Multinational validation of the PREVENT and SCORE2 cardiovascular risk equations across 6.4 million individuals

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing.

Please note there may be errors present which affect the content, and all legal disclaimers apply. The American Heart Association’s PREVENT equations estimate risk of total cardiovascular disease (CVD), atherosclerotic CVD (ASCVD), and heart failure (HF) to guide lipid and blood pressure-lowering therapy in people ages 30 to 79 years in the United States.

The SCORE2 risk algorithm is used to estimate CVD risk for similar purposes in people ages 40 and older in Europe. Neither set of equations has been comprehensively validated in global observational cohorts and randomized trials.

Here, in 44 observational cohorts and 18 randomized trials, we assessed discrimination and calibration of the two risk algorithms across geographical regions (North America, Europe, Asia/other, multi-region trials). We also created scaling factors for risk prediction over 1–9 years using the PREVENT equations, enabling shorter-term risk prediction for research purposes or to facilitate clinical trial enrolment.