Score limitations
What the PREVENT equations leave out
The AHA PREVENT equations (2023) predict cardiovascular risk from 12 input variables. This atlas catalogs many more risk factors that carry strong evidence. Below, each strongly-evidenced (grade A or B) factor is classified as directly used by PREVENT, captured indirectly through a proxy input, or genuinely omitted — the last group is where a more comprehensive predictor could add discrimination.
135
strongly-evidenced factors (A/B)
12
directly used by PREVENT
9
captured via a proxy input
114
genuinely omitted
Captured indirectly (proxy inputs)
PREVENT does not measure these directly, but a correlated input variable partially captures their signal — so they are not counted as gaps.
Genuinely-omitted strong factors by category
Inflammatory & Immune15
Systemic inflammation · Interleukin-6 · High-sensitivity C-reactive protein · Endothelial dysfunction · Periodontitis · Rheumatoid arthritis · Psoriasis · Tumor necrosis factor-alpha · Inflammatory bowel disease · COVID-19 · HIV infection · Systemic lupus erythematosus · C-reactive protein · inflammation · White blood cell count
Novel & Emerging Biomarkers15
Homocysteine · Oxidative stress · Gut microbiome composition · High-sensitivity cardiac troponin · Cardiac autonomic dysfunction (reduced heart rate variability) · Vitamin D deficiency · N-terminal pro-B-type natriuretic peptide · Circulating microRNAs · Leptin · Sex hormone levels (testosterone/estrogen) · Adiponectin · Trimethylamine N-oxide · Cortisol · Galectin-3 · Growth differentiation factor-15 (GDF-15)
Lifestyle & Behavioral12
Physical inactivity · Alcohol consumption · Diet quality · Sedentary behavior · Poor sleep quality · Sleep duration · Omega-3/fish intake · Saturated fat intake · Coffee consumption · Secondhand smoke exposure · Fruit and vegetable intake · Red/processed meat consumption
Comorbid Conditions11
Atrial fibrillation · Non-alcoholic fatty liver disease · Obstructive sleep apnea · Chronic obstructive pulmonary disease · Erectile dysfunction · Cancer · History of preeclampsia · Polycystic ovary syndrome · Osteoporosis/low bone mineral density · Gout · Migraine
Environmental & Occupational9
Air pollution (PM2.5) exposure · Shift work · Environmental noise exposure · Cadmium exposure · Lead exposure · Extreme heat exposure · Cold exposure · Ambient temperature · Arsenic exposure
Genetic & Family History8
Familial hypercholesterolemia · 9p21 chromosomal locus · APOE genotype · Polygenic risk score · LPA gene variants · Clonal hematopoiesis of indeterminate potential · Family history of premature coronary heart disease · 9p21.3 locus variant
Imaging & Subclinical Disease7
Coronary artery calcium score · Carotid atherosclerotic plaque · Carotid intima-media thickness · Ankle-brachial index · Retinal microvascular changes · Coronary artery plaque burden (CCTA) · Left ventricular hypertrophy
Lipids & Lipoproteins6
Triglycerides · Lipoprotein(a) · Apolipoprotein B · PCSK9 · Oxidized LDL · Remnant cholesterol
Anthropometric & Body Composition5
Overweight/obesity · Waist circumference · Epicardial adipose tissue · Weight gain · Waist-to-hip ratio
Hemostatic & Thrombotic4
D-dimer · Fibrinogen · Platelet reactivity/aggregation · Plasminogen activator inhibitor-1 (PAI-1)
Blood Pressure & Hemodynamics3
Arterial stiffness · Pulse wave velocity · Pulse pressure
Renal & Electrolyte2
Serum uric acid · Cystatin C
Highest-evidence omitted factors
| Risk factor | Category | Grade | Score | Causal | Refs | Trials | GWAS |
|---|---|---|---|---|---|---|---|
| Triglycerides | Lipids & Lipoproteins | A | 91 | genetic-causal | 389 ·28m | 138 | 563 |
| Systemic inflammation | Inflammatory & Immune | A | 90 | genetic-causal | 306 ·12m | 440 | 166 |
| Lipoprotein(a) | Lipids & Lipoproteins | A | 84 | genetic-causal | 147 ·6m | 55 | 258 |
| Interleukin-6 | Inflammatory & Immune | A | 77 | genetic-causal | 146 ·10m | 2 | 170 |
| Apolipoprotein B | Lipids & Lipoproteins | A | 74 | genetic-causal | 127 ·5m | 4 | 198 |
| Familial hypercholesterolemia | Genetic & Family History | A | 72 | genetic-causal | 62 ·2m | 70 | 418 |
| Chronic psychological stress | Psychosocial & Mental Health | A | 63 | trial evidence | 577 ·26m | 71 | — |
| Physical inactivity | Lifestyle & Behavioral | A | 62 | trial evidence | 483 ·33m | 271 | — |
| Metabolic syndrome | Glycemic & Metabolic | A | 61 | trial evidence | 358 ·18m | 85 | — |
| High-sensitivity C-reactive protein | Inflammatory & Immune | A | 60 | trial evidence | 293 ·23m | 51 | — |
| Insulin resistance | Glycemic & Metabolic | A | 59 | trial evidence | 263 ·10m | 42 | — |
| Depression | Psychosocial & Mental Health | A | 59 | trial evidence | 251 ·31m | 43 | — |
