Heart disease is the leading cause of death in the United States, affecting approximately one in every three people. 

The PREVENT (Predicting Risk of Cardiovascular Disease Events) risk calculator may help reduce those numbers by helping doctors determine a person’s future risk for an atherosclerotic cardiovascular event and recommend preventive measures to lower that risk. 

“There are a number of different heart disease risk calculators out there, but this one has recently been developed by the American Heart Association in 2023 and endorsed by the 2026 multi-society dyslipidemia guidelines,” says Amrin Kharawala, MD, Nebraska Medicine cardiology fellow. “The tool was tested and validated using data from more than 6.5 million people and is considered the gold standard for comprehensive, evidence-based assessments.” 

The PREVENT calculator estimates a person’s 10-year and 30-year risk for total cardiovascular disease, including heart attack, stroke and heart failure. It focuses specifically on atherosclerotic cardiovascular disease and heart failure risk. The tool is recommended for adults ages 30 to 79 who have not been previously diagnosed with cardiovascular disease.

“Heart disease is a progressive condition that gets worse over time,” notes Dr. Kharawala. “If we can detect it early on and help patients incorporate appropriate lifestyle changes and medications when necessary, we can slow or stabilize its progression its progression.”

How the PREVENT calculator works

The PREVENT tool uses the following information to estimate your cardiovascular disease risk:

• Age.
• Sex.
• Blood pressure.
• Body mass index (BMI).
• Total cholesterol and HDL/LDL ratio.
• Smoking status.
• Kidney function.
• History of diabetes.
• Current medication use for lowering blood pressure/cholesterol.

Optional PREVENT predictor tools include: 

• Social Deprivation Index.
• Hemoglobin A1c levels for diabetes
• Urine albumin-creatinine ratio to determine kidney function.

This is the first cardiovascular risk calculator to include kidney function parameters and Social Deprivation Index, which is based on ZIP code as optional variables, which can further personalize your risk estimates, says Dr. Kharawala.

“The developers of this tool removed race as a variable because race is a social construct, not a biological one,” notes Dr. Kharawala. “Medical experts found that including race as a predictor was scientifically flawed, could delay vital treatments, and risked perpetuating the false idea that race biologically drives disease.”

Lifestyle changes still matter

The test can be administered by your primary care doctor. The tool includes risk-based algorithms that provide your doctor with recommended prevention-focused treatment plans. 

No matter what a person’s risk level, everyone should consider healthy lifestyle modifications where needed, says Dr. Kharawala. 

These include:

• Following a plant-rich Mediterranean diet.
• Getting at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week.
• Quitting nicotine or marijuana smoking.
• Losing weight.
• Avoiding alcohol intake.

Start statins irrespective of your risk if:

• Your bad cholesterol or low-density lipoprotein level (LDL) is greater than 190 mg/dL.
• You are between 40 to 75 years of age and have diabetes mellitus.
• You are between 40 to 75 years of age and have human immunodeficiency virus (HIV).
• You are between 40 to 75 years of age and have chronic kidney disease stage 3 or above.
• You have familial hypercholesterolemia, a genetic disorder that prevents the body from effectively clearing LDL cholesterol from the blood.

If your risk is less than 3%:

• Look at your 30-year risk. If it is more than 10%, you and your doctor should discuss whether you should start cholesterol-lowering medications called statins.
• Continue lifestyle modifications.

If your risk is 3% to 5%:

• Your doctor will discuss risk estimate and therapy options, including possibly starting a moderate intensity statin.
• Your doctor may discuss special risk-enhancing factors, which include a detailed history and may recommend additional blood tests to determine true risk.
  • A coronary artery calcium score may be recommended. This test measures the amount of calcium buildup in your arteries. Statins may be recommended based on your calcium score.

If your risk is 5% to 10%:

• Start moderate- to high-intensity statins.

If your risk is more than 10%:

• Start high-intensity statins.

Misconceptions about statins

“Statins are extremely beneficial and tolerable for most people,” says Dr. Kharawala. “They decrease the amount of plaque in your arteries and can help decrease the progression of additional buildup. They have a significant protective benefit and despite some common misconceptions, side effects are rare.”

While uncommon, one side effect is muscle pain, but there are alternative statin medications and non-statin cholesterol lowering medications that can be tried to mitigate this, notes Dr. Kharawala. Additionally, pregnant women should not be on a statin unless they have very severe familial hypercholesterolemia or very high risk factors. 

Another misconception is that statins can contribute to dementia or Alzheimer’s disease. 

“To the contrary, statins actually provide a protective benefit by preventing plaque buildup in the arteries of the brain and thereby decreasing the risk of vascular dementia.”

Prevention starts early

“You’re never too young to start making lifestyle modifications to reduce your risk for heart disease,” says Dr. Kharawala. “Even if you’re only 25 years old, get a physical and have your provider test for things like blood pressure, cholesterol and HbA1c. The sooner you incorporate lifestyle changes, the better you will be able to prevent heart-related issues in the future.”