Cardiovascular Disease Risk Estimates in the US CKD Population Using the PREVENT Equation.

Walther CP, Gregg LP, Navaneethan SD. Cardiovascular Disease Risk Estimates in the US CKD Population Using the PREVENT Equation. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2025 Mar 5; doi: 10.1053/j.ajkd.2025.01.012..

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Abstract:

RATIONALE and OBJECTIVE: The 2023 American Heart Association's (AHA's) Predicting Risk of Cardiovascular Disease (CVD) EVENTs (PREVENT) equations incorporate estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). We estimated CVD risk in the US chronic kidney disease (CKD) population using PREVENT and compared estimates to the 2013 American Heart Association/American College of Cardiology pooled cohort equations (PCEs). STUDY DESIGN: Cross-sectional study. SETTING and PARTICIPANTS: Individuals aged 40-75 years with CKD (eGFR < 60 mL/min/1.73 m and/or UACR 30 mg/g) without CVD were identified from National Health and Nutrition Examination Survey (NHANES) data (2013-2020). PREDICTORS: Age, sex, total cholesterol, HDL cholesterol, systolic blood pressure, body mass index, eGFR, diabetes, smoking, antihypertensive use, statin use, urine albumin-to-creatinine ratio, HbA1c. OUTCOMES: Estimated ten-year CVD, atherosclerotic CVD (ASCVD), and heart failure (HF) risks, and guideline-based statin eligibility. ANALYTICAL APPROACH: Survey methods were used to produce cross-sectional estimates representing the US CKD population. RESULTS: We identified 1,814 eligible individuals, representing 17.5 million people. Mean age was 59.8 (CI 59.2-60.4) years and 56.2% (CI 52.4-60.0%) were female. Mean 10-year ASCVD risk in CKD using PREVENT was 8.8% (CI 8.3-9.4%). This was lower than the risk estimated by PCEs by 5.2 (CI 4.6-5.8) percentage points. Mean estimated 10-year HF risk was 11.6% (CI 10.8-12.3%) and 10-year CVD risk was 15.3% (CI 14.4-16.1%). The estimated proportion eligible for statin therapy with PREVENT was 63.4% (CI 59.8-67.0%) using the AHA primary prevention guideline, and 85.9% (CI 83.2-88.6%) using the Kidney Disease Improving Global Outcomes (KDIGO) guideline. Less than half of those eligible for statins for primary prevention based on the PREVENT equation and either the AHA or KDIGO guideline were receiving statin therapy. LIMITATIONS: NHANES survey weights were not derived for this subpopulation and years dating back to 2013 were included to achieve adequate sample size. CONCLUSIONS: Estimated ASCVD risk was lower with the PREVENT equations compared to the PCEs. Despite the reduced risk estimate, a substantial unmet need for statin therapy in CKD was found.