Coronary artery calcium burden across the pooled cohort equation versus the American Heart Association PREVENT risk calculator

Background

The Pooled Cohort Equation (PCE) and the Predicting Risk of cardiovascular disease EVENTs (PREVENT) calculator assess atherosclerotic cardiovascular disease (ASCVD) risk. Coronary artery calcium (CAC) scoring enhances ASCVD risk stratification beyond traditional risk factors, but CAC burden across PCE versus PREVENT risk groups remains unclear. This study evaluates the distribution of CAC burden across PCE and PREVENT risk groups.

Methods

A retrospective cohort study was conducted involving 7610 asymptomatic patients who underwent clinically indicated CAC scoring between 2010 and 2023. Ten-year ASCVD risk was calculated using PCE and PREVENT (low<5, borderline-intermediate 5–19, high≥20 %). CAC scores (0, 1–99, 100–299, ≥300) were compared across risk groups using Kendall Tau tests.

Results

The mean age was 57±9 years; 41 % of patients were women and 11 % identified as Black. PCE and PREVENT classified 52.5 % and 72.6 % as low-risk, 41 % and 27.1 % as borderline-intermediate risk, and 6.5 % and 3.7 % as high-risk, respectively. Higher PCE/PREVENT risk groups had increased median CAC (p < 0.001). For borderline-intermediate risk, 71 % for PCE and 79 % for PREVENT had CAC>0, while for low risk, 45 % and 51 %. Within the borderline risk group (5–7.5 %), 20.7 % of PCE and 35 % of ASCVD PREVENT group had CAC>100.

Conclusions

A significant number of patients had non-zero CAC in low-risk stratification groups for both PREVENT and PCE. CAC distribution was heterogeneous in the borderline-intermediate groups for both PREVENT and PCE. These results emphasize the significance of CAC in further stratifying risk beyond the PCE and PREVENT.