PREVENT Tool Accurately Predicts Heart Failure Risk and Highlights ASCVD Overlap

The PREVENT tool, developed by the American Heart Association (AHA), accurately predicts 10-year heart failure (HF) risk, according to new findings from the NHANES survey.

The analysis identified 15 million Americans with intermediate or high HF risk, of which 4.3 million had a low ASCVD risk.

This demonstrates a strong overlap between HF and atherosclerotic cardiovascular disease (ASCVD) risk factors, though they are not always identical.

The PREVENT tool includes risk calculators for ASCVD, HF, and CVD, incorporating broader factors like BMI for HF but excluding it for ASCVD.

Mean 10-year HF risk was 3.7%, with the highest risk seen in patients aged 70-79 years.

Race was consistent across risk groups, although Black adults were less represented in the low-risk group (9.7%) compared to the elevated-risk group (14.2%).

More than 50% of patients with elevated HF risk had systolic blood pressure > 130 mmHg (54.3%) or BMI > 30 kg/m² (55.6%).

Obesity and hypertension emerged as primary drivers of increased HF risk, particularly in patients with low ASCVD risk.

Unlike previous tools, PREVENT does not factor in race, and elevated HF risk in Black adults is likely driven by higher blood pressure rates.

The correlation between HF risk and ASCVD risk was significant (R² = 0.83), yet 4.6% of participants had higher HF risk than ASCVD risk.

While preventive strategies for high ASCVD risk include clear interventions like statins, guidance for addressing high HF risk remains unclear.

Experts emphasize that intensive blood pressure control and targeted obesity interventions are essential for HF prevention.

The study reinforces the need for large primary prevention trials to determine effective strategies for patients at high HF risk.

Experts propose re-evaluating the thresholds for HF risk, suggesting that interventions may be needed at lower cutoffs than the current standard of 20% risk.

Future work should focus on practical ways to screen and treat HF risk without burdening patients or providers.

Emerging therapies, like SGLT2 inhibitors and GLP-1 receptor agonists, may play a role in reducing HF onset in high-risk populations.

Take-Home Points:

1. The PREVENT tool accurately predicts HF risk over 10 years, showing a strong overlap with ASCVD risk factors.
2. Obesity and hypertension are key drivers of elevated HF risk, even in patients with low ASCVD risk.
3. Preventive strategies for HF are less clear compared to ASCVD, highlighting the need for new trials and clinical frameworks.
4. Lowering blood pressure and addressing obesity should be prioritized for HF prevention.
5. The thresholds for defining high HF risk may need to be adjusted for earlier intervention and treatment.