Performance of PREVENT equations for cardiovascular risk prediction in young patients with myocardial infarction: From the MGB YOUNG-MI registry

Background: Predicting cardiovascular risk in young adults remains challenging. The newly developed PREVENT equations offers several advantages for short and long-term cardiovascular risk prediction. Objective: To determine how often PREVENT equations identify increased cardiovascular risk among young adults who experience premature myocardial infarction compared with existing risk calculators Methods: The YOUNG-MI registry is a retrospective cohort from two large academic centers, which included individuals who experienced an MI at age ≤ 50 years. Study physicians adjudicated diagnosis of Type 1 MI. Cardiovascular risk was estimated by pooled cohort equations and PREVENT equations based on data available prior to MI or at the time of presentation. Results: The study cohort included 1149 individuals with a median age of 45 years and 19 % women. The median 10-year ASCVD risk calculated by pooled cohort equations and 2023 PREVENT equations was 4.6 % and 2.3 %, respectively. Using the 10-year ASCVD risk estimates from the 2023 PREVENT equations, only 33 (3 %) individuals met the 7.5 % threshold while 93 (8 %) met the 5 % threshold and 333 (29 %) met the 3 % threshold. For 30-year ASCVD risk using PREVENT, 827 (72 %) met a threshold of ≥ 10 %. Conclusion: The PREVENT equations may lead to undertreatment of young adults who experienced an MI. Using the 30-year risk PREVENT equations may improve long-term risk assessment in this population.