Tool to predict future risk of heart attacks and strokes across diverse, global populations given green light in latest study

A tool to predict the risk of future cardiovascular disease using measures of kidney function across diverse populations has been given the green light by researchers from the University of Leicester.

Known as the PREVENT (Predicting Risk of Cardiovascular Disease EVENTs) risk calculator, the tool uses information such as age, sex, blood pressure, cholesterol levels, smoking status, diabetes and blood and urine kidney tests to estimate a patient’s risk of developing major cardiovascular disease – including heart attack, stroke and heart failure – over a 10-year and 30-year period.

The results of this important evaluation, supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands, and Kidney Research UK, have now been published in Nature Medicine with the findings highlighting the importance of simple kidney tests in everyday care. 

Importantly, the tool allows clinicians to identify who is most likely to benefit from preventative therapies such as lipid-lowering medications, tighter blood pressure control and newer glucose-lowering treatments - potentially reducing the future burden of cardiovascular disease and heart failure worldwide.

PREVENT was originally developed using data from over 3.2 million individuals and validated for use in North America in 2023. However, until now it had not been extensively evaluated in diverse multinational populations across different healthcare systems.

Now, scientists including experts from the University of Leicester, alongside academics from Oxford, Dundee, Salford and Glasgow universities, have been able to analyse the tool in more than 6.4 million people from over 60 studies worldwide – including large observational cohorts and major randomised controlled trials, with participants from North and South America, Europe, Asia and other regions.

Evaluation of PREVENT’s predictive accuracy across diverse ethnicities and risk profiles supports wider international adoption of the tool to predict future cardiovascular events, and to ensure preventative treatments are put in place for the patients who will benefit most.

Dr Rupert Major, Associate Professor in the University of Leicester’s Public Health and Epidemiology Division and Honorary Consultant Nephrologist at University Hospitals of Leicester NHS Trust and Leicester, Leicestershire and Rutland Integrated Care Board, is co-lead author of the study.

He helped design and deliver the multinational analysis and led work linking cardiovascular and kidney risk in UK and European data.

PREVENT works best when doctors have results from a blood test for kidney function (estimated glomerular filtration rate, or eGFR) and a urine test for protein leakage called albumin:creatinine ratio (ACR). 

In the study, ACR emerged as one of the strongest predictors of future cardiovascular events, over and above traditional risk factors and eGFR alone. 

Adding ACR to the information already used in PREVENT made the tool more accurate at identifying people at highest risk – particularly those with diabetes or chronic kidney disease – and could help ensure that preventive treatments are targeted to the patients who need them most. 

Because ACR can be measured from a simple urine sample in primary care, researchers say it should be routinely included alongside blood pressure, cholesterol and eGFR in cardiovascular risk assessments.

Dr Major said: “Cardiovascular disease remains one of the leading causes of death and disability worldwide, but it often develops silently over many years, particularly in people living with conditions such as high blood pressure, diabetes and kidney disease. 

“By testing PREVENT in more than six million people across the globe, we’ve shown that this tool can reliably flag those at higher risk and support the shift from sickness to prevention of disease.

“Leicester played a key role in bringing together international datasets and highlighting how a simple urine ACR test – which is quick, inexpensive and already available in the NHS – can significantly sharpen our predictions and improve efficiency in the NHS. 

“This means clinicians can have more confident, personalised conversations with patients about starting preventive treatments earlier, potentially avoiding future heart attacks, strokes and heart failure admissions.”

Professor Nil Sanganee, Chief Medical Officer for the Leicester, Leicestershire and Rutland and Northamptonshire Integrated Care Board and Honorary Professor in the University of Leicester’s College of Life Sciences, added: “The findings of this pioneering research in Leicester are very encouraging and will help promote better health outcomes for our local diverse population as well as different ethnicities worldwide. 

 “The PREVENT risk calculator will help save lives by identifying and preventing the risk of developing cardiovascular disease and heart failure. This is particularly good news for those more prone to these conditions, even if they do not suspect it. 

 “Through detection, the tool will support the management of long-term health and inform preventative intervention where necessary, ensuring people live longer and healthier lives.”

Professor Mike Lewis, NIHR Scientific Director for Innovation, said: “Research like this has the potential to change how we approach cardiovascular care, shifting from reacting to illness to identifying risk earlier and intervening sooner. 

“Importantly, the study shows how better use of existing NHS tests and data could support more informed decisions for patients from a wide range of backgrounds and ethnicities, helping tackle inequalities in cardiovascular outcomes. 

“Supporting earlier, more personalised prevention is central to the government’s shift from sickness to prevention, helping people stay healthier for longer while reducing pressure on NHS services.” 

Professor Smeeta Sinha, NHSE National Clinical Director for Renal Services, said: “We welcome this publication from a global study involving more than six million people, including substantial UK representation. The findings show that a simple urine ACR test, which detects early kidney disease, significantly improves our ability to predict future cardiovascular risk. This improved approach to risk assessment will support more informed discussions between clinicians and patients and help drive earlier, more effective prevention of cardiovascular disease.”

David Crosby, chief research officer at Kidney Research UK added: “We are delighted to hear this new progress in Dr Major’s research, which follows on from his Kidney Research UK training fellowship. This larger scale testing of a tool that could predict cardiovascular risk across a diverse group of people living with kidney disease could mean earlier identification, so interventions can be made to try and prevent a cardiovascular event. More research is needed, and we look forward to hearing the next steps.”