EVALUATING THE ACCURACY OF THE PREVENT CALCULATOR COMPARED TO THE PCE IN ASSESSING ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK: THE DALLAS HEART STUDY

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2025-09-01 DOI:10.1016/j.ajpc.2025.101152

Gabrielle Schwab MD, Shanice Glasco MD, Colby Ayers MS, Parag Joshi MD, Ann Marie Navar MD, Eric Peterson MD, Anand Rohatgi MD, Amit Khera MD, MSc

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Abstract

Therapeutic Area

ASCVD/CVD Risk Assessment

Background

The predicting risk of cardiovascular disease events (PREVENT) calculator was recently (2023) developed as an updated cardiovascular disease risk calculator from the prior Pooled Cohort Equations (PCE) calculator. Few studies are available comparing the accuracy and implications on risk categorization of using the PREVENT vs. PCE calculator.

Methods

Participants from the Dallas Heart Study first phase (DHS1) aged 40 to 65 without known cardiovascular disease at baseline and with complete follow up data for atherosclerotic cardiovascular disease (ASCVD) events (fatal or non-fatal myocardial infarction or stroke) were included. Discrimination was assessed using the Harrell C-statistic. Calibration was assessed evaluating observed vs. predicted 10-year ASCVD risk across risk deciles using the Nam-D'Agostino χ2 test. Categorical net reclassification was performed by cross-tabulating risk estimates from PREVENT and PCE in those with and without ASCVD events. The predicted risk categories based on clinically relevant treatment thresholds were: <5%, <7.5% and ³7.5% 10-year ASCVD risk. Replication was performed in the Dallas Heart Study second phase (DHS2) cohort which was slightly more contemporary (enrollment 2009 vs. 2001).

Results

The DHS1 cohort comprised 1346 individuals, mean age 49.6 (±6.6) years, 42% male, 48% Black individuals. Applying the PREVENT and PCE calculators resulted in similar c-statistics (0.7291 vs. 0.7253). Both calculator risk estimates diverged from the observed risk deciles (p<0.0001 each) with PREVENT generally underestimating risk and PCE overestimating risk, particularly in the middle and higher deciles (Fig 1,2). Among the 170 individuals who experienced an ASCVD event, PREVENT incorrectly down-classified ASCVD risk compared with PCE in 70 (41%), and only up-classified risk in 3 (Fig 3). Among the 1176 who did not experience an event, PREVENT appropriately down-classified risk in 324 (28%), and up-classified risk in 6 (Fig 4). When evaluating the DHS2 cohort (n=1742, mean age 52 years), similar results were found.

Conclusions

In a large, multiethnic, population-based cohort, the PREVENT calculator had comparable discrimination of ASCVD events as the PCE. Both miscalibrated observed risk, with PREVENT underestimating and PCE overestimating risk. The lower estimates by PREVENT could result in fewer individuals recommended preventive therapies, reducing therapy burden but also potentially increasing ASCVD events.

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评估预防计算器与pce在评估动脉粥样硬化性心血管疾病风险中的准确性：达拉斯心脏研究

治疗领域ascvd /CVD风险评估背景预测心血管疾病事件风险（prevention）计算器是最近（2023年）开发的，作为先前的Pooled Cohort Equations （PCE）计算器的更新版心血管疾病风险计算器。很少有研究可以比较使用预防与PCE计算器对风险分类的准确性和影响。方法纳入来自达拉斯心脏研究第一阶段（DHS1）的参与者，年龄40至65岁，基线时无已知心血管疾病，并有动脉粥样硬化性心血管疾病（ASCVD）事件（致死性或非致死性心肌梗死或卒中）的完整随访数据。使用Harrell c统计量评估歧视。采用Nam-D'Agostino χ2检验，评估观察到的10年ASCVD风险和预测的10年ASCVD风险。在有和没有ASCVD事件的患者中，通过交叉表对prevention和PCE的风险估计进行分类净重新分类。基于临床相关治疗阈值的预测风险类别为：10年ASCVD风险为5%、7.5%和7.5%。在达拉斯心脏研究第二阶段（DHS2）队列中进行了重复研究，该队列稍微更现代（2009年与2001年登记）。结果DHS1队列共1346例，平均年龄49.6（±6.6）岁，男性占42%，黑人占48%。使用PREVENT和PCE计算器得到相似的c统计值（0.7291 vs. 0.7253）。两个计算器的风险估计值都偏离了观察到的风险十分位数（p<；各0.0001），其中prevention通常低估了风险，而PCE高估了风险，特别是在中间和较高的十分位数（图1,2）。在170名经历ASCVD事件的个体中，与PCE相比，prevention错误地降低了70人（41%）的ASCVD风险，只有3人的风险被上调（图3）。在未发生事件的1176人中，prevention适当降低了324人（28%）的风险等级，提高了6人的风险等级（图4）。在评估DHS2队列（n=1742，平均年龄52岁）时，发现了类似的结果。结论：在一个大的、多民族的、基于人群的队列中，预防计算器对ASCVD事件的辨别能力与PCE相当，两者都校准错误，预防低估了风险，而PCE高估了风险。prevention较低的估计值可能导致更少的人推荐预防性治疗，减少治疗负担，但也可能增加ASCVD事件。

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