Rose Yang, PharmD, Combined PGY1 Residency & Practice Advancement Fellowship - Smiley’s Clinic (Year 1)
The American Heart Association’s (AHA) Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator represents a major step forward in identifying adults at risk for cardiovascular disease, including heart failure, stroke, and myocardial infarction. PREVENT was developed and released by AAHA in 2023. A recent analysis using this tool suggests that nearly 15 million U.S. adults could be at risk of developing heart failure, which highlights the calculator's public health relevance. Unlike older models, which primarily focused on atherosclerotic cardiovascular disease (ASCVD), the PREVENT calculator incorporates heart failure as an outcome, giving clinicians a broader picture of overall cardiovascular risk. The PREVENT equations also removed race as a variable (unlike the Pooled Cohort Equation (PCE)). The older PCE model used race-specific equations for black and white patients. This was meant to reflect differences in observed cardiovascular event rates, but the problem is that race is a social construct, not a biological factor. This approach overestimated and/or underestimated risk for patients raising concerns about equity. The PREVENT calculator was designed to remove race entirely and instead use more precise social and clinical factors. PREVENT looks at social and environmental factors that have a greater impact on health outcomes and can be changed/addressed. The shift is meant to make the tool both more equitable and clinically relevant, while still improving accuracy across diverse populations. It can also flag patients earlier and open the door to preventive strategies, lifestyle interventions, and tailored therapies aimed at reducing future disease burden.
However, questions remain about the calculator’s performance in older adults, who account for a large portion of cardiovascular events. A study evaluating PREVENT in this population highlighted both its potential and its limitations, particularly the need for continued refinement to ensure accuracy across diverse age groups and clinical settings. Regardless, along with representation issues, there is low enrollment of certain demographics in validation studies, which could affect generalizability. To address this, future research must include more diverse populations, particularly those most vulnerable to cardiovascular disease to ensure accuracy across settings. Taken together, these findings highlight PREVENT’s promise to become a modernized risk assessment tool, while reinforcing the need for ongoing evaluations to confirm its reliability across populations most vulnerable to cardiovascular disease. Despite these challenges, PREVENT provides a more holistic approach to cardiovascular risk assessment. The new tool is relatively novel in healthcare practice, and the PCE still remains heavily used in many settings pending broader guideline shifts.
Published on November 17th, 2025.
References
- Dengue Cases in the Americas Highest Recorded. JAMA. Published online January 10, 2025. doi:10.1001/jama.2024.26880
- Fravel MA, Ernst ME, Woods RL, et al. Performance of the American Heart Association PREVENT cardiovascular risk equations in older adults. Circ Cardiovasc Qual Outcomes. 2025;18(6):e011719. doi:10.1161/CIRCOUTCOMES.124.011719
- American Heart Association. Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) Risk Calculator. Professional Heart Daily. Retrieved from https://professional.heart.org/en/guidelines-and-statements/prevent-risk-calculator