Association Between Predicting Risk of Cardiovascular Disease Events (PREVENT) Risk Scores and Subclinical Cardiovascular Disease: Insights From the Project Baseline Health Study

BACKGROUND: The American Heart Association Predicting Risk of Cardiovascular Disease Events risk scores estimate cardiovascular disease (CVD) risk, including heart failure (HF) and atherosclerotic CVD (ASCVD) events. Whether they associate with subclinical CVD in an asymptomatic community population is unknown. METHODS: We analyzed 1138 participants from the multicenter PBHS (Project Baseline Health Study) cohort, who underwent echocardiography and coronary artery calcium scoring and were free of known CVD. Subclinical CVD was defined as the presence of subclinical HF or subclinical coronary artery disease. Subclinical HF included left ventricular diastolic dysfunction, left ventricular hypertrophy, or low ejection fraction (<50%). Subclinical coronary artery disease was defined as coronary artery calcium >0. Predicting Risk of CVD Events 10-year risk score associations with subclinical CVD were assessed using logistic regression and area under the receiver operating characteristic curve analysis. RESULTS: Median age was 52 (41-64) years; 64% were White; and 57% were women. Subclinical HF was found in 182 (16%) participants, predominantly with left ventricular diastolic dysfunction (14%). Diastolic dysfunction prevalence increased from 5.8% in low-risk HF groups to 44.1% in intermediate-/high-risk HF groups. Each unit increase in 10-year HF risk corresponded to 2.67-fold higher odds of diastolic dysfunction (95% CI, 2.25-3.18; area under the curve, 0.81). Subclinical coronary artery disease was present in 466 (41%) participants, with prevalence increasing from 28.5% in low-risk ASCVD groups to 79.3% in intermediate-/high-risk ASCVD groups. Each unit increase in 10-year ASCVD risk was associated with 2.91-fold higher odds of any coronary calcification (95% CI, 2.54-3.35; area under the curve, 0.80), increasing to 4.76-fold for coronary artery calcium >100 (95% CI, 3.70-6.12; area under the curve, 0.86) and 5.60-fold for coronary artery calcium >300 (95% CI, 3.89-8.05; area under the curve, 0.87). CONCLUSIONS: In an asymptomatic CVD-free community sample, subclinical CVD was increasingly associated with higher 10-year HF and ASCVD risks calculated by the Predicting Risk of CVD Events equations.