Background: Chronic kidney disease (CKD) substantially increases cardiovascular disease (CVD) and mortality risks, yet few models account for integrated cardio-kidney outcomes (CKOs). The American Heart Association’s PREVENT (Predicting Risk of CVD Events) score incorporates kidney-specific measures, however, its accuracy for CKOs in patients with CKD remains unclear. We aimed to evaluate PREVENT for CKOs against the Pooled Cohort Equation (PCE) and Systematic Coronary Risk Evaluation 2 (SCORE2) in two ethnically distinct CKD cohorts: KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease KNOW-CKD from South Korea and Chronic Renal Insufficiency Cohort CRIC from the United States. Methods: This study included 4,268 patients with CKD and no known CVD (CRIC: 2,530, KNOW-CKD: 1,738). We compared PREVENT (CVD and ASCVD versions) with the PCE and SCORE2. The primary outcome was CKO, a composite of major adverse kidney events (MAKE: ≥50% estimated glomerular filtration rate decline or kidney failure requiring replacement therapy) and four-point-major adverse cardiovascular events (4P-MACE). Secondary outcomes included individual components and all-cause mortality. Results: The PREVENT-CVD score showed superior predictive accuracy for CKO (Harrell’s C: 0.688; 95% confidence interval CI: 0.675–0.701) compared with PREVENT-ASCVD (ΔC = –0.009; 95% CI: –0.011 to –0.007), PCE (ΔC = –0.104; 95% CI: –0.113 to –0.095), and SCORE2 (ΔC = –0.106; 95% CI: –0.114 to –0.097). This superiority was driven by robust prediction for MAKE, along with significant improvements in reclassification and discrimination for 4P-MACE and all-cause mortality. Although predictive gains for 4P-MACE were attenuated in the KNOW-CKD cohort, adding albuminuria further enhanced predictive performance for primary outcome. Conclusions: The PREVENT-CVD equation outperformed traditional cardiovascular risk models in predicting integrated CKOs in patients with CKD. Its consistent discrimination across both cardiovascular and kidney events suggests that PREVENT may reflect the shared pathophysiology of cardio-kidney disease and support broader risk stratification in CKD.
Ko et al. (Tue,) studied this question.