| Endothelial dysfunction | Inflammatory & Immune | A | 59 | trial evidence | 283 ·7m | 63 | — |
| Atrial fibrillation | Comorbid Conditions | A | 58 | trial evidence | 219 ·16m | 144 | — |
| Alcohol consumption | Lifestyle & Behavioral | A | 57 | trial evidence | 162 ·10m | 50 | — |
| Coronary artery calcium score | Imaging & Subclinical Disease | A | 56 | trial evidence | 135 ·11m | 53 | — |
| Homocysteine | Novel & Emerging Biomarkers | A | 56 | trial evidence | 127 ·8m | 146 | — |
| Fasting plasma glucose | Glycemic & Metabolic | A | 56 | trial evidence | 111 ·8m | 138 | — |
| Overweight/obesity | Anthropometric & Body Composition | A | 56 | trial evidence | 110 ·10m | 104 | — |
| Arterial stiffness | Blood Pressure & Hemodynamics | A | 55 | trial evidence | 190 ·8m | 16 | — |
| Carotid atherosclerotic plaque | Imaging & Subclinical Disease | A | 55 | trial evidence | 98 ·13m | 183 | — |
| 9p21 chromosomal locus | Genetic & Family History | A | 54 | observational only | 45 ·6m | — | 293 |
| Carotid intima-media thickness | Imaging & Subclinical Disease | A | 54 | trial evidence | 182 ·29m | 13 | — |
| Anxiety | Psychosocial & Mental Health | A | 54 | trial evidence | 104 ·14m | 23 | — |
| Periodontitis | Inflammatory & Immune | A | 54 | trial evidence | 142 ·14m | 16 | — |
| Non-alcoholic fatty liver disease | Comorbid Conditions | A | 53 | trial evidence | 117 ·6m | 40 | — |
| Rheumatoid arthritis | Inflammatory & Immune | A | 53 | trial evidence | 112 ·7m | 20 | — |
| Obstructive sleep apnea | Comorbid Conditions | A | 52 | trial evidence | 137 ·5m | 33 | — |
| Psoriasis | Inflammatory & Immune | A | 52 | trial evidence | 128 ·12m | 12 | — |
| Serum uric acid | Renal & Electrolyte | A | 52 | trial evidence | 152 ·7m | 10 | — |
| Oxidative stress | Novel & Emerging Biomarkers | A | 51 | trial evidence | 299 ·4m | 18 | — |
| Diet quality | Lifestyle & Behavioral | A | 51 | trial evidence | 92 ·7m | 16 | — |
| Race/ethnicity | Demographic & Social | A | 51 | trial evidence | 164 ·9m | 7 | — |
| APOE genotype | Genetic & Family History | A | 51 | observational only | 46 ·4m | — | 229 |
| Pulse wave velocity | Blood Pressure & Hemodynamics | A | 50 | trial evidence | 169 ·12m | 5 | — |
| Chronic obstructive pulmonary disease | Comorbid Conditions | A | 49 | trial evidence | 75 ·5m | 26 | — |
| Socioeconomic status | Demographic & Social | A | 48 | observational only | 216 ·22m | 2 | — |
| Polygenic risk score | Genetic & Family History | B | 48 | trial evidence | 100 | 5 | 2742 |
| Ankle-brachial index | Imaging & Subclinical Disease | A | 47 | trial evidence | 70 ·7m | 8 | — |
| D-dimer | Hemostatic & Thrombotic | A | 47 | trial evidence | 60 ·8m | 7 | — |
| Fibrinogen | Hemostatic & Thrombotic | A | 46 | trial evidence | 86 ·8m | 4 | — |
| Retinal microvascular changes | Imaging & Subclinical Disease | A | 46 | trial evidence | 32 ·6m | 19 | — |
| Air pollution (PM2.5) exposure | Environmental & Occupational | A | 45 | trial evidence | 167 ·4m | 7 | — |
| Sedentary behavior | Lifestyle & Behavioral | A | 45 | trial evidence | 50 ·9m | 5 | — |
| Tumor necrosis factor-alpha | Inflammatory & Immune | A | 45 | trial evidence | 73 ·8m | 3 | — |
| Inflammatory bowel disease | Inflammatory & Immune | A | 45 | trial evidence | 66 ·7m | 4 | — |
| COVID-19 | Inflammatory & Immune | A | 44 | trial evidence | 55 ·3m | 59 | — |
| Erectile dysfunction | Comorbid Conditions | A | 44 | trial evidence | 107 ·5m | 5 | — |
| Gut microbiome composition | Novel & Emerging Biomarkers | B | 44 | trial evidence | 179 ·2m | 15 | — |
| HIV infection | Inflammatory & Immune | A | 44 | trial evidence | 59 ·3m | 26 | — |
| High-sensitivity cardiac troponin | Novel & Emerging Biomarkers | A | 43 | trial evidence | 68 ·4m | 12 | — |
| Waist circumference | Anthropometric & Body Composition | A | 43 | observational only | 120 ·7m | 1 | — |
| Poor sleep quality | Lifestyle & Behavioral | A | 43 | trial evidence | 50 ·5m | 9 | — |
| Cardiac autonomic dysfunction (reduced heart rate variability) | Novel & Emerging Biomarkers | A | 41 | trial evidence | 40 ·4m | 13 | — |
| Vitamin D deficiency | Novel & Emerging Biomarkers | B | 41 | trial evidence | 25 ·3m | 31 | — |
| Cancer | Comorbid Conditions | B | 41 | trial evidence | 43 ·2m | 145 | — |
| LPA gene variants | Genetic & Family History | B | 40 | genetic-causal | 10 | — | 258 |
| Sleep duration | Lifestyle & Behavioral | A | 40 | observational only | 97 ·14m | — | — |
| History of preeclampsia | Comorbid Conditions | B | 40 | trial evidence | 67 ·2m | 16 | — |
| N-terminal pro-B-type natriuretic peptide | Novel & Emerging Biomarkers | B | 39 | trial evidence | 95 ·2m | 10 | — |