Older adults may benefit from a recently introduced tool that assesses their risk for heart disease, according to a new study led by University of Iowa researchers. 

For more than a decade, the Pooled Cohort Equations (PCE) calculator has been used to predict heart disease in adults. While effective in identifying high-risk patients who likely would benefit from medications that lower blood pressure and cholesterol, PCE has been shown to overestimate heart disease risk in certain populations, including older adults. In 2023, the American Heart Association introduced a new tool, called the Predicting Risk of Cardiovascular Disease Events (PREVENT) calculator.

Michelle Fravel and Michael Ernst, clinical professors in the College of Pharmacy, and their colleagues compared the performance of PREVENT and PCE in older adults to determine which tool was more accurate in predicting heart disease risk. 

The researchers examined data from more than 15,000 people age 65 and older who participated in the Aspirin in Reducing Events in the Elderly (ASPREE) trial. They found that PREVENT was more accurate than PCE in estimating the risk of atherosclerotic cardiovascular disease, which is the buildup of plaque that leads to hardening of arteries and limits blood flow to and from the heart.

The researchers found PREVENT provided a risk estimate much closer to the observed risk than PCE. The proportion of predicted events compared with the proportion of observed events was 1.3% higher with PREVENT and 13% higher with PCE. The researchers also found PREVENT was a more accurate tool for adults 80 years and older — a population that had been left out of studies that led to PREVENT. 

“I think [PREVENT] perhaps will be incorporated into future guidelines to help us more accurately decide which patients we should treat preventatively to avoid heart disease, versus those patients who may not need to start these medications,” says Fravel, the study’s corresponding author. 

Fravel and her team also found that PREVENT, when compared with PCE, better identified older adults at high enough risk of heart disease where aspirin appeared beneficial in reducing heart disease events.

Study authors include Shiva Ganjali, from Deakin University; Mark Nelson, Suzanne Orchard, Kevan Polkinghorne, Christopher Reid, Joanne Ryan, Rory Wolfe, Robyn Woods, Zhen Zhou, and Sophia Zoungas from Monash University; and James Wetmore, from Hennepin Healthcare. 

The study, “Performance of the American Heart Association PREVENT Cardiovascular Risk Equations in Older Adults,” was published online April 28 in the journal Circulation: Cardiovascular Quality and Outcomes.  

The research was funded by the National Institute on Aging and the National Cancer Institute, branches of the National Institutes of Health. Funding also came from the National Health and Medical Research Council of Australia and by Monash University and the Victorian Cancer Agency.