🎙️ Episode 27: Statin Confusion? Try the PREVENT Calculator

📊 What It Is:

A modern CV risk estimator developed from 2.3 million-person dataset.

Replaces outdated ASCVD calculator (based on 25k).

🧠 Features:

Adds BMI, GFR, A1C, and zip code.

Omits race — more equitable.

Outputs risk of heart disease, stroke, heart failure.

⚠️ Caveats:

Generally gives lower risk estimates vs ASCVD.

May reduce statin overuse, but some feel it's too conservative.

🧩 Clinical Takeaway:

Helpful in primary prevention — especially borderline cases.

Use side-by-side with ASCVD for now until guidelines update.

Chapters

• 0:00 Introduction to PREVENT Calculator
• 1:33 ASCVD vs PREVENT Differences
• 2:07 Controversy Over Risk Estimates
• 2:50 Future of Cardiovascular Risk Assessment

Transcript

Speaker 1: 0:11

All right, let's talk about the PREVENT calculator Now. This is newer in the armaturem of trying to determine, basically, should a patient get statin and what kind of risks they are for having a coronary event stroke. I love the name of this PREVENT. Look at this. The cardiologists always get this right P from PRE, from prevent and then risk of cardiovascular disease events. Now the ASCVD calculator, which is still in use, was developed in 2013 by the American College of Cardiology and American Heart Association. The variables on the calculator age, sex risk, blood pressure, total HDL, cholesterol, history of smoking, diabetes and treatment of hypertension. Now the problem with that calculator is that a lot of people felt that it caused more people to take statins than they should have, and that was the big discussion then. Should have, and that was the big discussion then.

Speaker 1: 1:23

Now there are some differences in the Prevent calculator from the ASCVD. The data okay 3.3 million people versus 25,000 people on the old calculator. New calculator includes BMI, gfr, hem, hemoglobin a1c and you can omit some of these urinary albumin to creatinine ratio. It omits race, but you can put in the zip code if you choose to and that zip code will show if people are in an area where um it's does not have as much resources of others gives the estimate for cardiovascular disease, overall heart failure, coronary disease plus stroke. So it gives more information. Now the risk estimates were lower with Prevent than they were with the older calculator. It's very easy to access. You can go right to it's a Google search and you can get it right here. Here's where I link if you need to get it to get it.

Speaker 1: 2:23

So in the validation studies it showed the lower risk in patients. An example would be the old calculator predicted risk was 8% versus 4.3% with Prevent. So much lower risk in the prevent calculator. Now in nothing in medicine is easy. And now the feedback is coming and it's from a lot of people are saying that it's too low of a risk so they're not recommending using it and then they're using like a hybrid of the old calculator with this calculator. So this is one of those things we're going to have to kind of see how it validates over time with anything in medicine. So they've put a lot of data in this. They've done a lot of work. They actually can find the kidney function. They've worked with adding with kidney function into this to give it more data, to give it more results. But the pushback is saying this is giving low risk versus the old calculator and there's going to cause people to mainly take less statins. So let's see how this plays out in the long term.