Predicting Risk of Cardiovascular Disease EVENTs (PREVENT™)

• Use results to support shared decision-making around cardiovascular prevention strategies. 
• Risk estimates should be interpreted in the context of: 
  
  • Patient comorbidities (e.g., diabetes, CKD, obesity).
  • Risk-enhancing factors (e.g., family history, lipoprotein(a), inflammatory conditions, coronary artery calcium score). 
  • Patient preferences.
  • Treatment goals.  
• Consider both 10-year and 30-year risk, particularly in younger patients, where long-term risk may better inform early preventive strategies. 
• As predicted risk increases, the intensity of lifestyle counseling and therapeutic intervention should increase accordingly. 
• In general, lipid-lowering therapy is now recommended in individuals with a ≥3% 10-year ASCVD risk estimate.
• Ensure management of modifiable risk factors (e.g., lipids, blood pressure, glycemia, smoking) regardless of calculated risk. 
• Reassess risk over time as clinical status and risk factors change.
• Evaluate for secondary causes of dyslipidemia or elevated CVD risk when appropriate.  

HYPERTENSION

The 2025 AHA/ACC Guideline recommends the following hypertension management (based on 10-year total CVD risk):

• BP ≥130/80 mmHg: 
  
  • Treat if risk estimate ≥7.5%, or if clinical CVD, diabetes, or CKD is present.
  • If risk estimate is <7.5%, try lifestyle modification for 3–6 months first; start medication if BP remains elevated.
• BP ≥140/90 mmHg: Treat all adults regardless of CVD risk estimate.

PRIMARY PREVENTION

The 2026 ACC/AHA Guideline uses the following risk categories and recommended primary prevention measures (based on 10-year ASCVD risk):

• Low (<3% risk):
  
  • Health behavior counseling.
  • If LDL-C 160–189 mg/dL or 30-year ASCVD risk is ≥10%, consider moderate-intensity statin therapy.
• Borderline (3% to <5% risk):
  
  • Health behavior counseling.
  • Engage in risk-benefit discussion about pharmacotherapy; consider risk enhancers to personalize the decision.
  • If moderate-intensity statin therapy is initiated, target a ≥30% LDL-C reduction with a goal of LDL-C <100 mg/dL and non-HDL-C <130 mg/dL.
  • If shared decision-making does not produce a clear treatment path, consider CAC assessment.
• Intermediate (5% to <10% risk):
  
  • Health behavior counseling.
  • Start moderate- to high-intensity statin therapy, targeting a ≥30% LDL-C reduction with a goal of LDL-C <100 mg/dL and non-HDL-C <130 mg/dL.
  • If uncertainty remains regarding whether to initiate therapy or its appropriate intensity, consider CAC assessment.
• High (≥10% risk):
  
  • Health behavior counseling.
  • Start high-intensity statin therapy, targeting a ≥50% LDL-C reduction with a goal of LDL-C <70 mg/dL and non-HDL-C <100 mg/dL.
  • If goals are not achieved on maximally tolerated statin therapy, additional therapies (e.g., ezetimibe, PCSK9 inhibitors, bempedoic acid) may be necessary.

The following groups should receive lipid-lowering therapy regardless of calculated risk:

• Established clinical ASCVD.
• LDL-C ≥190 mg/dL.
• Aged 40–75 with diabetes, chronic kidney disease stage 3 or higher, or HIV on stable combination antiretroviral therapy.

Statin Therapy Options