The PREVENT Risk Calculator is the newest cardiovascular risk assessment tool developed by the American College of Cardiology (ACC) and American Heart Association (AHA). It replaces the older ASCVD Risk Estimator (pooled cohort equations) and provides a more comprehensive estimate of cardiovascular disease risk, including ASCVD and heart failure.

In this episode, I explain how to use the PREVENT Risk Calculator in primary care, how to interpret the results, and how it differs from older cardiovascular risk calculators.

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What You’ll Learn:

In this episode, you'll learn:

What the PREVENT Risk Calculator is and why it was developed
How it differs from older ASCVD risk calculators
Which patient information is required to calculate risk
Optional risk-enhancing factors that improve risk estimation
How to interpret 10-year and 30-year cardiovascular risk
Current treatment thresholds for cardiovascular risk reduction
Differences between hypertension and cholesterol treatment decisions
Common limitations of cardiovascular risk calculators
How to use the PREVENT calculator to support shared decision-making with patients

Key Takeaways

The PREVENT Risk Calculator is the ACC/AHA's updated tool for estimating cardiovascular risk in adults without established cardiovascular disease.
Unlike older ASCVD risk calculators, PREVENT estimates the risk of ASCVD, heart failure, and overall cardiovascular disease using updated prediction models.
The calculator uses clinical information such as age, blood pressure, cholesterol values, BMI, kidney function, diabetes status, and optional risk-enhancing factors to estimate risk.
Risk estimates should support—not replace—clinical judgment and shared decision-making with patients.
Younger adults and patients with significant risk-enhancing factors may have a low calculated risk despite benefiting from earlier intervention.
Understanding how to interpret the PREVENT Risk Calculator can help primary care clinicians make more informed decisions about lifestyle counseling, blood pressure management, and lipid-lowering therapy.

Resources mentioned in this episode:

FAQs

The PREVENT Risk Calculator is a cardiovascular risk assessment tool developed by the ACC and AHA to estimate a patient's risk of atherosclerotic cardiovascular disease (ASCVD), heart failure, and overall cardiovascular disease. It replaces the older pooled cohort equations and incorporates updated evidence to support primary prevention decisions.
The PREVENT Risk Calculator estimates a patient's 10-year and 30-year cardiovascular risk using factors such as age, blood pressure, cholesterol, BMI, diabetes status, kidney function, and other clinical variables. The results should be interpreted alongside the patient's overall clinical picture, risk-enhancing factors, and preferences rather than used as the sole basis for treatment decisions.
The PREVENT Risk Calculator replaces the older ASCVD Risk Estimator (pooled cohort equations) with updated prediction models and estimates risk for additional cardiovascular outcomes, including heart failure. It also allows clinicians to incorporate optional risk-enhancing factors, providing a more comprehensive assessment of cardiovascular risk in primary prevention.
The PREVENT Risk Calculator is intended for use in adults without established cardiovascular disease to help guide primary prevention decisions. It can support conversations about lifestyle modification, blood pressure management, cholesterol treatment, and other strategies to reduce cardiovascular risk.

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Liz Rohr (they/them) (00:09.25)
Well, hey there. This week's episode, we are going to be talking about the Prevent Risk Calculator from the ACC AHA. So this was a tool developed in twenty twenty-three and its use is to help us estimate someone's cardiovascular risk.

Liz Rohr (they/them) (00:27.118)
So, this week we're going to be talking about the PREVENT Calculator. And this is a cardiovascular risk assessment tool that was developed by ACC and AHA. So it was developed in 2023. It is now incorporated into the brand new hypertension and hyperlipidemia guidelines released in the end of 2025 and like just now in 2026. So hot off the press. And so I want to talk about what this tool is, when we use it.

