Assessment of Mortality Risk Using the PREVENT equation: Insights into Cardiovascular Risk Stratification Across Diverse Racial and Ethnic Groups

Background: The PREVENT score offers a contemporary tool for assessing cardiovascular risk without incorporating race as a factor, raising concerns about its performance across diverse racial and ethnic groups.
Methods: Using 10-years data from the National Health and Nutrition Examination Survey [NHANES] (2009-2018), we analyzed a cohort representing over 177 million adults to evaluate the association between baseline cardiovascular risk, as determined by the PREVENT overall CVD risk equation, and long-term all-cause and cardiovascular mortality across racial and ethnic groups. The cohort was stratified by race and ethnicity. We employed Cox proportional hazards models to assess the relationship between cardiovascular risk and mortality.
Results: Our analysis revealed significant variation in baseline cardiovascular risk across racial and ethnic groups. Across all groups, there was a consistent incremental increase in both cardiovascular and all-cause mortality rates with higher estimated cardiovascular risk. When compared to people at low cardiovascular risk, individuals at high risk had a sixfold higher risk of all-cause mortality and a nine-fold higher risk of cardiovascular mortality during up to a decade of follow-up. The association between cardiovascular risk and mortality remained consistent across all racial and ethnic groups albeit with very different
risk estimates. For every 5% increase in estimated 10 years cardiovascular risk, there was a 54% increase in all-cause mortality and a 57% increase in cardiovascular mortality.
Conclusion: This study validates the PREVENT score across diverse racial and ethnic populations, highlighting its effectiveness in predicting cardiovascular risk and mortality regardless of race or ethnicity.