What is PREVENT Risk Age?
An individual's risk age represents the chronological age of a hypothetical person with the same predicted risk of cardiovascular disease but all risk factors at optimal levels. This then allows a person to compare their chronological age and risk age, and may be a useful way to communicate risk information to patients (PMID: 16735521).
For example, a 57-year-old woman with risk factors for cardiovascular disease (e.g., hypertension, hyperlipidemia) may have the same predicted 10-year risk of cardiovascular disease as a hypothetical 63-year-old woman with optimal risk factor levels. In this scenario, the person’s chronological age is 57 years, but their “risk age” is older at 63 years.
In this 57-year-old woman with a predicted 10-year CVD risk of 5% using PREVENT, her risk age of 63 years (greater than actual age) reflects that their risk is higher than what would be considered optimal for her age and sex. Additionally, this reflects that optimizing risk factors (e.g., lowering her blood pressure and cholesterol levels) could bring her risk age closer to her actual age. Therefore, presenting risk age of 63 years along with her predicted risk of 5% may improve risk communication and understanding between clinicians and patients. Conversely, a risk age lower than or equal to actual age may reflect that risk factors are already optimized.
How were optimal risk factor levels defined?
Optimal levels for cardiovascular disease risk factors for risk age calculation were defined based on prior publications and other online risk tools. Specifically, we defined an optimal profile with the following risk factor levels as: non-high density lipoprotein cholesterol of 120 mg/dL, high density lipoprotein cholesterol of 50 mg/dL, systolic blood pressure of 110 mmHg, and estimated glomerular filtration rate of 90 ml/min/1.73m2 in an individual without diabetes, who doesn’t smoke, and is not on anti-hypertensive or statin therapy.
How were the PREVENT Risk Age equations derived?
To derive the risk age equations for PREVENT, we followed methods defined by D’Agostino (PMID: 18212285) and Marma & Lloyd-Jones (PMID: 19620502) for the Framingham Risk Score. We first entered the optimal levels of cardiovascular disease risk factors (defined above) into the PREVENT base model (PMID: 37947085) and then solved for age with predicted risk as an independent variable. This resulted in sex-specific PREVENT Risk Age equations:
For example, a 60 year-old woman with the following risk factor profile (total cholesterol of 200 mg/dL, HDL cholesterol of 60 mg/dL, blood pressure of 140 mmHg, and estimated GFR 90 ml/min/1.73m2 who does not have diabetes, is non-smoking, and not on any current statin or anti-hypertensive medications) would have a risk age of 64 years based on her absolute 10-year CVD risk of 5.3% using PREVENT.
The PREVENT Risk Age equations are valid for adults aged 30 to 79 years without cardiovascular disease. For risk ages estimated at the extremes <30 or >79 years, risk age is reported as <30 or >79 years.
The table shows how absolute 10-year CVD risk from PREVENT approximately translates into a risk age regardless of chronologic age for women and men:
| PREVENT Base Model 10-year CVD risk | Risk Age for Women | Risk Age for Men |
|---|
| 1% | 45 | 42 |
| 3% | 57 | 54 |
| 5% | 63 | 60 |
| 7.5% | 68 | 65 |
| 10% | 71 | 69 |
| 15% | 76 | 73 |
| 20% | 79 | 77 |
| 25% | Over 79 | Over 79 |
What about risk age around the world?
Risk age has been adopted widely outside of the US, and was endorsed in the European Society of Cardiology’s 2021 guidelines on cardiovascular disease prevention (PMID: 34458905). Risk age tools are available in the
United Kingdom,
Europe,
and
Australia.
Where can I find more information about the PREVENT equations?
Please see the following links for more details about PREVENT:
PREVENT risk age equations and population distribution in US adults
AHA PREVENT Online Calculator
Development and Validation of the AHA PREVENT equations
AHA Scientific Statement on the PREVENT equations
Academic access to the PREVENT statistical software code (R or STATA)
How should this tool be used?
The PREVENT Risk Age Calculator is intended for primary prevention patients only (individuals without a history of atherosclerotic heart disease or heart failure).
The PREVENT Risk Age Calculator was developed for informational and educational purposes only. Risk age estimates are intended to accompany absolute risk estimates and do not replace clinical judgment. This tool is not a substitute for care provided by a qualified medical professional, and does not constitute medical advice or services. This tool should not be used without direct consultation or supervision of a healthcare professional. Using and accessing this tool does not create a relationship between the calculator owner and the user.
The use of the calculator is provided on an as is basis. The calculator owner, its affiliates, and developers are not responsible for ensuring that your implementation of the calculator, site content, or results of the calculator will be clinically sound, error-free, or that defects, if any, will be corrected.
References
1. D'Agostino RB, Sr., Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. Feb 12 2008;117(6):743-53.
doi:10.1161/CIRCULATIONAHA.107.699579
2. Goldman RE, Parker DR, Eaton CB, Borkan JM, Gramling R, Cover RT, Ahern DK. Patients' perceptions of cholesterol, cardiovascular disease risk, and risk communication strategies. Ann Fam Med. May-Jun 2006;4(3):205-12.
doi:10.1370/afm.534
3. Khan SS, Matsushita K, Sang Y, Ballew SH, Grams ME, Surapaneni A, Blaha MJ, Carson AP, Chang AR, Ciemins E, Go AS, Gutierrez OM, Hwang SJ, Jassal SK, Kovesdy CP, Lloyd-Jones DM, Shlipak MG, Palaniappan LP, Sperling L, Virani SS, Tuttle K, Neeland IJ, Chow SL, Rangaswami J, Pencina MJ, Ndumele CE, Coresh J for the Chronic Kidney Disease Prognosis Consortium and American Heart Association Cardiovascular-Kidney-Metabolic Science Advisory Group. Development and Validation of the American Heart Association's PREVENT Equations. Circulation. Feb 6 2024;149(6):430-449.
doi:10.1161/CIRCULATIONAHA.123.067626
4. 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. Dec 12 2023;148(24):1982-2004.
doi:10.1161/CIR.0000000000001191
5. Krishnan V, Huang X, Perak AM, Coresh J, Ndumele CE, Greenland P, Lloyd-Jones DM, & Khan SS (2025). PREVENT Risk Age Equations and Population Distribution in US Adults. JAMA Cardiology.
doi:10.1001/jamacardio.2025.2427
5. Krishnan V, Petito LC, Huang X, & Khan SS. (2024). 'AHAprevent': AHA PREVENT equations for R. R package version 1.0.0.
For academic access, please see Terms and Conditions at
https://professional.heart.org/en/guidelines-and-statements/prevent-calculator
6. Marma AK, Lloyd-Jones DM. Systematic examination of the updated Framingham heart study general cardiovascular risk profile. Circulation. Aug 4 2009;120(5):384-90.
doi:10.1161/CIRCULATIONAHA.108.835470.
7. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Back M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B, ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. Sep 7 2021;42(34):3227-3337.
doi:10.1093/eurheartj/ehab484