Research Highlights:
- The American Heart Association's PREVENTTM risk calculator accurately identified participants who had calcium buildup in their heart arteries and those who had a higher future heart attack risk, in an analysis of about 7,000 adults in New York City referred for heart disease screening.
- The PREVENT scores also predicted future heart attack risk.
Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, May 21, 2025
DALLAS, May 21, 2025 — The PREVENTTM risk calculator helped to identify people with plaque buildup in the arteries of the heart, in addition to predicting their risk of a future heart attack, according to new research published today in the Journal of the American Heart Association , an open access, peer-reviewed journal of the American Heart Association.
In addition, when combining PREVENT and a coronary calcium score, risk prediction was further improved, with patients with the highest risk of heart attack matched the group of participants who had a heart attack during the follow-up period.
"These findings are important because when we can better predict a patient's risk of heart attack, we can also tailor care and determine who may benefit from treatment to prevent a heart attack, such as cholesterol-lowering medications," said corresponding author Morgan Grams, M.D., Ph.D., the Susan and Morris Mark Professor of Medicine and Population Health at New York University's Grossman School of Medicine in New York City.
The PREVENT (Predicting Risk of cardiovascular disease EVENTs) risk calculator, released by the American Heart Association in 2023, can estimate 10-year and 30-year risk for heart attack , stroke , heart failure or all three in adults as young as age 30. PREVENT factors in age, blood pressure, cholesterol, body mass index, Type 2 diabetes status, social determinants of health, smoking and kidney function to estimate future risk of heart attack, stroke or heart failure.
One tool for screening heart health is coronary computed tomography angiography (CCTA), a non-invasive imaging test that visualizes plaque buildup in the heart's arteries. From the CCTA, patients are given a coronary artery calcium (CAC) score , which helps to inform decisions about heart disease prevention and treatment, including when it may be appropriate to prescribe cholesterol-lowering medications.
In this study, researchers investigated whether the PREVENT score matched the level of calcium buildup according to the CAC score. In addition, they used the PREVENT risk assessment and coronary artery calcium scores, separately and in combination, to predict future heart attack risk and assessed the accuracy of each with the participants who had a heart attack during the follow-up period.
They reviewed electronic health records for nearly 7,000 adults who had had CCTA screening at NYU Langone Health in New York City between 2010 and 2024.
The analysis found that for all participants:
- The PREVENT tool-estimated risk of a heart attack was low (less than 5%) for 43.6% of patients; mildly elevated (5%-7.5%) for 15.8% of the participants; moderately increased (7.5%-20%) for 34.4.%; and high (more than 20%) for 6.2% of people in the study.
- PREVENT scores were directly correlated with CAC scores, meaning those who had high PREVENT scores, indicating a higher risk of heart attack, matched the group who had higher CAC scores. PREVENT risk ranked as low-to-mildly elevated was associated with CAC of less than or equal to 1, which indicates low risk of heart attack. PREVENT risk ranked as moderate-high was associated with participants who had a CAC score higher than 100, which indicates moderate-to-high risk of heart attack.
- Researchers then added the CAC score to the PREVENT tool to calculate risk of future heart attack, and, together, they more accurately identified the participants who were at higher risk and who had a heart attack during the follow-up period.
"The findings illustrate that PREVENT is accurate in identifying people who may have subclinical risk for cardiovascular disease, meaning blocked arteries before symptoms develop," said Grams. "This study used a real-world set of patients, so our findings are important in shaping future guidelines on the use of the PREVENT calculator and coronary computed tomography angiography."
Study co-author and American Heart Association volunteer expert Sadiya Khan, M.D., MSc., FAHA, said the CAC score can help classify risk for heart disease by analyzing calcium buildup.
"CT scans to evaluate for coronary calcium and extent of coronary artery calcium buildup may be useful when patients are uncertain if they want to start lipid-lowering therapy or if lipid-lowering therapy should be intensified. We have so many tools in our armamentarium for reducing risk of heart attack, we want to be able to optimize treatments for patients, and especially those with higher risk," said Khan, who chaired the writing group for the Association's 2023 Scientific Statement announcing PREVENT, Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health .
Study details, background and design:
- More than 9 million electronic health records at NYU Langone Health in New York City were reviewed and included adults who had coronary computed tomography angiography performed between 2010 and 2024.
- Participants in this analysis included 6,961 adults between the ages of 30 and 79 years with no history of heart disease. Their average age was 57.5 years; 53% were women, and 77% were noted in the electronic health records as white adults.
- Participants' CAC scores were compared to the PREVENT scores calculated based on data in the electronic health records including demographics, vital signs, laboratory values and coexisting conditions.
- Participants who had a heart attack were noted according to the standard ICD-10 diagnosis codes in the electronic health records. Overall, there were 485 heart attacks during the average of 1.2 years of follow-up.
- Investigators evaluated the accuracy of using PREVENT or CAC score vs. both PREVENT and CAC combined to predict heart attack risk and compared this to data for patients with an ICD-10 code for heart attack.
The study had several limitations, including that patients were screened at a single institution and the majority of participants were noted as white, so the findings may not be generalizable to other people. The analysis only included people who had undergone coronary calcium screening, and electronic health records were the sole source of data. In addition, the follow-up time was short at 1.2 years, and the presence of non-calcified plaque in the heart's arteries was not assessed. Finally, the study may overestimate the prevalence of coronary artery calcium in low-risk people since participants in this study were referred for CCTA/CAC score by a health care professional, which means they may have more heart disease risk factors than the general population.
Co-authors, disclosures and funding sources are listed in the manuscript.
