Abstract Body (Do not enter title and authors here): Background
The 2013 Pooled Cohort Equation (PCE) has been a useful starting point to assess atherosclerotic cardiovascular disease (ASCVD) risk. In 2023, the PREVENT risk calculator was developed and validated as a contemporary calculator considering the cardiovascular-kidney-metabolic health paradigm. Coronary artery calcium (CAC), measured on non-contrast cardiac computed tomography (CT), improves ASCVD risk stratification beyond traditional risk factors. However, the prevalence of CAC burden across PCE versus PREVENT risk groups is unknown.

Hypothesis
We hypothesized that there would be a higher CAC burden for PREVENT vs PCE calculated risk across low, borderline-intermediate, and high-risk groups.

Methods
This retrospective study included 6,003 asymptomatic individuals who underwent CAC scoring for ASCVD risk stratification from 2010-2023 at Emory. The 10-year risk for ASCVD according to PCE and base PREVENT were retrospectively calculated. CAC was quantified using the Agatston method. CAC scores across PREVENT and PCE groups were compared using Chi-square tests, using CAC (0, 1-99, 100-299, ≥300) and PCE/PREVENT (low<5, borderline-intermediate 5-19, high≥20%) 10-year risk categories. Concordant/discordant groups were created according to agreement between PCE and PREVENT (>7.5 PCE/PREVENT <7.5).

Results
The mean age 57(9), 41% were women, and 11% were Black people. PCE classified 51.8% (n=3112) low, 41.5% (n=2490) borderline-intermediate, and 6.7% (n=401) high-risk participants, whereas PREVENT classified 72.1% (n=4329) low, 27.3% (n=1641) borderline-intermediate, and 0.6% (n=33) high-risk participants. Among participants, 41.2% (n= 2474) had CAC=0, 36.5% (n=2189) had 1-99, 11.4% (n=687) had 100-299, and 10.9% (n=653) had ≥300 CAC. For both PCE and PREVENT, higher risk groups had higher median CAC. CAC distribution was heterogeneous across risk categories within both PCE and PREVENT, and between PCE and PREVENT (p<0.001). CAC prevalence was 72% and 81% for individuals with borderline-intermediate risk according to PCE and PREVENT, respectively. Median CAC scores were similar across discordant PCE/PREVENT risk groups (33 (1-201) vs 29 (1-201)).

Conclusion
The prevalence of CAC was similar across calculated PCE and PREVENT risk groups, including individuals with borderline-intermediate risk. These results underline the continued utility of CAC at improving risk stratification beyond PCE and PREVENT.