The AHA’s Updated PREVENT Risk Calculator

When the AHA (American Heart Association) speaks, listen up! They recently released an updated cardiovascular risk assessment calculator, which includes factors related to social and kidney health.

The calculator removed race as a factor but included tobacco use, age, sex, and use of medications in reducing CVD risk in their evaluation.

By including race, the authors believe it may suggest that differences by race are non-modifiable and could reinforce race as a biological factor that could exacerbate health disparities. The researchers opted to exclude race as a predictor and emphasize that the PREVENT calculator offers similar accuracy within different ethnic and racial populations.

The predictors also incorporate an option to use the Social Deprivation Index, which includes assessments of adverse social determinants of health like education, poverty, unemployment, and an individuals’ environmental factors.

According to SS Khan, one of the developers of PREVENT, adding CKM (cardiovascular-kidney-metabolic syndrome) plus social factors to the equation is an important initial step to help reduce risk of CVD.

The online tool should be released soon once it’s finalized.

The scientific statement lists numerous knowledge gaps and areas for future research. These include:

• Adding "net benefit" to pinpoint the expected benefit of treatment recommendations based on an individual's level of risk.

• Including more data from more diverse race and ethnic populations to better represent the growing diversity in the United States. The amount of Hispanic and Asian people represented in the PREVENT datasets is lower than national estimates in the general US population, so risk assessments in these populations may not be as accurate.

• Growing the collection, reporting, and standardization of social determinants of health data, including individual information instead of neighborhood information.

• Expanding risk assessment and prevention to childhood and/or adolescence and in key periods of life, including the peripartum period, as adverse pregnancy outcomes are linked with increased CVD risk.

• Evaluating whether predicting negative kidney outcomes, especially within people with and without type 2 diabetes, may further pinpoint cardiovascular risk prediction.

Below are controllable lifestyle factors to PREVENT CVD and CKD

·         Know your risk factors. See your healthcare provider and get regular labs done including a lipid profile, renal panel, and blood sugar.

·         Limit red meat and processed meats. Both have been linked with the development of cardiovascular disease and diabetes.

·         Include green leafy vegetables in your diet daily. These aid in managing blood pressure, weight, and blood sugar.

·         Add low-fat dairy products to your diet. Calcium helps lower blood pressure as part of the DASH diet and has been linked with a reduced risk of diabetes.

·         Choose whole grains over refined grains. In addition to dietary fiber, these provide antioxidants, vitamins, and minerals to reduce chronic disease risk.

·         Keep moving. Regular exercise gets your blood flowing and helps manage your weight, blood pressure, blood sugar, and stress levels.

·         Get plenty of sleep. Poor sleep is linked with diabetes, hypertension, high cholesterol, and anxiety.

·         Avoid fad diets that stress excess protein or fat. Research indicates that these may be harmful to your heart and kidneys.

Lisa Andrews, MEd, RD, LD

References

Khan SS, Coresh J, Pencina MJ, Ndumele CE, Rangaswami J, Chow SL, Palaniappan LP, Sperling LS, Virani SS, Ho JE, Neeland IJ, Tuttle KR, Rajgopal Singh R, Elkind MSV, Lloyd-Jones DM; on behalf of the American Heart Association. Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation. 2023;148:e•••–e•••. doi: 10.1161/CIR.0000000000001191

Shi W, Huang X, Schooling CM, Zhao JV. Red meat consumption, cardiovascular diseases, and diabetes: a systematic review and meta-analysis. Eur Heart J. 2023 Jul 21;44(28):2626-2635. doi: 10.1093/eurheartj/ehad336. PMID: 37264855.

Lari A, Sohouli MH, Fatahi S, Cerqueira HS, Santos HO, Pourrajab B, Rezaei M, Saneie S, Rahideh ST. The effects of the Dietary Approaches to Stop Hypertension (DASH) diet on metabolic risk factors in patients with chronic disease: A systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2021 Sep 22;31(10):2766-2778. doi: 10.1016/j.numecd.2021.05.030. Epub 2021 Jun 10. PMID: 34353704.

Korostovtseva L, Bochkarev M, Sviryaev Y. Sleep and Cardiovascular Risk. Sleep Med Clin. 2021 Sep;16(3):485-497. doi: 10.1016/j.jsmc.2021.05.001. Epub 2021 Jun 25. PMID: 34325825.

Ko GJ, Rhee CM, Kalantar-Zadeh K, Joshi S. The Effects of High-Protein Diets on Kidney Health and Longevity. J Am Soc Nephrol. 2020 Aug;31(8):1667-1679. doi: 10.1681/ASN.2020010028. Epub 2020 Jul 15. PMID: 32669325; PMCID: PMC7460905.