10-Year Heart Disease Risk Calculator (PREVENT)

About the 10-Year Heart Disease Risk Calculator (PREVENT)

The PREVENT equations from the American Heart Association estimate the chance that an adult aged 30 to 79 without heart disease will have a cardiovascular event — a heart attack, stroke or heart failure — in the next 10 years and, up to age 59, the next 30 years. US cholesterol and blood-pressure guidelines now use them to decide who is offered a statin or blood-pressure medicine.

This calculator runs the PREVENT base model on your age, sex, cholesterol, blood pressure, diabetes, smoking, kidney function (eGFR), BMI and medicines, shows the category each result falls in, and adds the older Pooled Cohort Equations (PCE) 10-year ASCVD risk for comparison. Everything is calculated in your browser.

Common uses

• Getting your 10-year risk before a check-up, so you can ask informed questions about statins or blood-pressure treatment.
• Seeing how much quitting smoking or lowering blood pressure would change the estimate (change one input at a time).
• Comparing the new PREVENT result with the PCE result your doctor may have used before.

How PREVENT works

PREVENT was developed and validated in more than 6 million US adults from research cohorts and health-care records. Compared with the PCE it adds kidney function (eGFR), statin use and, for heart failure, BMI; it predicts heart failure as well as atherosclerotic disease; it starts at age 30; and it does not use race. Three outcomes are estimated separately:

• Total cardiovascular disease — heart attack, death from coronary heart disease, stroke or heart failure
• ASCVD (atherosclerotic cardiovascular disease) — heart attack, death from coronary heart disease or stroke
• Heart failure

Because each has its own equation, total CVD is less than ASCVD plus heart failure.

The formula

Each PREVENT model is a logistic equation, risk = eˣ ÷ (1 + eˣ), where x adds a coefficient times each predictor. The predictors are centred and scaled:

• age: (age − 55) ÷ 10, plus age² in the 30-year models
• non-HDL cholesterol in mmol/L − 3.5, and (HDL cholesterol − 1.3) ÷ 0.3
• systolic BP in two parts: (lower of SBP and 110 − 110) ÷ 20 and (higher of SBP and 110 − 130) ÷ 20
• eGFR in two parts: (lower of eGFR and 60 − 60) ÷ −15 and (higher of eGFR and 60 − 90) ÷ −15
• BMI, heart failure only: (lower of BMI and 30 − 25) ÷ 5 and (higher of BMI and 30 − 30) ÷ 5
• diabetes, current smoking, blood-pressure medicine and statin as 1 or 0, with interaction terms for treated blood pressure, treated cholesterol and age

The coefficients are the published base-model values (Supplemental Table S12 of the PREVENT paper); they reproduce the paper’s worked examples exactly.

The Pooled Cohort Equations use natural logs of age, total and HDL cholesterol and systolic BP in four sex and race groups: risk = 1 − S₀^exp(Σβx − mean), with the coefficients, means and baseline survival of Table A of the ACC/AHA risk-assessment guideline.

What the categories mean

• PREVENT 10-year ASCVD risk — the ACC/AHA multisociety dyslipidemia guideline groups it as low (below 3%), borderline (3% to below 5%), intermediate (5% to below 10%) and high (10% or more) when deciding about cholesterol-lowering treatment, together with LDL cholesterol, other risk-enhancing factors and, sometimes, a coronary calcium scan.
• PREVENT 10-year total CVD risk — the AHA/ACC high blood pressure guideline advises medicine for stage 1 hypertension (130–139/80–89 mmHg) when this risk is 7.5% or more, or with diabetes or chronic kidney disease.
• PCE 10-year ASCVD risk — the earlier cholesterol guideline, now replaced, used low (below 5%), borderline (5% to below 7.5%), intermediate (7.5% to below 20%) and high (20% or more).

PREVENT usually gives lower ASCVD estimates than the PCE for the same person, which is why its cut-offs are lower. A category is a starting point for a conversation with your doctor, not a decision.

People of South Asian descent

Neither model was developed specifically for people of South Asian descent. In a Kaiser Permanente study of South Asian adults, the PCE underestimated risk in the low-risk group, and US guidance has counted South Asian ancestry as a risk-enhancing factor. For PREVENT the evidence is still limited: in a large Californian health system it predicted risk reasonably well in Asian Indian patients, but in an Indian study of people admitted with a heart attack, most had not been classed as high risk beforehand by PREVENT or the other scores. If you are of South Asian descent, a "low" result may understate your risk — discuss it with your doctor.

Sources

• Khan SS et al. Development and validation of the American Heart Association’s PREVENT equations. Circulation
• Goff DC Jr et al. ACC/AHA guideline on the assessment of cardiovascular risk — Pooled Cohort Equations, Table A
• ACC/AHA multisociety guideline on the management of dyslipidemia — PREVENT-ASCVD risk categories
• AHA/ACC guideline for the prevention, detection, evaluation and management of high blood pressure in adults — the 7.5% threshold
• Mantri NM et al. Performance of the pooled cohort equation in South Asians. BMC Cardiovascular Disorders
• Performance of the PREVENT equations among disaggregated racial and ethnic subgroups. JAMA Cardiology
• Comparison of ASCVD risk prediction models in STEMI: insights from a South Asian cohort. JACC: Asia

Limitations

• Only for adults aged 30–79 who have never had a heart attack, stroke, heart failure or other cardiovascular disease. If you have, these equations do not apply — your doctor will treat you as high risk.
• The equations were developed in US populations and accept total cholesterol 130–320 mg/dL, HDL 20–100 mg/dL, systolic BP 90–200 mmHg and eGFR 15–140; heart-failure risk needs a BMI from 18.5 to below 40.
• This is the PREVENT base model. The full model can also use urine albumin-to-creatinine ratio, HbA1c and a US ZIP-code deprivation index, which are not included here.
• Some conditions — very high LDL cholesterol, diabetes, chronic kidney disease — can call for treatment whatever the calculated risk; your doctor takes them into account.

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