Brendon L. Neuen, Rupert W. Major, Morgan E. Grams, Yingying Sang, Josef Coresh, Shoshana H. Ballew, Aditya Surapaneni, Natalia Alencar de Pinho, Johan Arnlov, Clare Arnott, Samira Bell, Jarett Berry, Hermann Brenner, Elizabeth Ciemins, Alexander R. Chang, Mary Cushman, James A. de Lemos, Juan Miguel Díaz‐Tocados, Alfredo E. Farjat, Robert A. Fletcher, Ron T. Gansevoort, Hiddo J. L. Heerspink, William G. Herrington, Chuan Hong, Edward Horwitz, Shih-Jen Hwang, Simerjot K. Jassal, Philip A. Kalra, Ronit Katz, Sadiya S. Khan, Csaba P. Kövesdy, Florian Kronenberg, Jennifer S. Lees, Donald M. Lloyd-Jones, José Geraldo Mill, Д А Наймарк, Chiadi Ndumele, Kevan R. Polkinghorne, Bruce M. Psaty, Patrick Schloemer, Michael Shlipak, Prabin Shrestha, Zean Song, N Staplin, Dominik Steubl, Priya Vart, Frank L.J. Visseren, Mark Woodward, Kazumasa Yamagishi, Bessie A. Young, Charumathi Sabanayagam, José M. Valdivielso, ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation), John Chalmers, Katie Harris, Aichi (Aichi Workers’ Cohort Study), Hiroshi Yatsuya, Yuanying Li, Midori Takada, ALTITUDE, AusDiab (Australian Diabetes, Obesity, and Lifestyle Study), Steven Chadban, CANVAS (including CANVAS-R) (Canagliflozin Cardiovascular Assessment Study Program), Bruce Neal, CARMELINA, CAROLINA, CIRCS (Circulatory Risk in Communities Study), Isao Muraki, Hironori Imano, Hiroyasu Iso, Natalia Alencar de Pinho, Ziad Massy, Benedicte Stengel, Marie Metzger, Kenneth W. Mahaffey, Meg Jardine, Vlado Perkovic, CRIC (Chronic Renal Insufficiency Cohort Study), Matthew Weir, Jing Chen, James Lash, Panduranga Rao, DAPA-CKD, DHS (Dallas Heart Study), Colby Ayers, Amit Khera, Parag Joshi, Amil Shah, Michael J. Pencina, Matthew Engelhard, Mu Niu, Haoyuan Wang, ELSA-Brasil (Brazilian Longitudinal Study of Adult Health), Paula Bracco, Maria de Jesus Mendes da Fonseca, Isabela Bensenor, Maria da Conceição Chagas de Almeida, Luana Giatti, EMPA-KIDNEY (The Study of Heart and Kidney Protection with Empagliflozin), Richard Haynes
The American Heart Association's PREVENT equations estimate risk of total cardiovascular disease (CVD), atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF) to guide lipid-lowering and blood pressure-lowering therapy in people ages 30-79 years in the United States. The SCORE2 risk algorithm is used to estimate CVD risk for similar purposes in people ages 40 and older in Europe. Neither set of equations has been comprehensively validated in global observational cohorts and randomized trials. In this study, in 44 observational cohorts and 18 randomized trials, we assessed discrimination and calibration of the two risk algorithms across geographical regions (North America, Europe and Asia/Other or multiregional trials). We also created scaling factors for risk prediction over 1-9 years using the PREVENT equations, enabling shorter-term risk prediction for research purposes or to facilitate clinical trial enrollment. Over 5.1 years of mean follow-up, 293,737 PREVENT total CVD events (fatal and non-fatal ASCVD or HF) and 258,086 SCORE2 CVD events (myocardial infarction, stroke or cardiovascular death) were observed among 6,422,714 and 5,437,384 individuals, respectively. Despite differences in CVD outcome definitions, target populations and predictor variables, overall discrimination and calibration were similar for both equations, with generally good performance across regions, including in multiregional randomized trials. These findings lend support for adoption of PREVENT or SCORE2 for cardiovascular risk stratification across diverse settings.