AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Underestimation of Long-Term Cardiovascular Risk in Chronic Kidney Disease: Discordance Between 10-Year and 30-Year PREVENT Scores
By Kaufman C, Claudel S, Verma A
Background: Chronic kidney disease (CKD) is a known long-term cardiovascular disease (CVD) risk enhancer, yet clinical preventive strategies are often guided by short-term risk estimates. We evaluated discordance between 10- and 30-year CVD risk estimates using AHA PREVENT scores among U.S. adults with CKD. Research Questions: How frequently do adults with CKD have low estimated 10-year CVD risk but high estimated 30-year risk, and what is the impact of UACR on risk classification? Methods: We included participants in the National Health and Nutrition Examination Survey (1999-2018) with CKD (UACR ≥30mg/g or eGFR <60mL/min/1.73m ² ) and no prior CVD. We defined two cohorts: a 10-year cohort of adults aged 30-79 years (N=5078), and a discordance cohort of adults aged 30-59 years (N=2326). For participants in the 30-59 cohort, 10- and 30-year risk was estimated using the PREVENT Base and PREVENT + UACR equations. Discordance was defined as low 10-year risk (<10%) and high 30-year risk (≥15%), according to the PREVENT estimated CVD risk. We calculated sex-stratified median risk score percentage by 5-year age groups. We then calculated the number of adults appropriately reclassified into high risk categories after incorporating UACR into the risk estimate. Results: Median 10-year CVD risk remained below the 10% action threshold through ages 60-64 among women and 65-69 among men. In contrast, median 30-year risk exceeded the 15% action threshold for men aged 35-39 years (BASE 14.4%; +UACR 16.8%) and for women aged 45-49 years (BASE 15.5%; +UACR 17.9%) (Fig. 1) . Among those aged 55-59 years, the median 30-year risk was 33.0% in men and 31.7% in women, approximately fourfold higher than the corresponding 10-year estimates. Low 10-year and high 30-year discordance was present across all age-sex strata and increased with age (Fig. 2). Overall, 46.8% of adults aged 30-59 years had low 10-year, but high 30-year risk . The highest level of discordance was seen among men aged 45-49 years (68.2%) and among women aged 50-54 years (67.3%). Adding UACR reclassified an estimated 446,663 adults above the 30-year ≥15% risk threshold (Fig. 3). In older adults, UACR frequently increased the 10-year risk above the 10% risk threshold, appropriately reclassifying individuals from discordant to high-risk status across both estimates. Conclusions: The 10-year PREVENT risk estimates substantially under recognized lifetime cardiovascular risk among younger adults with CKD. Incorporating the PREVENT+UACR equation meaningfully improved risk stratification and should be used in adults with CKD to avoid systematic under-estimation of CVD risk.