How to actually use the tool, because I felt like I've I've been in practice for a while, but it just took me a minute to kind of get used to how to use it and how to incorporate it into my practice. So we're gonna go through those and we'll talk about some pitfalls to watch out for. So this tool is called Prevent, and it is predicting risk of cardiovascular disease events. And like I said, it was developed by American Heart Association and has been incorporated into the guidelines. And so our main job in primary care is to look and prevent.

illness, right? We're gonna support our patients to help do as much prevention as we can. And cardiovascular disease is one of the main things that we're seeing in primary care. And so one of the main ways that we're doing that is through hyperlipidemia management as well as hypertension management. So just as a quick note before we get any further, I have two courses that can help you both interpret lipid panels, manage hyperlipidemia, as well as how to manage hypertension and the brand new guidelines, how to navigate those, what's different, what's the same, things like that. So

Anyway, real quick note about that. But back to the tool. So the reason that we use this is because when we're trying to estimate someone's cardiovascular risk, it's not just about ordering a lipid panel according to screening guidelines. we obviously need to do that, but when it comes to the actual numbers, it really makes a difference whether or not somebody has what their other factors in their life are. So these this tool was developed after the pooled cohort equations.

So if you've been in practice for a little while, you're probably used to using the pooled cohort equations risk calculator. And what this new prevent tool is, is it better estimates someone's risk. The previous edition, the previous tools we were using overestimated and underestimated people's risk. And so this new tool was based on about six million patient data sets and is just a lot more specific and supportive. So the main benefits.

Liz Rohr (they/them) (02:45.713)
so overview of both tools if you haven't used either of them. Basically what we're looking at is the lipid profile as well as someone's blood pressure and some other information about them, putting it into an equation, and then we're getting a result of that is estimating their risk of ASCVD, AS atherosclerotic cardiovascular disease events in the next 10 years. So the new prevent calculator not only does this better in the next 10 years, but also is able to better estimate 30-year risk.

as well as look at things like heart failure risk, not just ASCVD events. So that's pretty cool.

Liz Rohr (they/them) (03:35.0)
So when I'm gonna talk about how to actually like input information and then interpret the results, but who do we use this tool in? So this is indicated for adults ages thirty to seventy-nine without known ASCVD. and their LDL is in that 70, 70 to 189 milligrams per deciliter range. And we're looking to help prevent primary, primary prevention. We're we're trying to do a

Liz Rohr (they/them) (04:05.815)
So before we get into the actual tool, let's talk about why we order this test and who it's for. So this is intended for adults ages 30 to 79. They do not have known ASCVD, so they've never had a heart attack or stroke. Their LDL, low density lipoprotein on their lipid panel, is between 70 and 189 milligrams per deciliter. And we're trying to assess what their

Primary we're trying to do primary prevention risk assessment. So what is their risk of their first ASCVD event, as well as where is what is their risk of heart failure?

Liz Rohr (they/them) (04:45.335)
So, how do we use the tool? So, there's a couple different ways. I like MDCalc, I'm not affiliated with them in any way, but this is an app that kind of puts all the different calculators together. So, whether it's cardiovascular, GI, things like that. So, I like using that tool, but you can just straight up go to the ACC AHA website and they have their risk prevent calculator tool. And so the in the information that we need to input for these patients, there's

A bare minimum that we need, and then there's like some extras that can further refine their risk. So we're looking for their sex assigned at birth. There's only male and female as an option, unfortunately. for age, we're looking for again 30 to 79. We're looking for their systolic blood pressure, total cholesterol, HDL cholesterol, estimated GFR, BMI, as well as their diabetes, smoking status.

Whether or not they take lipid lowering medications as well as antihypertensive medications. Three additional ones that are pretty cool that have been added to help us further estimate their risk is one is the urine albumin to creatinine ratio. So this is that urine test that's looking for hidden amounts of albumin, and that can help us understand if they have a higher risk for morbidity mortality. A1C, as well as zip code. So we know that not everybody lives in the same zip code all the time for their whole life.

but again, this is based on population studies. And so what they're looking for is the zip code can help us understand what the social deprivation index is of the area that they live. And so depending on the resources that they have access to can lead to different outcomes in their health.

