High-risk PREVENT category (≥20%) was significantly associated with increased prevalence of cardiac dysfunction compared to low-risk individuals (RR 2.57; 95% CI 1.27-5.20).
Cross-Sectional (n=557)
Do higher PREVENT risk categories correlate with an increased prevalence of cardiac dysfunction and coronary atherosclerosis in patients without known HF or CAD?
Higher PREVENT risk categories are significantly associated with an increased prevalence of subclinical cardiac dysfunction and coronary atherosclerosis, supporting their use for preventative strategies.
Effect estimate: RR 2.57 (95% CI 1.27-5.20)
Abstract Background The American Heart Association’s Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations were developed to quantify the absolute risk of incident atherosclerotic cardiovascular disease (CVD) and heart failure (HF) in general populations. They utilize routinely available clinical variables such as smoking status, systolic blood pressure, cholesterol levels, antihypertensive or statin use, diabetes, and estimated glomerular filtration rate. However, the relationship between PREVENT equations and the prevalence of cardiac dysfunction, or the coronary atherosclerosis index in routine clinical practice, remains incompletely elucidated. Methods This study included patients without a history of HF hospitalization or coronary artery disease (CAD) who underwent both coronary computed tomography angiography (CCTA) and transthoracic echocardiography (TTE). The 10-year CVD risk was estimated by PREVENT equations and stratified into three categories: low-risk (7.4%), intermediate-risk (7.5–19.9%), and high-risk (≥20%), as previously reported. Cardiac dysfunction on TTE was defined as a composite of systolic dysfunction (ejection fraction 50%) and diastolic dysfunction (ejection fraction ≥50% with at least three of the following criteria: average E/e' 14, septal e' 7 cm/s or lateral e' 10 cm/s, tricuspid regurgitation velocity 2.8 m/s, and left atrial volume index 34 mL/m²), as well as moderate or severe mitral or aortic valve stenosis or regurgitation. Obstructive CAD in CCTA was defined as stenosis of ≥50% in the left main coronary artery or ≥70% in any of the three major epicardial coronary arteries. Coronary artery calcium (CAC) was quantified using the Agatston method, with a threshold score of 10 defining the presence of CAC. Results A total of 557 patients (364 males, mean age 65 years) were included, with 134 categorized as low-risk, 251 as intermediate-risk, and 172 as high-risk. Multivariable Poisson regression with robust error variance demonstrated a significantly higher prevalence of cardiac dysfunction among individuals in the intermediate-risk (relative risk RR 1.78, 95% confidence interval CI 0.87 – 3.63) and high-risk (RR 2.57, 95% CI 1.27 – 5.20) compared to the low-risk individuals. Similarly, intermediate-risk and high-risk were associated with an increased prevalence of obstructive CAD (RR 2.13, 95% CI 1.61 – 6.09, and RR 5.87, 95% CI 3.07 – 11.22) and CAC (RR 2.50, 95% CI 1.79 – 3.50, and RR 3.88, 95% CI 2.81 – 5.37) relative to low-risk individuals. Conclusions A significant dose-dependent association was observed between PREVENT risk categories and the prevalence of cardiac dysfunction, obstructive CAD, and CAC. These findings suggest that the PREVENT equations may be valuable for establishing preventative strategies in routine clinical practice.
Kunimura et al. (Sat,) conducted a cross-sectional in Patients without a history of HF hospitalization or CAD (n=557). PREVENT equations high-risk category (≥20%) vs. Low-risk category (<7.4%) was evaluated on Prevalence of cardiac dysfunction (RR 2.57, 95% CI 1.27-5.20). High-risk PREVENT category (≥20%) was significantly associated with increased prevalence of cardiac dysfunction compared to low-risk individuals (RR 2.57; 95% CI 1.27-5.20).