Abstract Body (Do not enter title and authors here): Background: The American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) equations were recently developed to estimate risk of cardiovascular disease (CVD). Long-term risks of cardiovascular disease based on the PREVENT equations in the U.S. population are unknown.

Methods: Using data on adults aged 30-79 years from the National Health and Nutrition Examination Survey between 2011 and 2020, we determined long-term risks of total CVD (atherosclerotic cardiovascular disease or heart failure) based on the PREVENT equations. Age-standardized and survey-weighted risk prevalence was determined with further stratification by age group, sex, race and ethnicity.

Results: The study population included 14,256 participants representing 160.6 million U.S. adults (mean [SD] age 51.9 [11.2] years, 49.2% women, 66.4% non-Hispanic white, 9.8% non-Hispanic black, 5.7% non-Hispanic Asian and 14.8% Hispanic). Among adults aged 30-79 years, 9.6% had existing CVD and 20.2% were CVD-free but had intermediate or high (≥7.5%) 10-year risk of CVD. The prevalence of CVD-free US adults with low or borderline (<7.5%), intermediate (7.5-19.9%) and high (≥20%) estimated 10-year CVD risk was 65.6%, 18.8%, and 4.3% for men and 74.7%, 14.3% and 2.8% for women, respectively. Among adults 45 years and older, men and Black or Hispanic adults were more likely to be at intermediate or high 10-year CVD risk (Table). Among adults 65-79 years, 28.9% had existing CVD and 64.3% were CVD-free but had intermediate or high 10-year risk. Among CVD-free adults 30-59 years, the median 30-year risk of CVD was 17.8% for men and 12.6% for women, respectively. Among all U.S. adults 30-59 years of age, 65.4% were CVD-free with an intermediate or high 30-year risk of CVD and 6.1% had existing CVD.

Conclusions: Three in ten U.S. adults aged 30-79 years has an intermediate or high 10-year risk of CVD events, including more than 90% of adults over age 65. Nearly three in four middle-aged adults have an intermediate or high 30-year risk. Men, Black and Hispanic adults were generally higher risk. These findings emphasize the need for more intensive public health efforts to prevent cardiovascular disease in the U.S.