What PREVENT can tell you about heart disease risk

We often think about heart disease as something that suddenly happens, like a heart attack, that requires a trip to the emergency room. In reality, cardiovascular disease often develops silently over years or even decades before symptoms appear.

"If you can identify or predict who might be developing risk, then we can act earlier and try to prevent that from happening. The goal is that the heart attack never happens, that heart failure never develops, that a stroke never occurs," said Dr. Sadiya S. Khan, a preventive cardiologist at Northwestern Medicine and the Magerstadt Professor of Cardiovascular Epidemiology at Northwestern University's Feinberg School of Medicine in Chicago.

A growing body of research is making that possible through tools like the American Heart Association's PREVENT online calculator, a tool that helps healthcare professionals estimate a person's risk of cardiovascular disease, including heart attack, stroke and heart failure even before symptoms develop.

What are the PREVENT equations?

PREVENT, which stands for Predicting Risk of cardiovascular disease EVENTs, are equations that estimate an adult’s likelihood of having a heart attack, stroke or heart failure over the next 10 years and, for younger adults, over the next 30 years.

The equations were developed using data from more than 6.5 million adults in the U.S., making it one of the largest cardiovascular risk prediction efforts to date. Khan led the team of Association professional volunteers that developed the equations in 2023.

Unlike previous risk estimation tools that focused on heart attack and stroke, the PREVENT equations can also estimate the risk of total cardiovascular disease, as well as heart failure. It’s the first tool to include cardiovascular, kidney and metabolic (CKM) health factors. The CKM syndrome framework recognizes that cardiovascular disease, diabetes, obesity and kidney disease often occur together and can affect one another over time.

The PREVENT equations can be used for adults ages 30–79 without known cardiovascular disease.

A healthcare professional can use the results to develop a plan to lower a person’s cardiovascular risk even before symptoms appear.

What goes into your risk estimate?

A person’s individual risk estimate is calculated using common health information. Since health is influenced by where people live, there is also a ZIP code input to estimate how social factors can affect health.

Required inputs:

• Age
• Sex
• Systolic blood pressure (top number)
• Total and HDL cholesterol
• Kidney function
• Body mass index
• Diabetes status
• Smoking status
• Blood pressure medication use
• Cholesterol/triglyceride medication use

Khan notes that while exercise and nutrition are not directly measured in the tool, their effects are often reflected in other inputs.

Understanding your results

Using your health information, PREVENT equations estimate your 10-year and 30-year risk (for younger adults) of developing cardiovascular disease. A healthcare professional can interpret what the numbers may mean for you.

The tool also provides an estimated heart age (PREVENT-Age) by translating the estimated heart disease risk into an equivalent heart age.

If a person’s heart age is higher than their actual age, it suggests the chance of developing heart disease may be higher than expected for someone of similar age. If it is lower than their actual age, it suggests a lower risk.

Why long-term risk matters

A reassuring 10-year risk estimate doesn't always tell the whole story. Small elevations in blood pressure, cholesterol or blood sugar can accumulate over time and affect long-term cardiovascular health.

A 2024 study published in the journal Hypertension found that while many adults with high blood pressure had a low 10-year risk, they had a high risk over the next 30 years. With nearly half of adults in the U.S. having high blood pressure, understanding long-term cardiovascular risk may help people take action before serious health problems develop.

"If you're 35, you may not be concerned about having a heart event in the next 10 years. But we do want to be talking about it by the time you’re 65," Khan said.

How to lower your risk

The good news is that you can take steps to improve your health and lower your risk.

"The wonderful thing is that we have a lot of ways to be proactive and lower risk,” said Khan. "For some people, it may be exercise or changing diet. For some people, it may include medicines."

Life’s Essential 8 are key measures from the Association for improving and maintaining cardiovascular health. Each of these factors can provide an important target to help lower the risk for heart disease, stroke and other major health problems.

The eight components are:

• Eat better
• Be more active
• Quit tobacco
• Get healthy sleep
• Manage weight
• Control cholesterol
• Manage blood sugar
• Manage blood pressure

Measurable results can happen sooner than expected. "You can start to see improvements in cholesterol or blood pressure sometimes as early as six to eight weeks,” said Khan. "Every step counts. Prioritizing those small wins is really important."

What you can discuss with your doctor

Getting a risk estimate from PREVENT equations is just the starting point. The important and actionable information comes from the conversation with a healthcare professional about the results.

Khan recommends these questions to help guide the conversation about personal risk:

• What is my 10-year risk?
• What is my 30-year risk? (for younger adults)
• Which factors are driving my risk?
• What are my options for lowering it?
• Should I consider additional testing?
• When should we reassess my risk?

Focus on questions that answer, "What are the things I can do to lower that risk, what are my options, when should we check in again, and how do we come up with a comprehensive and personalized plan?,” Khan said.

Khan also notes that the PREVENT equations are a starting point, not the entire picture. Family history and other conditions should still be part of the conversation, she said.

Understanding heart health risk is the first step

"It's never too early to focus on cardiovascular health," said Khan.

Understanding heart disease and stroke risk today can help people make informed decisions that protect their health for decades to come. Tools like PREVENT give patients and healthcare professionals a more complete picture of future cardiovascular risk and opportunities for prevention.

"If it's predictable and preventable, then we can see progress,” Khan said. “We have ample evidence that heart disease is preventable, and PREVENT gives us the ability to predict the risk and be able to do that.”

At your next checkup, ask your healthcare professional about your 10-year and 30-year cardiovascular risk, and whether the PREVENT equations are appropriate for you. You can begin making strides toward better cardiovascular health today with Life’s Essential 8.