Also known as PREVENT, AHA PREVENT, PREVENT Equations, ASCVD Risk
10- and 30-year ASCVD risk from the AHA PREVENT equations.
Applies to / doesn’t apply to4
Applies to: US primary-prevention adults aged 30 to 79 without established cardiovascular disease at baseline, including people with diabetes or chronic kidney disease. Derived and validated in a pooled consortium of 46 datasets (Khan 2024). Race and ethnicity are deliberately not predictors: the authors state that they are social constructs and were not considered in risk modelling, and retained them only for calibration assessment.
- Established atherosclerotic cardiovascular disease or heart failure — these equations estimate a first event, in people who have not had one.
- Age outside 30 to 79. The equations were not developed or validated outside that range.
- A 30-year estimate above age 59. The 30-year equations were developed for ages 30 to 59, and no estimate is produced above that age.
- Any required predictor missing, or outside the range the equations support; no estimate is produced rather than an unvalidated one.
Selects the published male- or female-specific coefficient set. No non-binary coefficient set was published.
An exact age is required — age is a term in the equation and interacts with every risk factor, so a band cannot stand in for it. The 30-year estimate is shown only up to age 59.
Measured total cholesterol. Fasting is not required.
Measured HDL from the same lipid profile. Non-HDL cholesterol is derived from these two values, never entered.
The current measured systolic pressure, not a diagnosis of hypertension. Treatment is asked separately below.
From the 2021 CKD-EPI creatinine equation without race, using a standardized creatinine.
Any history of diabetes — not restricted to insulin-treated disease. (RCRI asks a narrower question, so the two are never shared.)
Any cigarette use within the last 30 days. Cigarette-specific, not nicotine use generally.
Current use of any medication for hypertension, separate from the measured pressure above.
Current statin use. The derivation identified statins specifically; whether another lipid-lowering agent alone counts has no published answer.
What this score estimates
Estimates the probability of a first atherosclerotic cardiovascular disease event — myocardial infarction, fatal coronary heart disease, or fatal or nonfatal stroke — using the American Heart Association PREVENT equations. Two figures are reported from one set of inputs: a 10-year estimate for adults aged 30 to 79, and a 30-year estimate for adults aged 30 to 59. The 10-year figure carries the four risk categories defined for it in the 2026 ACC/AHA cholesterol guideline; the 30-year figure carries none, because none has been published.
Pearls & pitfalls
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- The 30-year estimate is a looser approximation than the 10-year one. The published equations are simplified log-odds regressions fitted to the underlying model’s output, and the supplement reports an R² of 0.9987 to 0.9997 at 10 years against 0.976 to 0.9945 at 30 years (Khan 2024).
- Calibration is the improvement over the pooled cohort equations; discrimination is largely unchanged. Validation C-statistics for ASCVD were 0.774 in women and 0.736 in men, a gain of only 0.005 to 0.007 over the pooled cohort equations, and a 2026 meta-analysis of about 2.3 million people found no significant difference in discrimination (Khan 2024; Discrimination meta-analysis 2026).
- The validation reported in the derivation paper was internal to the same 46-dataset consortium, with follow-up averaging 4.8 years and censored at 15. Those C-statistics are not 30-year validation figures (Khan 2024).
- A multinational validation of 6.4 million people across 44 observational cohorts and 18 randomized trials, in North America, Europe and Asia, reported generally good discrimination and calibration across regions (Multinational validation 2026). Its summary gives no per-region figures.
- Independent US validations conflict. One multi-health-system study of 680,864 people found near-perfect calibration, while a four-academic-system study found calibration varying widely, with under-estimation at three of its four sites (Truveta validation 2026; Four-health-system validation 2025).
- The derivation paper reports that Black and White individuals had similar C-statistics, but its own Table S5B shows 0.757 against 0.805 for women (total cardiovascular disease) — a gap of 0.048. The claim holds for men and not for women (Khan 2024).
- The equations are sex-specific, and no coefficient set was published for a patient outside a binary sex. For such a patient the equations have no answer rather than an approximate one.
- Reported discrimination falls in the oldest adults, to a C-statistic of roughly 0.62 to 0.68 above age 75, attributed to competing non-cardiovascular mortality. No age-stratified performance figure exists anywhere in the paper or supplement for ages 30 to 39.
Risk factors the score does not count:
- Race and ethnicity are not used, by the authors’ explicit design — a deliberate departure from the 2013 pooled cohort equations.
- Family history, lipoprotein(a), coronary artery calcium, inflammatory conditions and every other biomarker beyond the ten inputs above are not used. Their absence is a modelling choice, not a statement that they do not matter.
- Body-mass index is not collected here. It has coefficients only in the heart-failure equations, so it cannot change an ASCVD estimate.
- The three optional extended predictors — urine albumin-to-creatinine ratio, HbA1c and the social deprivation index — are not offered; this is the base model. They are never imputed, so a base-model estimate is not an extended-model estimate with values guessed.
- Only the ASCVD outcome is reported. PREVENT also publishes total cardiovascular disease, heart failure, coronary heart disease and stroke equations, which are not shown here.
What the guidelines say
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The 2026 ACC/AHA cholesterol guideline uses 10-year PREVENT-ASCVD risk in place of the 2013 pooled cohort equations for its defined primary-prevention population, and defines four risk categories at boundaries of 3%, 5% and 10%.
View guideline source ↗The American Heart Association states that the equations were developed for adults aged 30 to 79 without established cardiovascular disease, and describes the calculator as designed for use by clinicians. It also states that no formal cutoffs or thresholds have been established to define high 30-year risk in current guidelines, which is why the 30-year figure here carries no risk category.
The 2026 cardiovascular-kidney-metabolic guideline, citing the 2026 ACC/AHA cholesterol guideline, names a 30-year PREVENT-ASCVD risk of 10% as a threshold. It is a single threshold, not a set of risk categories, so the 30-year figure here still carries no category.
View guideline source ↗The derivation paper reports that at a pooled-cohort-equations estimate of 7.5%, the median PREVENT-ASCVD estimate was 4.9% in women and 3.7% in men. Every category boundary moved downward, so a threshold defined against the older equations does not carry over to a PREVENT number.
View guideline source ↗Guideline positions are stated as published. Curie.MD Calc does not publish treatment direction.
Where this comes from
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Bands
References
- Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association’s PREVENT equations. Circulation. 2024;149(6):430-449. View source ↗
- Khan SS, Coresh J, Pencina MJ, et al. Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation. 2023;148(24):1982-2004. View source ↗
- 2026 ACC/AHA guideline on the management of dyslipidemia. Circulation. 2026;153(17):e1154-e1276. The source of the four 10-year PREVENT-ASCVD risk categories used here (3%, 5% and 10% boundaries). View source ↗
- Correction to: Development and validation of the American Heart Association’s PREVENT equations. Circulation. 2024;149(11):e956. Corrects only the American Community Survey year range for the social deprivation index; no coefficient, equation, range or outcome definition was changed. View source ↗
- Multinational external validation of the PREVENT equations across 44 cohorts and 18 trials (6.4 million individuals). Nat Med. 2026. View source ↗
- External validation of the PREVENT equations in a US multi-health-system population (n=680,864). 2026. View source ↗
- External validation of the PREVENT equations across four academic health systems, reporting calibration that varied widely by site. 2025. View source ↗
- Meta-analysis comparing the discrimination of the PREVENT equations with the pooled cohort equations (approximately 2.3 million individuals). 2026. View source ↗