Impact of PREVENT-ASCVD vs pooled cohort equations on statin eligibility across demographic groups: Insights from the NIH All of Us Research Program.

We compared the predicting risk of cardiovascular EVENTS-atherosclerotic cardiovascular disease (PREVENT-ASCVD) risk equation with the pooled cohort equation (PCE) for estimating statin eligibility across demographic subgroups in the All of Us Research Program in patients without ASCVD, heart failure, diabetes, or lipid-lowering therapy. Statin eligibility was defined as a 10-year ASCVD risk for PREVENT-ASCVD ≥5% and PCE ≥7.5%. Eligibility estimates were compared across age, sex, and race/ethnicity, and by quintile of polysocial risk score (PsRS). Among 25,188 participants, overall statin eligibility was 23.1% under PREVENT-ASCVD compared with 28.0% under PCE (Δ = 4.9%, P < 0.001). The largest differences were among participants aged 60 to 69 years and among Black participants. Among those with PsRS data (n = 6213), PREVENT-ASCVD estimated lower statin eligibility than PCE across all quintiles (P < 0.05). Differences in statin eligibility between PREVENT-ASCVD and PCE persist even when applying guideline-recommended thresholds, highlighting the importance of incorporating additional risk-enhancing factors beyond those included in either equation to better inform primary prevention decisions.