Prognostic value of PREVENT, PCE, and social determinants of health for cardiovascular mortality in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study

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Abstract Background The Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations were designed to predict CVD outcomes in adults aged 30–79, using a race-free model that includes kidney function and statin use. Their performance compared to the Pooled Cohort Equations (PCE) needs evaluation in diverse populations to assess clinical utility. Methods In a sample of Black and White individuals aged 30–64 from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) cohort, we assessed the performance of the base PREVENT equations and the PCE using complementary methods (discrimination, reclassification) and evaluated if adding social determinants of health (SDoH) to base PREVENT improved the prediction of CVD deaths. Results Among 1,998 HANDLS participants free of CVD, the 10-year cumulative incidence of CVD death (95% confidence intervals [CI]) was 2.75% (2.10%, 3.54%). The PREVENT equation exhibited better discrimination (AUCt=10 (95% CI): 0.77 (0.71, 0.83)) than the PCE (0.71 (0.64, 0.78)), and modest improvement in risk reclassification (continuous net reclassification index: 0.38 (0.10, 0.67)). Out of four SDoH variables (poverty, education, employment, and homeownership status) evaluated, only unemployment was strongly associated with CVD mortality independently of PREVENT-predicted risk (HR (95% CI): 3.39 (1.80, 6.40)). However, updating PREVENT-predicted risks with unemployment status only modestly improved discrimination and risk reclassification. Conclusions In a socially and racially diverse cohort, the PREVENT total CVD risk equation demonstrated better discrimination and risk reclassification compared to the PCE. After adjustment for PREVENT-estimated risk, unemployment remained strongly associated with CVD mortality, but only modestly, and non-significantly, improved model discrimination and risk reclassification.

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