How is the prevent (Primary Risk Evaluation and Management) calculator used in clinical practice?

How to Use the PREVENT Calculator in Clinical Practice

Use the PREVENT calculator by entering patient age, sex, blood pressure, cholesterol levels, diabetes status, smoking status, kidney function (eGFR), and BMI to generate 10-year and 30-year risk estimates for total CVD, atherosclerotic CVD, and heart failure—then use these risk estimates to guide shared decision-making about preventive therapies, particularly for patients with borderline or intermediate risk. 1

Patient Selection and Timing

• Apply PREVENT to adults aged 30-79 years without known cardiovascular disease who are being evaluated for primary prevention 1
• Measure traditional risk factors at least every 4-6 years starting at age 20, though formal risk calculation is most useful after age 40 2
• For adults 20-39 years, use risk assessment primarily to guide lifestyle interventions and consider 30-year or lifetime risk rather than 10-year risk 2

Required Clinical Data Entry

Base model inputs (always required): 1

• Age and sex
• Systolic blood pressure
• Total cholesterol and HDL cholesterol
• Current use of antihypertensive medications or statins
• Diabetes status (yes/no)
• Current smoking status
• Estimated glomerular filtration rate (eGFR)
• Body mass index (BMI)

Optional enhanced inputs (when available): 1

• Urine albumin-to-creatinine ratio (particularly valuable if >300 mg/g)
• Hemoglobin A1c
• Social Deprivation Index (to incorporate social determinants of health)

Interpreting the Results

PREVENT generates three separate risk estimates: 1

• Total CVD risk (includes both atherosclerotic CVD and heart failure)
• Atherosclerotic CVD risk (coronary heart disease and stroke)
• Heart failure risk (separate prediction)

Risk categories for treatment decisions: 2

• Low risk: <5% 10-year ASCVD risk
• Borderline risk: 5% to <7.5% 10-year ASCVD risk
• Intermediate risk: ≥7.5% to <20% 10-year ASCVD risk
• High risk: ≥20% 10-year ASCVD risk

Clinical Decision-Making Algorithm

For patients with 10-year ASCVD risk ≥10%: 2

• Initiate statin therapy for cholesterol management
• Consider antihypertensive therapy if blood pressure is 130-139/80-89 mm Hg (stage 1 hypertension)

For borderline (5-7.5%) or intermediate (7.5-20%) risk patients where treatment decision is uncertain: 2

• Use risk-enhancing factors to guide decisions (family history, chronic inflammatory conditions, metabolic syndrome, chronic kidney disease, ethnicity with higher CVD risk, premature menopause, pregnancy complications)
• Consider coronary artery calcium scoring to reclassify risk upward or downward as part of shared decision-making 2

For patients >75 years: 2

• Engage in discussion about benefits of preventive therapies in context of comorbidities and life expectancy
• Use clinical judgment as validation data are more limited in this age group

Practical Implementation Strategies

Embed the calculator into electronic health records to automatically populate risk scores from existing patient data—this approach increased CVD risk documentation four-fold in primary care settings 2

Use the calculator's visual outputs (infographics showing CVD-free life years gained with interventions) to facilitate patient communication and shared decision-making 2

Generate printed reports showing the impact of specific interventions (e.g., smoking cessation, blood pressure control, statin therapy) on lifetime CVD risk to improve patient motivation and adherence 2

Key Advantages Over Previous Tools

PREVENT addresses major limitations of the Pooled Cohort Equations: 1, 3

• Eliminates race-based calculations (race-free model)
• Reduces overprediction—PREVENT estimates approximately half the 10-year ASCVD risk compared to PCE in many populations 3
• Incorporates kidney function (eGFR) as a standard variable, recognizing cardiovascular-kidney-metabolic syndrome 1
• Provides separate heart failure risk prediction, not available in PCE 1
• Derived from contemporary data (1992-2017) representing 6.6 million adults 1

Common Pitfalls to Avoid

Do not use PREVENT for patients with established CVD—these patients already warrant intensive preventive therapy regardless of calculated risk 1

Do not apply risk calculators to patients with familial hypercholesterolemia—they require treatment based on diagnosis alone, not risk calculation 2

Recognize that PREVENT may underestimate risk in patients with chronic inflammatory conditions (autoimmune disease, HIV infection) or significant socioeconomic disadvantage not fully captured by Social Deprivation Index 2

Understand that adding optional variables (urine albumin-to-creatinine ratio, HbA1c, SDI) provides only modest improvement in discrimination (ΔC-statistic 0.004-0.005), though calibration improves significantly when urine albumin-to-creatinine ratio is added for patients with marked albuminuria 1

Facilitating Patient Communication

Present risk as both percentages and absolute numbers—for example, "Your 10-year risk is 12%, meaning 12 out of 100 people like you would have a heart attack or stroke in the next 10 years" 2

Show CVD-free life years gained with specific interventions rather than just risk reduction percentages, as this format is more motivational and supports adherence 2

Acknowledge uncertainty—risk estimates are "ballpark approximations" with a margin of error, not precise predictions for individual patients 4