Cardiology

PREVENT Score: 10-Year ASCVD Risk Calculator

Q: PREVENT vs SCORE2 — which should I use?

SCORE2 is widely used in Europe. PREVENT is newer, derived from a larger and more diverse cohort, but external validation outside the US is limited. Many centers use both scores in parallel.

Q: At what threshold should a statin be started?

At 7.5% (intermediate risk) — discuss with the patient, taking risk-enhancing factors into account. At ≥ 20%, a statin is indicated for most patients.

Q: Why does PREVENT predict heart failure separately?

In patients with diabetes and CKD, the risk of developing heart failure is higher than that of ASCVD. A separate prediction supports earlier initiation of SGLT2 inhibitors.

Q: Does the score need to be recalculated every year?

Every 4-6 years in low- or borderline-risk patients. More frequently if risk factors change or the patient enters a new decade of life.

10-year risk of atherosclerotic cardiovascular disease (AHA PREVENT 2024)

Primary source: Khan SS et al. Circulation 2024; 149(6): e430-e449. AHA PREVENT Equations

Aleksandr A. Aulov, MD, internal medicine Last clinical review: April 28, 2026

Online calculation

Age

years

Sex

Total cholesterol

1 mmol/L ≈ 38.67 mg/dL

mmol/L

HDL cholesterol (HDL-C)

mmol/L

Systolic blood pressure

mm Hg

eGFR

Can be calculated using the CKD-EPI calculator above

mL/min/1.73 m²

Diabetes mellitus

Current smoking

Antihypertensive medication use

Statin use

About this score

PREVENT (Predicting Risk of cardiovascular disease EVENTs) is a new AHA 2023 risk score for estimating the 10-year and 30-year risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure. It was developed in a cohort of 6.6 million participants and replaces the outdated 2013 Pooled Cohort Equations.

Key innovations in PREVENT: removal of the race coefficient (which previously overestimated risk in Black patients), inclusion of eGFR as a marker of chronic kidney disease, and optional extensions for HbA1c, urine albumin-to-creatinine ratio, and a social deprivation index. The score predicts not only classic ASCVD events but also incident heart failure, which is critical for patients with diabetes and CKD.

Use: primary prevention in adults 30-79 years without established ASCVD. Risk categories: < 5% low, 5-7.4% borderline, 7.5-19.9% intermediate, ≥ 20% high. The decision to start a statin is generally made at the 7.5% threshold.

When to use

Primary prevention of ASCVD in patients 30-79 years without established cardiovascular disease.
Deciding whether to start statin therapy and at what intensity.
Motivational conversation with the patient — visualizing risk improves adherence to risk factor modification.
Screening during routine health checkups.

Clinical example

Case

55-year-old man, non-smoker, BP 140/85 (on losartan), total cholesterol 5.9 mmol/L, HDL 1.1 mmol/L, no diabetes, BMI 27, eGFR 78 mL/min/1.73 m².

Calculation

10-year ASCVD risk by PREVENT ≈ 12% (intermediate).

Interpretation and management

Intermediate 10-year ASCVD risk. Indicated: moderate-intensity statin (atorvastatin 20 mg or rosuvastatin 10 mg) with a target LDL < 2.6 mmol/L. In parallel: tighter blood pressure control (target < 130/80), weight loss, walking ≥ 150 min/week. Follow-up in 3 months.

Limitations and cautions

Validated primarily in US cohorts; applicability outside the US population requires confirmation.
Does not account for Lp(a), high-sensitivity CRP, or family history — these are risk-enhancing factors at borderline values.
Not applicable to patients with established ASCVD (secondary prevention).
Accuracy is limited in patients younger than 30 or older than 80 years.

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Frequently asked questions

PREVENT vs SCORE2 — which should I use?

SCORE2 is widely used in Europe. PREVENT is newer, derived from a larger and more diverse cohort, but external validation outside the US is limited. Many centers use both scores in parallel.

At what threshold should a statin be started?

At 7.5% (intermediate risk) — discuss with the patient, taking risk-enhancing factors into account. At ≥ 20%, a statin is indicated for most patients.

Why does PREVENT predict heart failure separately?

In patients with diabetes and CKD, the risk of developing heart failure is higher than that of ASCVD. A separate prediction supports earlier initiation of SGLT2 inhibitors.

Does the score need to be recalculated every year?

Every 4-6 years in low- or borderline-risk patients. More frequently if risk factors change or the patient enters a new decade of life.

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Aleksandr A. Aulov Physician, internal medicine, Sechenov School — independent medical education platform. Calculators are compiled from the original publications and current clinical guidelines. Interpretation thresholds follow the source study unless stated otherwise.

This calculator is intended for healthcare professionals. Do not use it for self-diagnosis or self-treatment. Management decisions are made by the treating clinician based on the full clinical picture of the individual patient.