is underway to support clinical workflow and risk assessment. Electronic Health Record Integration
A Toolkit for Healthcare Professionals 15 1. Aggarwal R, Ostrominski J, Vaduganathan M. Prevalence of Cardiovascular-KidneyMetabolic Syndrome Stages in US Adults, 2011-2020. JAMA Network. 2024;331;(21):18581860. doi:10.1001/jama.2024.6892. 2. Khan SS, Bhave N, Blumenthal RS, Coresh J, Huang X, Joseph JJ, Khera A, Ho JE, LloydJones DM, Low Wang CC, Lu Y, Morris PB, Nasir K, Natarajan P, Rangaswami J, Rodriguez F, Sperling LS, Virani SS, Zhang S, Ndumele CE. Use of Predicted Risk and Expected Benefit to Guide Decision-Making in Cardiovascular- Kidney-Metabolic Syndrome for the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology, Circulation, 2026;154(4). doi/10.1161/CIR.0000000000001447. 3. Khan SS, Coresh J, Pencina MJ, et al; American Heart Association. Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation. 2023;148(24):19822004. doi:10.1161/CIR.0000000000001191. 4. Khan SS, Matsushita K, Sang Y, et al. Development and Validation of the American Heart Association Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) Equations. Circulation 2023;149(5):430-449. DOI: 10.1161/CIRCULATIONAHA.123.067626. 5. Krishnan V, Huang X, Perak AM, Coresh J, Ndumele CE, Greenland P, Lloyd-Jones DM, Khan SS. PREVENT risk age equations and population distribution in US adults. JAMA cardiology. 2025;10:962-964. DOI: 10.1001/ jamacardio.2025.2427. 6. Krishnan V, Huang X, Zhang S, Shah NS, Navar AM, Coresh J, Rangaswami J, Ho JE, Khera A, Blumenthal RS, Pencina M, LloydJones DM, Greenland P, Ndumele CE, Khan, SS. Age and sex-specific percentiles of 30-year cardiovascular disease risk based on the PREVENT equations. Journal of the American College of Cardiology. 2025;86:2017-2027. DOI: 10.1016/j.jacc.2025.09.1509. 7. Schutte AE, Pilote L. Implementing the PREVENT Risk Equation in the 2025 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2025;82(10):1541-1544. doi:10.1161/HYPERTENSIONAHA.125.25465. 8. Khan SS, Matsushita K, Sang Y, et al; Chronic Kidney Disease Prognosis Consortium and the American Heart Association CardiovascularKidney-Metabolic Science Advisory Group. Development and Validation of the American Heart Association’s PREVENT Equations. Circulation. 2024;149(6):430-449. doi:10.1161/ CIRCULATIONAHA.123.067626. 9. ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/ American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(17):e1154-e1276. doi:10.1161/ CIR.0000000000001423. How PREVENT handles medication use. 10. AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/ AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;152(11):e114-e218. doi:10.1161/CIR.0000000000001356. 11. Top Take-Home Messages for Clinicians: Using the PREVENT Equations for RiskBased Cardiovascular-Kidney-Metabolic (CKM) Syndrome Management; https:// professional.heart.org/en/science-news/-/ media/3709C2459E924575B12A2E2435E97185. ashx. Top Takeaway: Adopt the PREVENT Equations Into Your Workflow Today It’s important for clinicians in the primary care setting to implement the PREVENT equations for the primary prevention of CVD in routine clinical practice. Use the PREVENT online calculator during annual wellness or management visits for adults aged 30 to 79 years without CVD to guide personalized prevention treatment decisions. Compared to the older PCE, the PREVENT equations offer numerous advantages, including use of a larger, more contemporary and diverse dataset of over 6.5 million U.S. adults, earlier risk calculation starting at age 30, equations with predictors for kidney and metabolic health to support a more holistic approach for screening, assessing risk and preventing CVD among patients with or at risk for CKM syndrome, optional markers (such as UACR, HbA1c and SDI), and a broader view of long-term health a decade earlier than previous tools. Additional resources: References WEBINAR/TUTORIAL: American Heart Association PREVENT™ Online Calculator Clinical Slide Decks
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