Background: The American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) equations were recently developed to estimate risk of total cardiovascular disease (CVD), which includes both atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Long-term risks of total CVD in the US population are unknown.
Objectives: This study sought to determine the long-term risks of CVD in the US population.
Methods: Using data on US adults aged 30-79 years from the National Health and Nutrition Examination Survey between 2011 and 2020, we determined 10-year and 30-year risks of total CVD, ASCVD and HF based on the PREVENT equations. Age-standardized and survey-weighted risk prevalence was determined with further stratification by age, sex, race and ethnicity.
Results: The study population included 14,184 participants aged 30-79 years, representing 160.6 million US adults with and without CVD. The prevalence of existing CVD was 9.6%, including 26.8% among adults 65-79 years. Survey-weighted prevalence of having elevated (≥7.5%) 10-year predicted risk of developing CVD was 20.2%, though only 10.7% were considered at risk for ASCVD and 12.7% at risk for HF. Prevalence of having elevated 10-year risk of developing CVD was 1.0% in adults aged 30-44 years, 18.3% in adults 45-64 years, and 66.3% in adults 65-79 years. Due to underlying risk factor profiles, men, Black and Hispanic adults had higher 10-year risks of total CVD, ASCVD and HF. Mean 10-year risks of total CVD, ASCVD and HF modestly increased over time. For 30-year risks, 66.7% of adults aged 30-59 were without CVD but had elevated total CVD risk, including 89.7% of adults aged 45-59 years. Men and Black adults had higher 30-year risks of ASCVD and HF.
Conclusions: Three in ten US adults aged 30-79 years have existing CVD or an elevated 10-year predicted risk of CVD, including >90% of adults over age 65. Two-thirds of middle-aged adults are without CVD but have an elevated 30-year CVD risk. Men, Black and Hispanic adults are higher risk. These findings emphasize the need for intensive efforts to prevent CVD in the US.
Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC
CME Editor
Ragavendra R. Baliga, MD
Author
Ahmad Slim, MD, FACC
Important Dates
Date of Release: June 9, 2025
Term of Approval/Date of CME/MOC Expiration: June 8, 2026