Taking the long and total view in new AHA CV risk equations

AHA 2023 The AHA has developed new equations for CVD risk assessment with optional equations that include cardiovascular-kidney-metabolic (CKM) health and the endorsement of the life course perspective on prediction and prevention of CVD.

Presented at the AHA Scientific Sessions 2023 by: Sadiya Khan, MD - Chicago, IL, US

Introduction

The 2019 ACC/AHA guidelines on the primary prevention of CVD provide recommendations focusing on risk assessment of CVD for adults age 40-79 years. The framework in these guidelines is used to calculate risk using the pooled cohort equations (PCEs) or the ASCVD risk calculator to identify individuals at high risk.

This risk-based framework continues to be the foundation of how we move forward for prevention, but it has several limitations. First, it was developed only in black and white adults in a relatively small sample and therefore not generalizable to the entire, diverse population. Second, it begins at age 40 and can not be used in younger adults while the burden of cardiovascular-kidney-metabolic syndrome is increasing, particularly in young adulthood. Third, it relies on historical data and the burden of risk factors in the population has changed, as well as treatments.

These gaps were addressed and led to the development of the AHA predicting risk of CVD events – AHA PREVENT™.

Main results

AHA Prevent™

• The base model consists of risk factors including those in the PCEs and kidney function
• There are optional models for personalization of risk prediction
• Developed in >6 million individuals including real-world contemporary datasets to ensure generalizability of these models
• Includes prediction of risk for heart failure in addition to that of MI and stroke
• Removes race from CVD clinical care algorithms
• Optional equations recognize the role of social determinants of health and the need for personalization of risk assessment with additional markers of kidney and metabolic health

Life course perspective on prediction and prevention

• This framework highlight the upstream drivers or social determinants of health that are critical to the determinants or CKM factors leading to subclinical disease and disease manifestations.
• It allows risk assessment to begin at age 30
• It enables 10- and 30-year risk estimations to begin conservations with patients early and expand time horizon for prevention
• It serves as a launching pad top optimize cardiovascular-kidney-metabolic health across the life course

Future directions

• Development of an online calculator that will support clinicians to start conversions with patients to guide holistic and patient-centered preventive care
• Calculating the expected benefit based on risk to determine if and when and which therapies should be considered
• Prioritize equity in CVD prevention: take the long view to target upstream social determinants of health

Conclusion

The new equations developed by the AHA (the American Heart Association Predicting Risk of Cardiovascular Disease EVENTs; PREVENT™) to assess CVD risk with the inclusion of CKM health focusses on a life course perspective on prediction and prevention of CVD.

- Our reporting is based on the information provided at the AHA Scientific Session 2023 -

Find the publication on the PREVENT equations online at CIrculationFind the publication on the novel equations incorporating CKM health online at CIrculation