Recent research published in the Journal of the American Heart Association, an open-access, peer-reviewed publication from the American Heart Association, reveals that the PREVENT risk calculator effectively detects individuals with plaque accumulation in the coronary arteries while also forecasting their likelihood of experiencing a future heart attack.
Furthermore, integrating the PREVENT calculator with a coronary artery calcium score enhances the precision of risk assessment. Notably, patients identified as having the highest heart attack risk through this combined approach aligned closely with the cohort that actually suffered heart attacks during the study’s observation period.
“These results hold significant value because improved accuracy in predicting heart attack risk enables healthcare providers to customize patient care more effectively and pinpoint those who stand to gain the most from preventive interventions, such as medications to lower cholesterol levels,” explained lead author Morgan Grams, M.D., Ph.D., who serves as the Susan and Morris Mark Professor of Medicine and Population Health at New York University’s Grossman School of Medicine in New York City.
Launched by the American Heart Association in 2023, the PREVENT (Predicting Risk of cardiovascular disease EVENTs) calculator provides estimates for both 10-year and 30-year risks of heart attack, stroke, heart failure, or a combination thereof in adults starting from age 30. This sophisticated tool incorporates a wide array of factors, including age, blood pressure readings, cholesterol levels, body mass index, status of Type 2 diabetes, social determinants of health, smoking habits, and kidney function metrics to project the probability of future cardiovascular events like heart attacks, strokes, or heart failure.
A key method for evaluating cardiac health involves coronary computed tomography angiography (CCTA), which is a non-invasive imaging procedure designed to detect and visualize plaque deposits within the arteries supplying the heart. From CCTA results, clinicians derive a coronary artery calcium (CAC) score, a critical metric that guides decisions on preventing and managing heart disease, including determining the suitability of initiating statin therapy or other cholesterol-reducing treatments.
For this investigation, the research team examined the alignment between PREVENT risk scores and the degree of calcium buildup as quantified by CAC scores. They further evaluated the predictive power of PREVENT assessments and CAC scores—both individually and together—for anticipating heart attack occurrences, benchmarking their performance against actual heart attack events recorded among study participants during follow-up.
The researchers analyzed electronic health records from approximately 7,000 adults who underwent CCTA screening at NYU Langone Health in New York City from 2010 to 2024. Key findings across the entire participant group included the following:
- The PREVENT tool classified heart attack risk as low (under 5%) for 43.6% of patients; mildly elevated (5%-7.5%) for 15.8%; moderately elevated (7.5%-20%) for 34.4%; and high (over 20%) for 6.2% of the study population.
- PREVENT scores demonstrated a strong positive correlation with CAC scores. Individuals with elevated PREVENT scores, signaling greater heart attack risk, consistently showed higher CAC scores. Specifically, low-to-mildly elevated PREVENT risk levels corresponded to CAC scores of 1 or below, indicative of minimal heart attack risk, whereas moderate-to-high PREVENT risk aligned with CAC scores exceeding 100, signifying moderate-to-high risk.
- By incorporating CAC scores into the PREVENT framework to refine future heart attack risk predictions, the combined metrics proved superior in pinpointing participants at elevated risk who subsequently experienced heart attacks during the monitoring phase.
“Our results highlight PREVENT’s reliability in spotting individuals with subclinical cardiovascular disease risk—essentially, arterial blockages that precede any noticeable symptoms,” noted Grams. “Drawing from a real-world patient population, these insights carry substantial weight for informing upcoming clinical guidelines on deploying the PREVENT calculator alongside coronary computed tomography angiography.”
Sadiya Khan, M.D., MSc., FAHA, a study co-author and volunteer expert with the American Heart Association, emphasized the role of CAC scoring in stratifying heart disease risk through quantification of calcium deposits. “Performing CT scans to assess coronary calcium presence and extent can prove invaluable for patients ambivalent about commencing lipid-lowering therapy or needing to escalate such treatments. With a robust arsenal of risk-reduction strategies at our disposal, optimizing therapies—particularly for high-risk individuals—is paramount,” stated Khan, who led the writing committee for the Association’s 2023 Scientific Statement introducing PREVENT, titled Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health.
Study Methodology, Participant Details, and Design Elements:
- Investigators sifted through over 9 million electronic health records at NYU Langone Health, focusing on adults who received coronary computed tomography angiography from 2010 to 2024.
- The final cohort comprised 6,961 adults aged 30 to 79 years without prior heart disease history. The group’s mean age was 57.5 years, with 53% female participants and 77% identified as white in their records.
- Researchers compared participants’ CAC scores against PREVENT scores derived from electronic health data encompassing demographics, vital signs, lab results, and comorbid conditions.
- Heart attack incidents were tracked via standard ICD-10 diagnostic codes in the records, yielding 485 events over an average follow-up of 1.2 years.
- The team assessed predictive accuracy by contrasting standalone PREVENT or CAC scores against their combined use, relative to confirmed heart attack cases per ICD-10 documentation.
Despite its strengths, the study faced certain limitations. It was conducted at a single medical center, and most participants were white, potentially limiting generalizability to broader demographics. Only individuals who had received coronary calcium screening were included, and data relied exclusively on electronic health records. The follow-up duration averaged just 1.2 years, non-calcified plaque was not evaluated, and the referral-based nature of CCTA/CAC testing may have inflated calcium prevalence among lower-risk individuals compared to the wider population, as these patients likely harbored more cardiovascular risk factors.
