Work

Statin Eligibility Disparities with Transition from the Pooled Cohort Equations to the AHA PREVENT

Year: 2026

Type: preprint

Abstract: Background: The 2023 AHA PREVENT (Predicting Risk of Cardiovascular Disease Events) equations were expected to replace the 2013 ACC/AHA Pooled Cohort Equations (PCE) for estimating atherosclerotic cardiovascular disease (ASCVD) risk. The real-world implications of this transition on statin eligibility and disparity are unknown. Objectives: To evaluate how transitioning from PCE to AHA PREVENT alters statin eligibility across risk thresholds and racial and ethnic subgroups. Design Setting and Participants: Retrospective cohort analyses of adults aged 40-75 years without diabetes, LDL-C ≥190 mg/dL, or prior statin use from Sutter Health (2010-2024) and NHANES (2011-2020). Ten-year ASCVD risk was estimated using both equations. Weighted analyses were applied to NHANES data. Main Outcomes and Measures: Statin eligibility at PREVENT-ASCVD thresholds (3%, 4%, 5%, 6%, 7.5%) compared with PCE ≥7.5%, and the proportion of individuals reclassified below PREVENT-ASCVD thresholds. Results: Among 229,839 Sutter Health patients (mean age 53.7 years; 53.8% women), 22.3% had PCE risk ≥7.5%. Among individuals above PREVENT-ASCVD 5% threshold level (18.0% in the cohort) 94.7% also met PCE criteria. However, 6.3% (11,866) would lose eligibility, disproportionately affecting non-Hispanic Black adults (18.7%) compared with non-Hispanic Asian adults (3.3%) among individuals who were below PREVENT-ASCVD 5% threshold. In NHANES (n=3,226; representing 32.7 million adults), 9.4% overall and 21.7% of non-Hispanic Black adults with PCE ≥7.5% lost eligibility at PREVENT-ASCVD 5% threshold level. Conclusions: Transitioning from PCE to PREVENT recalibrates statin eligibility and may disproportionately affect non-Hispanic Black adults. Disparity-focused monitoring is essential for clinical implementation of this new model.

Source: medRxiv

DOI: 10.64898/2026.01.29.26345173