Cardiovascular

Association Between Predicting Risk of Cardiovascular Disease Events (PREVENT) Risk Scores and Subclinical Cardiovascular Disease: Insights From the Project Baseline Health Study.

TL;DR

In an asymptomatic CVD-free community sample, subclinical CVD was increasingly associated with higher 10-year HF and ASCVD risks calculated by the Predicting Risk of CVD Events equations.

Key Findings

Subclinical heart failure was found in 16% of asymptomatic, CVD-free community participants, predominantly driven by left ventricular diastolic dysfunction.

  • 182 of 1138 participants (16%) had subclinical HF
  • Left ventricular diastolic dysfunction accounted for the majority of subclinical HF cases (14% of total sample)
  • Other components of subclinical HF included left ventricular hypertrophy and low ejection fraction (<50%)
  • Study population had median age of 52 (41-64) years; 64% were White; 57% were women

Diastolic dysfunction prevalence increased markedly with higher PREVENT HF risk categories, from 5.8% in low-risk groups to 44.1% in intermediate-/high-risk groups.

  • Diastolic dysfunction prevalence was 5.8% in the low-risk HF group
  • Diastolic dysfunction prevalence rose to 44.1% in intermediate-/high-risk HF groups
  • Each unit increase in 10-year HF risk corresponded to a 2.67-fold higher odds of diastolic dysfunction (95% CI, 2.25–3.18)
  • Area under the receiver operating characteristic curve for HF risk score predicting diastolic dysfunction was 0.81

Subclinical coronary artery disease, defined as coronary artery calcium (CAC) >0, was present in 41% of asymptomatic participants, with prevalence increasing from 28.5% in low-risk to 79.3% in intermediate-/high-risk ASCVD groups.

  • 466 of 1138 participants (41%) had CAC >0
  • CAC >0 prevalence was 28.5% in the low-risk ASCVD group and 79.3% in intermediate-/high-risk ASCVD groups
  • Each unit increase in 10-year ASCVD risk was associated with 2.91-fold higher odds of any coronary calcification (95% CI, 2.54–3.35)
  • Area under the curve for ASCVD risk score predicting CAC >0 was 0.80

The association between PREVENT ASCVD risk scores and coronary calcification strengthened substantially at higher CAC thresholds.

  • Each unit increase in 10-year ASCVD risk was associated with 2.91-fold higher odds of CAC >0 (AUC, 0.80)
  • The odds ratio increased to 4.76-fold for CAC >100 (95% CI, 3.70–6.12; AUC, 0.86)
  • The odds ratio further increased to 5.60-fold for CAC >300 (95% CI, 3.89–8.05; AUC, 0.87)
  • This gradient suggests PREVENT ASCVD scores are particularly discriminating for more severe subclinical coronary artery disease

The PREVENT 10-year HF risk score demonstrated strong discriminative ability for diastolic dysfunction with an AUC of 0.81, and the PREVENT ASCVD risk score demonstrated strong discriminative ability for subclinical coronary artery disease with AUCs ranging from 0.80 to 0.87 depending on CAC threshold.

  • AUC for HF risk score predicting diastolic dysfunction: 0.81
  • AUC for ASCVD risk score predicting CAC >0: 0.80
  • AUC for ASCVD risk score predicting CAC >100: 0.86
  • AUC for ASCVD risk score predicting CAC >300: 0.87
  • Associations were assessed using logistic regression and area under the receiver operating characteristic curve analysis in 1138 participants from the multicenter PBHS cohort

The study population was drawn from the multicenter Project Baseline Health Study (PBHS) cohort, comprising asymptomatic adults free of known CVD who underwent both echocardiography and coronary artery calcium scoring.

  • 1138 participants were analyzed
  • Median age was 52 (interquartile range 41–64) years
  • 64% were White and 57% were women
  • All participants were free of known CVD and asymptomatic
  • Subclinical HF was defined as presence of left ventricular diastolic dysfunction, left ventricular hypertrophy, or low ejection fraction (<50%); subclinical coronary artery disease was defined as CAC >0

What This Means

This research suggests that a relatively new cardiovascular risk calculator developed by the American Heart Association, called PREVENT (Predicting Risk of Cardiovascular Disease Events), can identify people with hidden signs of heart disease even before symptoms appear. The study examined over 1,100 adults who had no known heart disease and used heart ultrasounds (echocardiography) and CT scans measuring calcium buildup in coronary arteries to detect these early, silent signs. They found that 16% of participants had subtle signs of heart failure (mostly stiff heart muscle, called diastolic dysfunction), and 41% had calcium deposits in their coronary arteries indicating early-stage coronary artery disease. The key finding is that as the PREVENT risk scores increased, the likelihood of having these hidden heart problems rose dramatically. For example, people in the intermediate or high risk category for heart failure had diastolic dysfunction at a rate of 44%, compared to only 6% in the low-risk group. Similarly, people at higher predicted risk for atherosclerotic cardiovascular disease were far more likely to have significant calcium buildup in their arteries. Importantly, the risk scores were especially good at identifying people with more severe calcium deposits (scores above 100 or 300), with the odds of having severe calcification being more than five times higher per unit increase in predicted risk. This research suggests that PREVENT scores, which can be calculated from routine clinical information, may be useful for flagging people who would benefit from further testing or early preventive interventions — even when they have no symptoms. This is significant because treating cardiovascular disease early, before symptoms develop, generally leads to better outcomes. The strong performance of these scores across both heart failure and coronary artery disease endpoints, and across a diverse community sample, supports their potential value as a screening tool in everyday clinical practice.

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Citation

Fahed G, Gjermeni D, Cauwenberghs N, Santana E, Celestin B, Bagherzadeh S, et al.. (2026). Association Between Predicting Risk of Cardiovascular Disease Events (PREVENT)&#xa0;Risk Scores and Subclinical Cardiovascular Disease: Insights From the Project Baseline Health Study.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.045753