Roy O Mathew, Sadiya S Khan, Katherine R Tuttle, Jennifer E Ho, Dmitry Abramov, Sripal Bangalore, Mandeep S Sidhu, Chiadi E Ndumele, Tiffany M Powell-Wiley, Ian J Neeland, Josef Coresh, Mitchell S V Elkind, Janani Rangaswami
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We assessed the discrimination and calibration performance of ASCVD prediction with PREVENT ASCVD compared with a previous risk-prediction score, pooled cohort equations (PCEs). Among 2,500,291 veterans aged 30-79 years (93.9% men and 6.1% women), 407,342 total CVD events occurred over a median (interquartile range (IQR)) follow-up of 5.8 (IQR = 3.1-8.3) years. The Concordance index (C-index) (95% confidence interval (CI)) for PREVENT-CVD was 0.65 (95% CI = 0.65-0.65) in the overall sample and was similar across different race and ethnic groups (Asian, Native Hawaiian or Pacific Islander, 0.70 (95% CI = 0.69-0.71); Hispanic, 0.70 (95% CI = 0.69-0.70); non-Hispanic Black. 0.68 (95% CI = 0.68-0.69) and non-Hispanic White, 0.65 (95% CI = 0.64-0.65)). C-indices were similar between PREVENT ASCVD and PCEs and ranged from 0.61 to 0.63. Calibration slopes for PREVENT-CVD and -ASCVD in the overall sample were 1.09 (s.e. = 0.04) and 1.15 (s.e. = 0.04), respectively. In contrast, PCEs demonstrated overprediction for ASCVD with a calibration slope of 0.51 (s.e. = 0.06). Calibration slopes for PREVENT and PCEs were similar across race and ethnic groups. Among US veterans, the PREVENT equations accurately estimated CVD and ASCVD risk with some variability across race and ethnicity groups and outperformed PCEs for ASCVD risk prediction.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":" ","pages":""},"PeriodicalIF":58.7000,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Performance of the American Heart Association's PREVENT risk score for cardiovascular risk prediction in a multiethnic population.\",\"authors\":\"Roy O Mathew, Sadiya S Khan, Katherine R Tuttle, Jennifer E Ho, Dmitry Abramov, Sripal Bangalore, Mandeep S Sidhu, Chiadi E Ndumele, Tiffany M Powell-Wiley, Ian J Neeland, Josef Coresh, Mitchell S V Elkind, Janani Rangaswami\",\"doi\":\"10.1038/s41591-025-03789-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>The Predicting Risk of Cardiovascular EVENTS (PREVENT) equations, created and endorsed by the American Heart Association, provide cardiovascular risk estimates for the general population, but have not yet been tested in multiethnic populations. 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The Concordance index (C-index) (95% confidence interval (CI)) for PREVENT-CVD was 0.65 (95% CI = 0.65-0.65) in the overall sample and was similar across different race and ethnic groups (Asian, Native Hawaiian or Pacific Islander, 0.70 (95% CI = 0.69-0.71); Hispanic, 0.70 (95% CI = 0.69-0.70); non-Hispanic Black. 0.68 (95% CI = 0.68-0.69) and non-Hispanic White, 0.65 (95% CI = 0.64-0.65)). C-indices were similar between PREVENT ASCVD and PCEs and ranged from 0.61 to 0.63. Calibration slopes for PREVENT-CVD and -ASCVD in the overall sample were 1.09 (s.e. = 0.04) and 1.15 (s.e. = 0.04), respectively. In contrast, PCEs demonstrated overprediction for ASCVD with a calibration slope of 0.51 (s.e. = 0.06). Calibration slopes for PREVENT and PCEs were similar across race and ethnic groups. 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引用次数: 0
