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Publications

Journal Article Ahead of print

PubMed: 42086979 DOI: 10.1038/s41591-026-04437-z

Multinational validation of the PREVENT and SCORE2 cardiovascular risk equations across 6.4 million individuals.

Nat Med

Authors: 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 Diaz-Tocados, Alfredo E Farjat, Robert A Fletcher, Ron T Gansevoort, Hiddo J L Heerspink, William G Herrington, Chuan Hong, Edward J Horwitz, Shih-Jen Hwang, Simerjot K Jassal, Philip A Kalra, Ronit Katz, Sadiya S Khan, Csaba P Kovesdy, Florian Kronenberg, Jennifer S Lees, Donald M Lloyd-Jones, Jose Geraldo Mill, David M J Naimark, Chiadi Ndumele, Kevan R Polkinghorne, Bruce M Psaty, Patrick Schloemer, Michael Shlipak, Prabin Shrestha, Zean Song, Natalie Staplin, Dominik Steubl, Priya Vart, Frank L J Visseren, Mark Woodward, Kazumasa Yamagishi, Bessie A Young … and 2 other authors

Affiliations

  • The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
  • Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
  • School of Medical Sciences - Public Health and Epidemiology Division (SAPPHIRE Group) College of Life Sciences, University of Leicester, Leicester, UK.
  • NIHR Leicester Biomedical Research Centre, Leicester, UK.
  • University Hospitals of Leicester NHS Trust Leicester, Leicester, UK.
  • Leicester, Leicestershire and Rutland Integrated Care Board, Leicester, UK.
  • Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
  • Optimal Aging Institute, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
  • Optimal Aging Institute, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
  • Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
  • Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, Villejuif, France.
  • Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Stockholm, Sweden.
  • The George Institute for Global Health, University of New South Wales, Sydney, Australia.
  • Department of Cardiology St Vincent's Hospital, Sydney, Australia.
  • Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
  • Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.
  • Department of Medicine, UT Tyler School of Medicine, Tyler, TX, USA.
  • Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
  • Network Aging Research, University of Heidelberg, Heidelberg, Germany.
  • American Medical Group Association, Virginia, USA.
  • Department of Nephrology, Geisinger, Danville, PA, USA.
  • Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
  • Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
  • Vascular and Renal Translational Research Group, Biomedical Research Institute of Lleida, Dr. Pifarré Foundation (IRBLleida), RICORS, Lleida, Spain.
  • Clinical Statistics & Analytics, Bayer BV, Hoofddorp, Netherlands.
  • British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
  • University Medical Centre Groningen, Groningen, Netherlands.
  • Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands.
  • Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom and Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
  • Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.
  • Department of Medicine, Division of Nephrology & Hypertension, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
  • Framingham Heart Study, Framingham, MA, USA.
  • Population Sciences Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • Department of Medicine, Division of General Internal Medicine, University of California San Diego, San Diego, CA, USA.
  • Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.
  • Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
  • Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
  • The University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA.
  • Memphis VA Medical Center, Tennessee, USA.
  • Department of Genetics, Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria.
  • School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
  • Framingham Center for Population and Prevention Science and Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
  • Department of Physiological Sciences and Cassiano Antonio Moraes University Hospital (Hucam/Ebserh), Federal University of Espírito Santo, Vitória, ES, Brazil.
  • Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
  • Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
  • Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA.
  • Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
  • Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.
  • Department of Medicine, Monash University, Melbourne, Victoria, Australia.
  • School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
  • Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, Washington, USA.
  • Clinical Statistics & Analytics, Pharmaceuticals, Bayer AG, Berlin, Germany.
  • Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, California, USA.
  • Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan.
  • Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
  • Boehringer Ingelheim International GmbH, Ingelheim, Germany.
  • Department of Nephrology, Hospital rechts der Isar, Technical University Munich, Munich, Germany.
  • Department of Vascular Medicine, Utrecht University, Utrecht, The Netherlands.
  • The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom.
  • Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.
  • Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
  • Division of Nephrology, University of Washington, Seattle, WA, USA.

Abstract

The American Heart Association's PREVENT equations estimate risk of total cardiovascular disease (CVD), atherosclerotic CVD (ASCVD), and heart failure (HF) to guide lipid and blood pressure-lowering therapy in people ages 30 to 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. Here, in 44 observational cohorts and 18 randomized trials, we assessed discrimination and calibration of the two risk algorithms across geographical regions (North America, Europe, Asia/other, multi-region 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 enrolment. 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 multi-regional randomized trials. These findings lend support for adoption of PREVENT or SCORE2 for cardiovascular risk stratification across diverse settings.

MeSH

Molecular Biology, Multiple Chronic Conditions, Algorithms