Most US adults meeting PREVENT risk thresholds lack lipid therapy
Among eligible adults without baseline cardiovascular disease, 67.1% at intermediate risk and 71.2% at borderline risk were not receiving lipid-lowering therapy.
American Journal of Preventive Cardiology
In a nationwide observational study of 39,277 U.S. adults aged 30 to 79 years, researchers evaluated treatment gaps and fatal cardiovascular disease under the PREVENT-ASCVD framework. During follow-up, 1,606 cardiovascular deaths occurred. Although death rates were higher in people with established cardiovascular disease (11.54 versus 0.97 per 1,000 person-years), 38.5% of cardiovascular deaths took place in adults without baseline diagnosed disease.
Among 22,505 participants without baseline cardiovascular disease who had calculable scores, 23.6% met the intermediate-or-higher risk threshold of at least 5%, but 67.1% of them were not receiving lipid-lowering therapy. At the borderline-or-higher threshold of 3% or more, 35.9% met criteria and 71.2% were untreated. Within this primary-prevention group, male sex, current smoking, and higher systolic blood pressure were independently associated with fatal cardiovascular disease, whereas diabetes was not after adjustment.
Why it matters
Cardiovascular disease represents a major burden in aging populations, and retrospective data suggest that many adults who later experience fatal events meet contemporary thresholds for preventive therapy without receiving it. Identifying these treatment gaps may help researchers evaluate how current risk models track cardiovascular risk across adulthood.
Caveats
The observational design relied on retrospective application of PREVENT thresholds and cannot show that treatment initiation would have prevented mortality. The analysis was also limited to U.S. adults with complete risk data.
The paper
U.S. Army Research Institute of Environmental Medicine
American Journal of Preventive Cardiology · 20 Jun 2026