PERFORMANCE OF PREVENT AND POOLED COHORT EQUATIONS FOR PREDICTING 10 YEAR ASCVD RISK IN THE UK BIOBANK

Therapeutic Area

ASCVD/CVD Risk Assessment

Background

The Pooled Cohort Equations (PCE) were created in 2013 to assess ASCVD risk in primary prevention. In 2023 the American Heart Association published the PREVENT equations to assess the risk of cardiovascular disease, including ASCVD and heart failure, in primary prevention. The comparative performance of PCE and PREVENT for predicting 10-year ASCVD risk has not been evaluated in an external large-scale epidemiologic cohort.

Methods

The study population includes participants of the UK Biobank who were free of clinical cardiovascular disease. 10-year ASCVD risk was calculated using the PCE and PREVENT equations, respectively.

Individuals who died from non-ASCVD events, or were lost to follow-up before 10 years without developing ASCVD were excluded. C-statistics (AUCs) were calculated separately for men and women to evaluate risk discrimination, and correlated delta AUCs were calculated using DeLong's method. Predicted 10-year risks were divided into deciles for each equation and stratified by gender to compare predicted risk versus observed risk within each decile, with a Hosmer-Lemeshow test performed for goodness of fit.

Results

The final cohort was 370,885 individuals (mean age 56, 55.3% women, 94.0% white), after excluding 14,604 individuals lost to follow-up before 10 years without developing ASCVD. The observed 10-year ASCVD (95% CI) was 2.4% (2.31%-2.44%) for women and 5.5% (5.45%-5.56%) for men; the median (IQR) PCE predicted 10-year ASCVD risk was 3.6% (1.53%-7.12%) for women and 10.6% (5.33%-17.03%) for men. The median PREVENT predicted 10-year ASCVD risk was 2.9% (1.47%-4.95%) for women and 5.2% (3.02%-7.93%) for men. The C-statistics for PCE were 0.732 (0.7253-0.7389) for women and 0.695 (0.6893-0.7000) for men. In comparison, the C-statistics for PREVENT were 0.732 (0.7249-0.7382) for women and 0.695 (0.6894-0.6998) for men. Delta AUC was -0.0009 (p=0.36) for women and -0.0009 (p=0.21) for men. Figure 1 displays the mean PCE and PREVENT predicted 10-year ASCVD risks compared to observed risks for each decile. The PREVENT equations appear to be better calibrated than the PCE.

Conclusions

There is no significant difference in 10-year ASCVD risk discrimination between PCE and PREVENT equations. However, the PREVENT equations appear to be better calibrated at predicting risk compared to the PCE.