Novel equations estimate long-term risk from cardiovascular-kidney-metabolic syndrome

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Key takeaways:

• The new AHA PREVENT equations are designed to predict long-term absolute risk tied to CV-kidney-metabolic syndrome.
• An online calculator to estimate benefit of specific preventive therapies is in development.

PHILADELPHIA — A speaker unveiled the American Heart Association’s new PREVENT equations to evaluate 10- and 30-year absolute risk associated with cardiovascular-kidney-metabolic syndrome.

Details on the PREVENT equations were presented at the AHA Scientific Sessions and simultaneously published in Circulation.

“The current guidelines for primary prevention released in 2019 offer several recommendations focusing on risk assessment of cardiovascular disease for U.S. adults. This framework … is to calculate risk for U.S. adults aged 40 to 79 years using the pooled cohort equations or the [atherosclerotic] CVD risk calculator to identify individuals who are at high risk. Now, this risk-based framework continues to be the foundation of how we move forward for prevention, but there are significant limitations in 2023 with the [pooled cohort equation] model,” Sadiya Sana Khan, MD, MSc, FACC, FAHA, associate professor of medicine and preventive medicine, associate program director of the cardiovascular disease fellowship and director of research in the section of heart failure at Northwestern University Feinberg School of Medicine, said during a press conference. “First, they were developed only in Black and white adults in a relatively small sample, so they may not be generalizable to the diverse U.S. population. They begin at age 40 and so can’t be used in younger adults when we know the burden of [cardiovascular-kidney-metabolic disease] is increasing, particularly in young adulthood. Third, they relied on historical data from the ’80s and ’90s, and the population-level burden of risk factors has changed, as have treatments to address these gaps. The [cardiovascular-kidney-metabolic] working group on risk prediction, co-led by myself and Josef Coresh, MD, PhD, FAHA, developed the AHA predicting risk of CVD events, or the AHA PREVENT, equations.”

As Healio previously reported, the AHA coined the term “cardiovascular-kidney-metabolic syndrome” to highlight the ties between metabolic and renal risk factors and CVD risk.

The PREVENT equations were developed using real-world contemporary datasets including more than 6 million adults and includes HF risk in addition to risk for MI and stroke; omit race from CVD clinical care algorithms; include kidney function on top of traditional CVD risk factors for heart disease; and include components such as social determinants of health, blood glucose and kidney function, when clinically available.

“A key conceptual advance in the PREVENT equations is this endorsement of the life course perspective of prediction and prevention,” Khan said during the press conference. “Importantly, this framework highlights the upstream drivers or social determinants of health that are critical to the determinants or [cardiovascular-kidney-metabolic] factors and lead to subclinical disease and disease manifestations.”

With use at age 30 years, the PREVENT equations would enable 10- and 30-year total CV risk estimates and aid clinical decision-making in terms of intervention strategy based on predicted risk and expected benefit, Khan said.

“We are developing an online calculator that will support clinicians to start these conversations with patients to guide holistic and patient-centered preventive care,” Khan said during the press conference.

“The amount of benefit of a specific therapy is directly related to that predicted risk. … This will help us guide if, when and which therapies should be considered and allow us to move beyond statins as a solo approach for prevention. It’s not a question of replacing statins, but ‘statins and?’” Khan said. “We need to take the long view to target upstream social determinants of health. As we know those are upstream of the drivers and determinants of disease as we think and move forward in how we can optimize [cardiovascular-kidney-metabolic] health for everyone in the U.S. population.”

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