Elizabeth Cooney , 2025-05-21 09:00:00
In what researchers hope could be a case of 1 + 1 = 3, new research suggests that combining a model to predict 10-year cardiovascular risk with an imaging test of coronary arteries could be better than either method alone at identifying people in danger of their first heart attack.
The model is PREVENT, which computes a risk score based on measures familiar from the primary care office: blood pressure, cholesterol levels, kidney function, age, and BMI, as well as questions about type 2 diabetes, smoking, and social determinants of health. The imaging test is a CT scan that detects calcium buildup in arteries leading to the heart. High amounts of calcium, alone and inside fatty plaques, can lead to blockages and heart attacks.
CT scans yield a coronary artery calcium score that might be the reason for prescribing a statin or more medications to lower cholesterol.
The value of combining the two predictors of heart disease lies in revealing risk before symptoms show up, the study authors said. The difference between solo and combined scores was modest.
“It’s not always clear who should be screened for coronary calcium; thus, we decided to see if the PREVENT score could be used in this novel manner,” Morgan Grams of New York University’s Grossman School of Medicine told STAT. She is an author of the study published Wednesday in the Journal of the American Heart Association. “Once we determined that it could, we assessed whether the coronary calcium score could add information to PREVENT in the prediction of incident cardiovascular disease. It did.”
To arrive at this conclusion, the researchers used real-world evidence, in this case the medical records of nearly 7,000 people in New York who were referred for cardiovascular disease screening. The PREVENT model sorted people by low, mildly elevated, moderately elevated, or high risk of heart attack. Those scores matched what CT scans estimated for risk, but when the scores were combined, they more accurately identified the participants who were at slightly higher risk and who had a heart attack in the following year.
“Both are valid measures of cardiovascular disease risk and might be used together to better risk stratify patients,” Grams said.
Tim Anderson, isn’t so sure CT scans would prove to be sufficiently better at predicting heart attacks than the PREVENT score alone, given imaging’s cost (starting at around $300), concern about radiation exposure, and the lack of a recommendation from the U.S. Preventive Services Task Force to use it as a screening test.
While not disputing the value of measuring coronary artery calcium in some cases, he said the study subjects weren’t typical of patients in primary care whose risk can be identified by PREVENT. And the improvement when doing both tests was modest, on the order of 1% or 2%.
“People who get coronary artery calciums are not run-of-the-mill folks,” he told STAT. “I think the challenge comes with how much more useful that is than the usual stuff that we already do in clinic, like checking someone’s blood pressure and cholesterol and knowing their age.”
Cardiologists might use calcium artery scores for patients already taking statins who may need an additional cholesterol medicine, Anderson said, or as more information for patients on the fence about starting a statin.
A high coronary artery calcium score is a strong sign of high risk for cardiovascular events, while a low score is a sign that a problem is unlikely in the next five to seven years.
“The PREVENT score is a useful predictor of cardiovascular events, while coronary artery calcium scores are a sign of subclinical coronary artery disease,” Anderson said about unseen problems. “And that in and of itself is even more predictive of having events like heart attacks.”
The PREVENT model, released by the American Heart Association in 2023, is not yet officially adopted as a guideline for practice by two medical societies still reviewing them. Formally known as Predicting Risk of cardiovascular disease EVENTs, it was intended to improve on a version created in 2013, known as the Pooled Cohort Equations and widely criticized for overestimating risk. The American Heart Association and American College of Cardiology review is expected to be completed next year.
PREVENT drew on billing and electronic health record data from a more diverse real-world population than the older one, incorporating current statin use as well as metabolic and kidney diseases. It has drawn attention for potentially narrowing the number of people who qualify for a statin, but the jury is still out.
Meanwhile, most people who would be advised to take statin, by either model, don’t.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