Liz Rohr (they/them) (06:36.471)
So, what are the results that we get? So, like I said, so in the estimation of their 10 and 30 year risk, we are look, we're gonna get a percentage point. And so the interpretation of the percentage depends on are we focusing on hyperlipidemia management in this moment? Are we talking about hypertension management in this moment? Are we looking at both? And so the results that you get, whatever that percentage is, is going to tell you what pathway of management you're going to go with each of those conditions. For example,

With hyperlipidemia, there's brand new guidelines that just came out that I'm still in the process of reviewing and updating, but updating our content on, but there's a couple categories. So there's low, borderline, intermediate, and high risk. And so low is less than three percent, borderline is three to five percent, intermediate is five to less than ten percent, and then high is greater than or equal to ten percent.

And depending on that result, you will follow the guidelines pathway of how do you manage that level of hyperlipidemia? What are the recommendations? What medications should they take or not? What testing should we do further? Et cetera. And when it comes to hypertension, anything greater than or equal to 7.5% is going to give us a pathway of higher risk hypertension management for that patient. So again, it really like you just have to take it and apply it to the thing that we're talking about. And like I said, we go all into this in both of those courses, hyperlipidemia as well as hypertension.

and so yeah, so that's how basically how we use the tool. And so where do we go from there? So again, this is a converse, this is a I want to talk about a couple of pitfalls before we wrap up. So one of them is that this is a starting point. This is not the end all be all. And I think that when we're new grads, especially, it can be very tempting to want to cling on to something that's like, hard and fast rule, 7.5%, you're gonna do this now. but it is a starting point of conversation because the other piece that's involved with the tool.

Is that it is it has risk enhancing factors. And so we start there, but it may be underestimating someone's risk, especially in the younger side of the of the tool's use. And so we want to look at what those risk enhancing factors are, which again are on the ACC AHA website on their tool, like right underneath. And you can just l literally go through them. And that's gonna bump up their risk potentially, or it's going to help us understand, okay, are they

Liz Rohr (they/them) (08:48.757)
do they need further testing to assess what their actual risk is? And again, those are inside of each of those respective guidelines of, you know, do we knew do we need coronary artery calcium score or do we need the little do we need an APO B or LP little A test, like things like that. So

Liz Rohr (they/them) (09:10.999)
So yeah, so so I guess that's that's one of the pitfalls is to just kind of like take it and run and not apply the risk assessment, risk enhancing factors. And then one of the other pitfalls, like I said, I sort of touched on is that the ten-year risk underestimates risk in younger adults. so again, we wanna think about those other things we wanna evaluate for them. we wanna pay attention to the risk-enhancing factors.

And we don't want to assume that a normal lipid profile means low risk. And I think that's really tempting when we're looking through our lab results and it's like, that's normal, just sign it off. Let's just take a second, take a beat, think about the prevent calculator, and then think about the risk enhancing factors and then go from there because they may actually have a higher risk than you're expecting, especially for hyperlipidemia.

Liz Rohr (they/them) (10:10.743)
So, two kind of last pitfalls to watch out for. One is that just remembering that this is a population-based tool. And so it's not a definitive like 6% risk you are going to get this. It will happen. Like I think we know that. But just as a reminder, like to have those conversations with your patient of this is no guarantee. This is just estimating risk on a very large group of people's outcomes. And then keeping in mind that we're not going to use this for patients who have known ASCVD. So they've had a heart attack, a stroke, they have.

peripheral arterial disease, those patients are gonna have their own pathway of management when it comes to hyperlipidemia as well as hypertension. So we don't even need to do this risk assessment tool. We already know that they're on that kind of higher risk pathway of management.

Liz Rohr (they/them) (11:01.933)
So yeah, hopefully that helps you understand how to use this tool and hopefully you can start incorporating it into your practice. And we'd love to support you further with your hyperlipidemia and hypertension patients. And that's it for this episode today. Thanks so much.

How to Use the PREVENT Calculator

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What You’ll Learn:

Key Takeaways

Resources mentioned in this episode:

FAQs

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How to Use the PREVENT Calculator

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What You’ll Learn:

Key Takeaways

Resources mentioned in this episode:

FAQs

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