Association of the PREVENT 10-year ASCVD risk score with left ventricular mass and myocardial mechano-energetic efficiency: a cross-sectional study

For decades, doctors have relied on a set of standard questions to guess who might suffer a heart attack or stroke in the future. They look at age, blood pressure, cholesterol, and whether a person smokes or has diabetes. These factors are well-known troublemakers that slowly damage the heart and blood vessels long before a person ever feels sick. Recently, a new set of tools called the PREVENT equations was introduced to refine these guesses. These formulas are designed to calculate a person's ten-year risk of developing cardiovascular disease by combining those traditional risk factors with newer information about kidney function and body weight. The big question for researchers was whether this new math could spot trouble that was already happening inside the body, even in people who felt perfectly fine. Specifically, they wanted to know if a high risk score meant the heart muscle itself had already begun to change shape or struggle with its energy use, signaling damage that standard exams might miss.

A team of researchers in Italy decided to put this idea to the test using a large group of adults who had no history of heart disease. They gathered data from 2,802 people between the ages of twenty and seventy-nine who were visiting a university hospital because they had risk factors like high blood pressure, excess weight, or problems with blood sugar. The scientists did not wait for these people to get sick; instead, they used the new PREVENT formulas to sort everyone into four groups: low risk, borderline risk, intermediate risk, and high risk. The lowest group had a calculated ten-year risk of less than three percent, while the highest group had a risk of ten percent or more. Once sorted, the researchers performed detailed ultrasound scans of the heart, known as echocardiograms, to measure two specific things. First, they measured the mass of the left ventricle, the main pumping chamber of the heart, to see if it had grown too thick. Second, they calculated how efficiently the heart muscle converted chemical energy into the mechanical work of pumping blood, a measure of how hard the heart has to work to do its job.

The results revealed a clear and steady pattern as the risk scores went up. People in the higher risk categories were not just statistically more likely to get sick in the future; they already showed signs of physical strain on their hearts. As the calculated risk increased, the heart muscle became noticeably heavier and thicker. In the low-risk group, about thirty-eight percent of participants had a thickened heart muscle, a condition known as left ventricular hypertrophy. By the time the researchers looked at the high-risk group, that number had climbed to seventy-five percent. This means that someone with a high PREVENT score was roughly three times more likely to have this thickening than someone with a low score, even though neither group had ever been diagnosed with heart disease. The heart was essentially working harder and growing larger in response to the body's metabolic stress, a change that often precedes clinical failure.

The study also uncovered a decline in the heart's efficiency. The researchers found that as the risk score rose, the heart's ability to turn energy into pumping power dropped. In the lowest risk group, the heart muscle pumped a certain amount of blood for every gram of tissue it contained. In the highest risk group, that efficiency had fallen significantly. It was as if the engine of the car was burning more fuel to move the same distance, a sign that the machinery was beginning to wear down. This drop in efficiency happened alongside other signs of a body under stress, such as higher levels of inflammation, worse blood sugar control, and more visceral fat, which is the deep belly fat that surrounds internal organs. The data showed that these metabolic problems were tightly linked to the physical changes in the heart, suggesting that the body's internal environment was driving the damage.

These findings suggest that the PREVENT equations are doing more than just predicting the future; they are identifying people who are already in the early stages of heart damage. The study indicates that a high risk score is a strong signal that the heart has already begun to remodel itself, becoming thicker and less efficient, long before a patient experiences symptoms like chest pain or shortness of breath. The researchers noted that their work was observational, meaning they looked at a snapshot in time and could not prove that the risk score caused the heart changes, but the connection was too strong to ignore. They also pointed out that their study group was drawn from a specific region in Italy and consisted mostly of white individuals, so the results might look different in other populations. Nevertheless, the study offers a compelling reason to take these risk scores seriously. It suggests that doctors might use these calculations not just to decide who needs medication, but to identify patients who need immediate lifestyle changes to stop the heart from deteriorating further, catching the problem while it is still silent and reversible.