Journal article
Performance of the American Heart Association PREVENT Cardiovascular Risk Equations in Older Adults
Circulation Cardiovascular quality and outcomes, Vol.18(6), pp.482-491
06/2025
DOI: 10.1161/CIRCOUTCOMES.124.011719
PMCID: PMC12173798
PMID: 40289804
Abstract
The ability of the American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) calculator to accurately assign 10-year atherosclerotic cardiovascular disease (ASCVD) risk in older individuals, including those aged ≥80 years, is unknown. This study compares PREVENT with the 2013 Pooled Cohort Equation (PCE) calculator for predicting 10-year ASCVD risk in a large cohort of older adults.
This was a prospective cohort study of adults without CVD from Australia and the United States aged ≥70 years (≥65 years, if US minorities). They were enrolled from 2010 to 2014 in the ASPREE trial (Aspirin in Reducing Events in the Elderly), a 5-year randomized trial of low-dose aspirin in community-dwelling older adults with posttrial observational follow-up extending to 2022. ASCVD events were adjudicated by expert panels. The discriminative ability of the 2 risk calculators was assessed by Harell C statistic following Cox regression in the 65- to 79-year age group and >80-year age group, separately. For calibration, predicted event numbers were calculated using PREVENT and PCE, scaled for the actual length of follow-up, and compared with the number of observed events in-trial and during extended follow-up.
Among the 15 510 participants aged 65 to 79 years (median age, 73.2 years; 56.1% women), 1084 ASCVD events occurred (median follow-up, 8.3 years); PCE predicted 3102 events while PREVENT predicted 1290 events. For the 2787 participants ≥80 years (median age, 82.6 years; 59.2% women), 355 ASCVD events occurred (median follow-up, 7.4 years); PCE predicted 1067 events while PREVENT predicted 350 events. PREVENT showed superior discriminative performance compared with PCE (PREVENT versus PCE, C statistic, 0.793 versus 0.740;
<0.001 in participants aged 65 -79 years; 0.854 versus 0.799;
<0.001 in those aged ≥80 years).
The PREVENT risk calculator is superior to the PCE calculator in predicting ASCVD events in older adults from the United States and Australia, including those aged ≥80 years.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583. URL: https://www.isrctn.com; Unique identifier: ISRCTN83772183.
Details
- Title: Subtitle
- Performance of the American Heart Association PREVENT Cardiovascular Risk Equations in Older Adults
- Creators
- Michelle A Fravel - University of IowaMichael E Ernst - Department of Family Medicine, Carver College of Medicine (M.E.E.), The University of IowaRobyn L Woods - Monash UniversitySuzanne G Orchard - Monash UniversityShiva Ganjali - Deakin UniversityJames B Wetmore - Hennepin Healthcare Research InstituteChristopher Reid - Curtin UniversityJoanne Ryan - Monash UniversityKevan R Polkinghorne - Monash UniversityRory Wolfe - Monash UniversityMark R Nelson - University of TasmaniaSophia Zoungas - Monash UniversityZhen Zhou - Monash University
- Resource Type
- Journal article
- Publication Details
- Circulation Cardiovascular quality and outcomes, Vol.18(6), pp.482-491
- DOI
- 10.1161/CIRCOUTCOMES.124.011719
- PMID
- 40289804
- PMCID
- PMC12173798
- NLM abbreviation
- Circ Cardiovasc Qual Outcomes
- ISSN
- 1941-7705
- eISSN
- 1941-7705
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Grant note
- National Institute on Aging and the National Cancer Institute at the National Institutes of Health: U01AG029824, U19AG062682 National Health and Medical Research Council of Australia: 334047, 1127060 Monash University and the Victorian Cancer Agency
ASPREE trial (Aspirin in Reducing Events in the Elderly) was supported by grants (U01AG029824 and U19AG062682) from the National Institute on Aging and the National Cancer Institute at the National Institutes of Health, by grants (334047 and 1127060) from the National Health and Medical Research Council of Australia and by Monash University and the Victorian Cancer Agency.
- Language
- English
- Electronic publication date
- 04/28/2025
- Date published
- 06/2025
- Academic Unit
- Family and Community Medicine; Pharmacy Practice and Science
- Record Identifier
- 9984816013102771
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