New cardiovascular risk guidelines in the U.S. are shifting how doctors classify patient health, moving away from race-based formulas toward more personalized metrics. Research published in JAMA, led by Allison Peng, MD, of the Johns Hopkins University School of Medicine, indicates that 22% of adults will change risk categories under the new PREVENT-atherosclerotic cardiovascular disease (ASCVD) tool compared to the 2013 standard. While the total number of patients recommended for statin therapy remains largely stable, the criteria for who receives those prescriptions—and who requires further diagnostic testing—is undergoing a significant transition.
How the PREVENT Tool Reclassifies Patient Risk
The transition from the 2013 pooled cohort equations to the PREVENT-ASCVD tool marks a departure from simplified demographic categories. According to the study of 24,403 adults aged 40 to 79, the old model relied on race as a binary input (Black vs. White). The new tool eliminates race entirely, instead incorporating body mass index, markers of glycemia, and kidney disease data to predict both 10-year and 30-year cardiovascular risk.
The impact of this shift varies by demographic:
- Men and Black adults: Frequently moved into lower-risk categories compared to the previous model.
- Women and patients with diabetes: Often see their risk classification upgraded to a higher category.
Overall, 14% of the population studied moved into a lower-risk group, while 7% moved into a higher-risk group. The “borderline” risk category expanded significantly, growing from 13% to 18% of the population.
Did you know? While the new tool reshuffles risk categories for more than one-fifth of the population, the actual proportion of U.S. adults recommended for cholesterol-lowering statins remains nearly unchanged at approximately 50%.
Diagnostic Shifts and Personalized Care
With the expansion of the “borderline” risk category, clinicians are expected to lean more heavily on personalized diagnostics. Allison Peng, MD, and her colleagues suggest that the new guidelines provide opportunities for clinicians to utilize coronary artery calcium scoring and other risk enhancers. This approach favors shared decision-making, where patients and doctors weigh the necessity of medication against specific, individualized test results rather than relying solely on a standardized risk score.
The Persistent Challenge of Treatment Gaps
Despite the refinement of risk assessment tools, a significant public health gap remains. In an editorial accompanying the JAMA report, Philip Greenland, MD, of Northwestern University Feinberg School of Medicine and Karen Lasser, MD, of Boston Medical Center, emphasize that the primary issue is not just identifying risk, but ensuring treatment adherence. Many patients currently eligible for lipid-lowering therapy are not reaching established cholesterol goals. The authors characterize this as a “major challenge” and a “missed opportunity” for the U.S. healthcare system.
Pro Tip: If your risk category changes under new guidelines, ask your physician about the role of coronary artery calcium scoring. This test can provide a more granular look at your heart health beyond traditional lipid panels.
Frequently Asked Questions
- Why was race removed from the new cardiovascular risk tool?
- The new PREVENT-ASCVD tool focuses on clinical markers like kidney function and glycemia rather than race, aiming for a more personalized assessment that reflects an individual’s specific physiology.
- Does the new tool mean I will stop taking my statins?
- Not necessarily. While some people may be reclassified, the study found the overall number of people recommended for statins remained consistent. Always consult your doctor before making changes to prescribed medication.
- What is the difference between 10-year and 30-year risk?
- The old 2013 model focused only on the 10-year outlook. The new tool provides both 10-year and 30-year projections.
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