Department of Research & Evaluation News

A Kaiser Permanente study found that the PREVENT cardiovascular risk equation had strong overall ability to predict 10-year cardiovascular disease risk in Asian, Native Hawaiian, and Other Pacific Islander adults. However, its accuracy differed across specific Asian ethnic subgroups and showed consistent patterns of over- and under-estimating when grouping by race and ethnicity.

The study went online in February 2026 in JAMA Network Open.

Equation models calculate cardiovascular risk

Cardiovascular diseases include heart attack, stroke, and heart failure. Doctors use risk prediction equations to estimate a person’s chance of developing these conditions within a set time period. These estimates support clinical decisions about prevention, such as prescribing medications or recommending lifestyle changes.

The PREVENT equation was introduced in 2023 by the American Heart Association to estimate 10- and 30-year cardiovascular disease risk. The equation model included important clinical factors and the Social Deprivation Index, which is an area‑level measure of socioeconomic disadvantage, but removed race as a predictor to promote health equity and reduce bias. Now researchers are evaluating how well it performs across different populations.

Equation shows varying performance across groups

“Our findings demonstrate significant variation in cardiovascular risk prediction among distinct Asian, Native Hawaiian, and Other Pacific Islander groups,” said the study’s senior author Jaejin An, PhD, a pharmacoepidemiologist with the Kaiser Permanente Southern California Department of Research & Evaluation.

“Although various Asian, Native Hawaiian, and Other Pacific Islander subgroups have distinct health profiles related to cardiovascular risk, they are often grouped together in studies because of limited data,” Dr. An said. “Our Kaiser Permanente patient population includes a good representation of Asian ethnicities, so our study could evaluate whether the new PREVENT equation accurately predicts risk in these subgroups, which were underrepresented in the original equation development.”

Researchers analyzed electronic health records from 542,848 adults who were members of Kaiser Permanente in Southern California. All participants were between 30 and 79 years old and had no history of cardiovascular disease at the start of the study. They were followed for up to 10 years to observe new cases of cardiovascular disease.

Two versions of PREVENT tested

The study tested 2 versions of the PREVENT equation: a base equation and a full equation. The base equation used traditional risk factors, including cholesterol levels, systolic blood pressure, body mass index (BMI), kidney function, diabetes status, smoking status, and use of blood pressure or cholesterol medications. The full equation added hemoglobin A1c, urine albumin creatinine ratio, and a Social Deprivation Index based on neighborhood characteristics.

Overall performance of the base and full equations was similar.

Asian participants were analyzed both as combined groups and as separate ethnic groups, including Chinese, Filipino, Japanese, Korean, South Asian, Vietnamese, and other Southeast Asian populations.

Detailed findings on risk equations

When all Asian ethnic groups were combined together, the performance of the PREVENT equation was similar to that for White adults. However, the PREVENT equation slightly overestimated cardiovascular disease risk in Asian adults and underestimated risk in Native Hawaiian and Other Pacific Islander adults.

When Asian ethnic groups were examined separately, there was substantial variation in how well the equation predicted cardiovascular disease risk. The PREVENT equation did the best job of ranking high-risk people for those who were Chinese, but the poorest job for those who were Vietnamese. Other Asian ethnicities fell between those 2 extremes.

“What we’ve learned is that consolidating Asian and Pacific Islander groups into a single category misses crucial differences in risk among specific ethnic and racial groups,” Dr. An said. “This finding supports development of tailored equations and cautious application in prevention decisions.”

In addition to Dr. An, other authors of the study from Kaiser Permanente Southern California include Matt M. Zhou, BS; Soon Kyu Choi, MSc; Hui Zhou, PhD; Teresa N. Harrison, SM; Matthew T. Mefford, PhD; Mingsum Lee, MD, PhD; and Kristi Reynolds, PhD.

Other authors include Yiyi Zhang, PhD, Columbia University, New York, New York; Eugene Yang, MD, MS, University of Washington, Seattle, Washington; and Nilay S. Shah, MD, MPH, Northwestern University, Chicago, Illinois. Authors affiliated with the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, Calif. are Dr. Au, Dr. Zhou, Dr. Lee, Dr. Reynolds, and Dr. An.