Evaluation of the PREVENT risk assessment tool and visceral adiposity: Insights from the UK Biobank.

Higher visceral adiposity was independently associated with significantly increased risk of ASCVD after adjusting for age and sex.

• 38,373 UK Biobank participants with no known CVD at baseline underwent abdominal MRI
• The median VAT volume was 3.58 L (IQR: 2.14–5.33 L), used as the threshold for high vs. low visceral adiposity
• VAT > 3.58 L was associated with HR of 1.32 (95% CI: 1.15–1.51) for incident ASCVD
• Mean age was 54.86 years (SD 7.49) and 52% of participants were female

Higher visceral adiposity was independently associated with significantly increased risk of heart failure after adjusting for age and sex.

• VAT > 3.58 L was associated with HR of 1.55 (95% CI: 1.27–1.89) for incident heart failure
• This represented the strongest hazard ratio among the three cardiovascular outcomes examined
• The association remained robust after adjustment for age and sex

Higher visceral adiposity was independently associated with significantly increased risk of total CVD after adjusting for age and sex.

• VAT > 3.58 L was associated with HR of 1.38 (95% CI: 1.23–1.55) for incident total CVD
• The association remained robust after adjustment for age and sex
• This finding was consistent across all three cardiovascular outcomes assessed

Adding VAT to the PREVENT model did not significantly improve discrimination for any of the three cardiovascular outcomes.

• C-statistic for ASCVD was 0.731 with VAT vs. 0.729 without VAT (p = 0.85)
• Discrimination was also not significantly improved for HF or total CVD when VAT was added to the PREVENT model
• The PREVENT model was the primary comparator cardiovascular risk assessment tool evaluated

Adding VAT to the PREVENT model significantly improved net reclassification for all three cardiovascular outcomes.

• NRI for ASCVD was 0.37 (95% CI: 0.30–0.33)
• NRI for HF was 0.48 (95% CI: 0.35–0.61), the largest improvement among the outcomes
• NRI for total CVD was 0.37 (95% CI: 0.28–0.46)
• These results suggest VAT improves individualized cardiovascular risk stratification beyond what discrimination statistics capture

The study population was drawn from UK Biobank participants who had undergone abdominal MRI and had no known CVD at baseline.

• Total sample size was 38,373 participants
• VAT volume was quantified using standardized MRI protocols
• Mean age was 54.86 years (SD 7.49) and 52% were female
• The study was designed to evaluate whether MRI-derived VAT enhances discrimination and calibration of the PREVENT model for ASCVD, HF, and total CVD