PREVENT cardiovascular risk calculator (AHA)

PREVENT is the set of equations published in 2023 by the AHA (American Heart Association) for estimating the risk of cardiovascular disease. It was developed and validated on data from more than 6.6 million adults and replaced the older equations, which overestimated risk in today's population [1].

Compared with the earlier calculators, PREVENT brings four new things. It includes kidney function, through the glomerular filtration rate, and it adds heart failure to the list of estimated diseases. It also drops race from the variables, because race is not a biological cause of disease. In addition, it lowers the age limit to 30 years, so it also applies to younger people.

The large figure is the probability of developing cardiovascular disease over the next 10 years. A result of 12% means that, out of 100 people with exactly the same profile, about 12 will have an event in that period, and 88 will not. It is an estimate for a group, not a prediction for you.

Below it are the two components. Atherosclerosis covers heart attack and stroke, while heart failure is counted separately, because it has different causes and a different treatment. The 30-year risk is shown only for people between 30 and 59 years of age, and it covers the span between your current age and three more decades. At 50, the estimate therefore runs to age 80. This figure matters above all in a young person with a low 10-year risk. In such a person, the risk looks small in the short run but builds up substantially over the long run.

The base equations use diabetes as a simple answer, yes or no. The extended equations add the HbA1c value, so they tell the difference between well-controlled diabetes and diabetes with high blood glucose over the last 2–3 months. In the same person, better control of blood glucose, blood pressure and cholesterol lowers the estimated risk, and poor control raises it.

HbA1c also works in people without diabetes, where a higher HbA1c remains a risk signal, even below the diagnostic threshold. You can also add the urine albumin-to-creatinine ratio (UACR), which shows how much albumin passes through the kidneys and matters most above 300 mg/g (30 mg/mmol) [1]. If your lab report gives UACR in mg/mmol, choose the unit next to the field. Fill in the fields only if you have recent laboratory values, and if you have just one of them, the calculator uses only that one. Without either, the calculator uses the base equations, which are just as valid.

The equations were built on cohorts from the United States, so their calibration for other populations is not guaranteed. In countries with a higher cardiovascular risk the figure can be underestimated, and in those with a lower risk overestimated. The order of magnitude stays useful anywhere, above all for comparison over time in the same person. The equations do not distinguish between type 1 and type 2 diabetes. For type 1 diabetes there are dedicated calculators, such as the Steno Type 1 Risk Engine and LIFE-T1D [2].

If you have already had a heart attack, a stroke or heart failure, the figure here does not apply to you [1]. The result does not decide treatment on its own. The threshold at which a statin or another drug is started depends on the guideline your doctor follows, on family history, on other tests and on your preferences. If you have diabetes and are over 40, your doctor will usually consider a statin, whatever the figure here [2]. Use the figure as a starting point for the conversation with your doctor, not as a final answer.