What are the differences between the new PREVENT index and its predecessor?

Differences Between the New PREVENT Index and the Past PREVENT

The new PREVENT (Predicting Risk of Cardiovascular Disease EVENTs) risk algorithm significantly differs from its predecessor by incorporating kidney function metrics and providing more nuanced risk stratification, particularly for patients with abnormal estimated glomerular filtration rates (eGFR) 1.

Key Differences in the New PREVENT Index

1. Incorporation of Kidney Function

• The new PREVENT algorithm now weighs chronic kidney disease as a significant risk factor
• Progressive decreases in eGFR correlate with increased cardiovascular risk prediction in the new model
• This represents a major advancement over the previous version which did not adequately account for renal function 1

2. Risk Reclassification

• The new PREVENT substantially reclassifies cardiovascular risk compared to its predecessor
• When comparing to standard algorithms that identify moderate risk:
  • In patients with normal eGFR (90 or 60 ml/min/1.73 m²), PREVENT identifies lower risk in 18-88% of cases
  • In patients with abnormal eGFR (45 or 30 ml/min/1.73 m²), PREVENT identifies higher risk in 4-94% of cases 1

3. Metabolic Factor Impact

• The new algorithm was specifically developed to better reflect the impact of metabolic factors on cardiovascular risk
• This represents an evolution from previous models that focused more heavily on traditional risk factors 1

4. Comparison with Other Risk Algorithms

• The new PREVENT shows different risk stratification patterns compared to:
  • Framingham risk score
  • Pooled cohort equation
  • SCORE2 (Systematic COronary Risk Evaluation2) 1

Clinical Implications of the New PREVENT Index

Potential Benefits

• More accurate identification of high-risk patients with renal dysfunction
• Better alignment with the pathophysiological understanding of how kidney disease impacts cardiovascular risk
• Potentially improved targeting of preventive therapies to those who would benefit most

Potential Concerns

• The tendency to assign lower risk (compared to standard algorithms) when eGFR is normal may reduce implementation of preventive therapy in some patients
• Healthcare systems need to monitor whether these changes improve overall public health outcomes 1

Risk Assessment Considerations

• The European Association of Preventive Cardiology (EAPC) emphasizes that risk prediction tools should be selected based on patient characteristics
• For patients with different risk factor profiles and baseline cardiovascular risk, different risk algorithms may be appropriate 2

Practical Application

When determining which cardiovascular risk assessment tool to use:

1. Consider the patient's medical history first (primary vs. secondary prevention)
2. Evaluate if the patient has specific conditions like diabetes or kidney disease
3. For patients with kidney disease, the new PREVENT index provides more nuanced risk stratification
4. For general population screening, tools like HeartScore may still be appropriate 2

Caveats and Limitations

• The new PREVENT index's performance needs ongoing validation in diverse populations
• Risk prediction tools should be calibrated to the geographical region and population being assessed
• No single risk calculator is perfect for all patient populations 2
• The impact of the new PREVENT algorithm on actual clinical outcomes requires further study 1

The evolution of the PREVENT index reflects the ongoing refinement of cardiovascular risk prediction tools to better identify at-risk individuals and guide preventive interventions, with particular attention to the important role of kidney function in cardiovascular risk.