摘要
由美国心脏协会创建并认可的心血管事件风险预测（prevention）方程为一般人群提供了心血管风险估计，但尚未在多种族人群中进行测试。在目前的研究中，在美国退伍军人的一个全国性的多种族样本中，预防用于预测总心血管疾病(CVD：致死性和非致死性心肌梗死、中风或心力衰竭；预防- cvd)、动脉粥样硬化性心血管疾病(ASCVD：致死性和非致死性心肌梗死或中风；预防ASCVD)和心力衰竭进行评估。我们将prevention ASCVD与先前的风险预测评分、合并队列方程（pce）相比较，评估了ASCVD预测的鉴别和校准性能。在2,500,291名30-79岁的退伍军人中（男性占93.9%，女性占6.1%），在中位（四分位间距（IQR）） 5.8年（IQR = 3.1-8.3）的随访期间，总共发生了407,342例CVD事件。在整个样本中，prevention - cvd的一致性指数（C-index）（95%置信区间（CI））为0.65 (95% CI = 0.65-0.65)，在不同种族和民族群体中相似(亚洲人、夏威夷原住民或太平洋岛民，0.70 (95% CI = 0.69-0.71)；西班牙裔，0.70 (95% CI = 0.69-0.70)；非西班牙裔黑人为0.68 (95% CI = 0.68-0.69)，非西班牙裔白人为0.65 （95% CI = 0.64-0.65）。c -指数在PREVENT ASCVD和pce之间相似，范围为0.61 ~ 0.63。整体样品中prevention - cvd和-ASCVD的校准斜率分别为1.09 （s.e = 0.04）和1.15 （s.e = 0.04）。相比之下，pce对ASCVD的校准斜率为0.51 （s.e. = 0.06）。不同种族和民族的PREVENT和pce的校准斜率相似。在美国退伍军人中，prevention方程准确地估计了CVD和ASCVD的风险，在种族和民族群体中存在一些差异，并且在ASCVD风险预测方面优于pce。
Performance of the American Heart Association's PREVENT risk score for cardiovascular risk prediction in a multiethnic population.
The Predicting Risk of Cardiovascular EVENTS (PREVENT) equations, created and endorsed by the American Heart Association, provide cardiovascular risk estimates for the general population, but have not yet been tested in multiethnic populations. In the present study, in a large nationwide multiethnic sample of US veterans, the utility of PREVENT to predict the risk of total cardiovascular disease (CVD: fatal and nonfatal myocardial infarction, stroke or heart failure; PREVENT-CVD), atherosclerotic cardiovascular disease (ASCVD: fatal and nonfatal myocardial infarction or stroke; PREVENT ASCVD) and heart failure was evaluated. We assessed the discrimination and calibration performance of ASCVD prediction with PREVENT ASCVD compared with a previous risk-prediction score, pooled cohort equations (PCEs). Among 2,500,291 veterans aged 30-79 years (93.9% men and 6.1% women), 407,342 total CVD events occurred over a median (interquartile range (IQR)) follow-up of 5.8 (IQR = 3.1-8.3) years. The Concordance index (C-index) (95% confidence interval (CI)) for PREVENT-CVD was 0.65 (95% CI = 0.65-0.65) in the overall sample and was similar across different race and ethnic groups (Asian, Native Hawaiian or Pacific Islander, 0.70 (95% CI = 0.69-0.71); Hispanic, 0.70 (95% CI = 0.69-0.70); non-Hispanic Black. 0.68 (95% CI = 0.68-0.69) and non-Hispanic White, 0.65 (95% CI = 0.64-0.65)). C-indices were similar between PREVENT ASCVD and PCEs and ranged from 0.61 to 0.63. Calibration slopes for PREVENT-CVD and -ASCVD in the overall sample were 1.09 (s.e. = 0.04) and 1.15 (s.e. = 0.04), respectively. In contrast, PCEs demonstrated overprediction for ASCVD with a calibration slope of 0.51 (s.e. = 0.06). Calibration slopes for PREVENT and PCEs were similar across race and ethnic groups. Among US veterans, the PREVENT equations accurately estimated CVD and ASCVD risk with some variability across race and ethnicity groups and outperformed PCEs for ASCVD risk prediction.
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