AHA's new PREVENT 10-year cardiovascular risk and all-cause, CVD, and non-CVD mortality among US adults: The NHANES 2003-2019.

Introduction: The relationship between the American Heart Association's (AHA) new Predicting Risk of cardiovascular disease EVENTs (PREVENT) risk and long-term disease progression, like mortality, is unresolved. We investigated the associations of PREVENT cardiovascular disease (CVD) risk with all-cause, CVD, and non-CVD mortality among adults in the US.

Methods: This cohort study used data from 30,544 adults from 2003-2018 survey cycles of the National Health and Nutrition Examination Survey and linked to the mortality data until 2019. All-cause mortality, further stratified into CVD and non-CVD mortality, were defined by the leading cause of death using the International Classification of Diseases codes. Employing PREVENT's base model and component variables, we estimated 10-year total CVD risk stratified into low (<5%), borderline (5-7.4%), intermediate (7.5-19.9%), and high (≥20%). Multivariable Cox proportional hazards regression (hazard ratio [HR] and 95% confidence interval [CI]) analyses were used.

Results: Participants' mean±SD age was 50.3±13.1 years, with a balanced sex distribution. Compared to individuals with low CVD risk, those with borderline and intermediate risks had a greater risk of all-cause mortality (HR [95% CI], 1.08 [1.03-1.13] and 1.12 [1.08-1.16], respectively). Those with borderline, intermediate, and high risks had a greater risk of CVD mortality (HR [95% CI], 1.11 [1.06-1.16], 1.21 [1.18-1.25], and 1.40 [1.33-1.47], respectively), compared to low-risk individuals. Similar trends were observed for non-CVD mortality. With significant racial/ethnic group-interactions, the associations were evident in Mexican Americans.

Conclusions: Higher PREVENT 10-year CVD risk is associated with higher risk of all-cause, CVD, and non-CVD mortality, and the associations differ by race/ethnicity.