New Study Backs AHA PREVENT Equations, Highlights Added Value of Lipoprotein(a) in Predicting Heart Risk
USA: A new large-scale analysis has validated the effectiveness of the American Heart Association's (AHA) recently developed PREVENT equations in predicting cardiovascular disease (CVD) risk, even among individuals with elevated levels of lipoprotein(a) [Lp(a)]. The study, published in JAMA Cardiology and led by Dr. Harpreet S. Bhatia from the University of California, San Diego, provides insights into how these equations perform and the added predictive value of Lp(a) in specific populations.
“The analysis of two large cohort studies showed that the new PREVENT equations were reliable in predicting heart disease risk, even for people with high levels of lipoprotein(a) [Lp(a)],” the researchers noted. They added, “However, having elevated Lp(a) was still linked to a higher chance of heart-related problems. These results suggest that including Lp(a) in risk assessments could help improve predictions, especially for certain groups of people.”
The analysis combined data from two well-known population-based cohorts—the Multi-Ethnic Study of Atherosclerosis (MESA) and the UK Biobank (UKB)—comprising over 314,000 individuals without prior cardiovascular disease. Researchers aimed to assess whether incorporating Lp(a), a known independent risk factor for atherosclerotic cardiovascular disease (ASCVD), could further refine risk estimates offered by the new PREVENT equations.
The key findings include the following:
- Individuals with elevated Lp(a) levels (≥125 nmol/L) had a 30% higher risk of ASCVD, CHD, heart failure, and total cardiovascular disease compared to those with lower levels.
- This increased risk associated with elevated Lp(a) was consistent across both the MESA and UK Biobank cohorts.
- Lp(a), though not included in the original PREVENT equations, contributed to modest improvements in cardiovascular risk prediction.
- The benefit of adding Lp(a) was more noticeable among individuals classified as low or borderline risk using traditional methods.
- Risk classification improved most significantly in those previously identified as borderline risk when Lp(a) was included.
- The PREVENT equations accurately predicted 10-year cardiovascular event rates across all risk groups, regardless of Lp(a) status.
- Individuals with high Lp(a) consistently showed worse cardiovascular outcomes, reinforcing its potential as a meaningful risk marker.
- Net reclassification improvement (NRI) analysis showed a category-free NRI of 0.058 and a categorical NRI of 0.006 upon adding Lp(a).
- These improvements, though modest, were statistically significant and most evident in low- and high-risk individuals for CHD.
These findings highlight the need to consider Lp(a) in personalized cardiovascular risk assessments. While the PREVENT equations are robust and reliable on their own, incorporating Lp(a) could fine-tune risk prediction in select groups, helping clinicians make more tailored treatment decisions.
The researchers concluded, "The study reinforces the predictive strength of the AHA PREVENT model and underscores Lp(a)’s independent role in cardiovascular risk. As precision medicine continues to evolve, such markers may increasingly inform individualized care strategies—especially in those whose risks might otherwise be underestimated."
Reference:
Bhatia HS, Ambrosio M, Razavi AC, et al. AHA PREVENT Equations and Lipoprotein(a) for Cardiovascular Disease Risk: Insights From MESA and the UK Biobank. JAMA Cardiol. Published online June 04, 2025. doi:10.1001/jamacardio.2025.1603
