Predicting mortality risk using the PREVENT equation across diverse racial groups.

Objectives: The Predicting Risk of CVD Events (PREVENT) score offers a contemporary tool for assessing cardiovascular risk without incorporating race, which has raised concerns about its performance across diverse racial and ethnic groups. We aimed to validate the performance of the PREVENT cardiovascular risk equation across diverse racial and ethnic groups and assess its association with long-term all-cause and cardiovascular mortality.

Study Design: Observational cohort study using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) linked with mortality data.

Methods: Using 10-year data from the NHANES (2009-2018), we analyzed a cohort of more than 177 million adults in the US to evaluate the association between baseline cardiovascular risk, as determined by the PREVENT overall cardiovascular disease risk equation, and long-term all-cause and cardiovascular mortality across racial and ethnic groups. The cohort was stratified by race and ethnicity. We employed Cox proportional hazards models to assess the relationship between cardiovascular risk and mortality.

Results: Our analysis revealed significant variations in baseline cardiovascular risk across racial and ethnic groups. Across all groups, there was a consistent incremental increase in both cardiovascular and all-cause mortality rates with higher estimated cardiovascular risk. During up to a decade of follow-up, we found that individuals at high risk had a 6-fold higher risk of all-cause mortality and a 9-fold higher risk of cardiovascular mortality compared with individuals at low cardiovascular risk. The association between cardiovascular risk and mortality remained consistent across all racial and ethnic groups, albeit with very different risk estimates. For every 5% increase in estimated 10-year cardiovascular risk, there was a 54% increase in all-cause mortality and a 57% increase in cardiovascular mortality.

Conclusions: These study findings validate PREVENT scores across diverse racial and ethnic populations, highlighting the tool's effectiveness in predicting cardiovascular risk and mortality regardless of race or ethnicity.