External validation of the 2023 American Heart Association Predicting Risk of cardiovascular disease EVENTs equations for atherosclerotic cardiovascular disease in primary cardiovascular prevention setting and comparison with 2021 Systematic COronary Risk Evaluation and 2013 Pooled Cohort Equations
Authors' conclusion
Our study confirmed the PREVENT model demonstrated adequate discrimination and calibration capabilities, along with significant clinical utility, particularly at intermediate-risk thresholds. However, it did not outperform the established models, SCORE2 or PCE. Additionally, PREVENT may systematically underestimate risk, which could raise concerns about the underprescription of preventive treatments.
Study context
- Population
- Swiss prospective cohort, aged ≥40, without pre-existing atherosclerotic cardiovascular disease (ASCVD), primary prevention4,356 followed
- Participants
- 5,064 participants
- Comparison
- PREVENT vs SCORE2 and Pooled Cohort Equation (PCE)
- Outcome
- Adjudicated ASCVD events (fatal and non-fatal MI and strokes)
- Follow-up
- Median 9 years
Methodological detailsprospective cohort
- Prospective cohort
Performance
As reported in the abstract
Adjudicated ASCVD events
| Test or model | C-index | Observed/Expected ratio |
|---|---|---|
| PREVENT | 76% (95% CI 0.73 to 0.79) | 1.45 (95% CI 1.44-1.46) |
PREVENT
C-index76% (95% CI 0.73 to 0.79)
Observed/Expected ratio1.45 (95% CI 1.44-1.46)
- First incident ASCVD
- 224
Further findings
- Positive clinical utility across all subgroups, particularly at 7.5% threshold
Original publication
External validation of the 2023 American Heart Association Predicting Risk of cardiovascular disease EVENTs equations for atherosclerotic cardiovascular disease in primary cardiovascular prevention setting and comparison with 2021 Systematic COronary Risk Evaluation and 2013 Pooled Cohort Equations. Eur J Prev Cardiol. Published 30 May 2025. doi:10.
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