The Role of Risk Equations in Primary Prevention of Atherosclerotic Cardiovascular Disease

Review The Role of Risk Equations in Primary Prevention of Atherosclerotic Cardiovascular Disease Rishi Rikhi and Michael D. Shapiro * Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA * Correspondence: [email protected]; Tel.: +1-(336)-713-7085; Fax: +1-(336)-716-9188 Received: 24 January 2025; Accepted: 11 February 2025; Published: 1 March 2025 Abstract: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States. The 2018 American Heart Association (AHA)/American College of Cardiology (ACC) blood cholesterol guideline recommends the use of the pooled cohort equations (PCE) for the assessment of 10-year ASCVD risk in participants aged 40–75 years without a history of ASCVD or diabetes, and low-density lipoprotein-cholesterol (LDL-C) ≥70 mg/dL and <190 mg/dL. Recently, AHA released the Predicting Risk of Cardiovascular Disease (CVD) EVENTs (PREVENT) risk equations that calculate both 10- and 30-year ASCVD, CVD, and heart failure (HF) risk in participants aged 30–79 years. This review provides an overview of cardiovascular risk assessment in primary prevention and performance of PREVENT compared to the PCE. PREVENT offers an enhanced approach to cardiovascular risk assessment by integrating markers of cardiovascular, kidney, and metabolic health along with social determinants of health, providing superior calibration and discrimination compared to PCE. PREVENT holds promise for refining statin eligibility and identifying individuals at risk for ASCVD. However, additional research is essential to define clinical thresholds and evaluate its potential in directing the use of emerging preventive therapies.