Differences in Statin Eligibility with the Use of Predicting Risk of Cardiovascular Disease EVENTs Versus Pooled Cohort Equations in the UK Biobank

The Pooled-Cohort Equations (PCEs), developed by the American Heart Association (AHA) and American College of Cardiology (ACC), have been widely used since 2013 to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk and guide statin therapy. Recently, the AHA introduced the Predicting Risk of CVD EVENTs (PREVENT) equations to improve ASCVD risk estimation. However, the effect of using PREVENT instead of PCEs on risk classification and statin eligibility remains unclear. This retrospective cohort study analyzed 261,303 UK Biobank participants, aged 40 to 69 years, who were free from cardiovascular disease and not on statin therapy. The PCEs and the base PREVENT equations were used to estimate 10-year ASCVD risk, categorize risk levels, and determine statin eligibility based on a common risk threshold of 7.5%. The median 10-year ASCVD risk was 5.2% (2.2%, 10.6%) using the PCEs and 3.5% (1.8%, 5.8%) with the PREVENT equations. The PREVENT equations classified 14.0% of participants as high-risk (ASCVD risk >7.5%), compared to 36.9% classified by PCEs. Among participants classified as intermediate-risk by PCEs, 75.3% were reclassified as low-risk by PREVENT. The proportion of individuals eligible for statin use by the PREVENT equation was 19.9%, and by the PCEs was 40.7%. The corresponding difference was 20.8% (95% CI: 20.6%-20.9%). More men (33.0% [95% CI: 32.7%-33.3%]) than women (11.5% [95% CI: 11.3%-11.7%]) and more individuals in the older age group (60-69 years: 34.0% [95% CI: 34.3%-33.7%]) than in the younger age group (40-49 years: 3.5% [95% CI: 3.3%-3.6%]) would not be recommended for statin consideration with the PREVENT equations. In conclusion, based on the common risk threshold of 7.5%, replacing the PCEs with the base PREVENT equation would reduce statin eligibility in the UK Biobank participants by ∼20%, especially among men and older adults.