From Framingham to PREVENT: The New Era of Cardiometabolic Risk

How modern science is redefining prevention for heart attack, stroke, and diabetes

The Evolution of How We Measure Heart and Metabolic Disease Risk

For more than half a century, clinicians have relied on population-based equations to estimate who is most likely to develop heart disease, stroke, or diabetes. These tools shaped preventive care, but they were designed for groups, not individuals. Medicine is now shifting toward a personalized approach to prevention. By integrating both cardiovascular and metabolic data, cardiometabolic disease risk management connects risk factors that were once considered separately by different specialists like cardiologists and endocrinologists.

The Framingham Foundation

The Framingham Heart Study, launched in 1948, transformed medicine by identifying the classic risk factors for cardiovascular disease:

  • Smoking

  • High blood pressure

  • Age and gender

  • Total and HDL cholesterol

  • Diabetes

Those findings led to the Framingham Risk Score, which categorized people into low, intermediate, or high-risk groups based on the number of risk factors present.

📖 Learn more from the National Heart, Lung, and Blood Institute (NHLBI)

While groundbreaking, this population model could not account for the complexity of individual biology. Two people with similar cholesterol and blood pressure values might face dramatically different outcomes depending on genetics, inflammation, and metabolic health.

The Rise of Metabolic Insight

By the late 1980s, research highlighted that cardiovascular and metabolic diseases are deeply interconnected. Metabolic syndrome emerged as a concept describing a cluster of findings that substantially increase lifetime risk for heart attack, stroke, and diabetes:

  • Increased waist circumference

  • Elevated triglycerides

  • Low HDL cholesterol

  • Elevated blood pressure

  • Elevated fasting glucose

📚 American Heart Association: Understanding Metabolic Syndrome

Individuals with three or more of these findings were shown to have far higher cardiometabolic risk. Recognizing and quantifying these overlapping mechanisms is now central to prevention. The Cardiometabolic Risk Assessment takes a big step further by using the Metabolic Syndrome Severity Score to give a much more granular view of individual metabolic syndrome risk on a scale of 1-100 instead of just a number of factors.

Learn more about the Metabolic Syndrome Severity Score: Explore the Metabolic Syndrome Severity Score

Risk-Enhancing Factors: Beyond the Basics for ASCVD Risk

Traditional risk calculators capture only part of the story. Today, clinicians consider a set of risk-enhancing factors that refine and personalize risk assessment. These include:

  • ApoB: Measures the number of atherogenic cholesterol-carrying particles that are the precursors to arterial plaque buildup. Unlike measuring LDL-cholesterol, measuring ApoB using NMR technology gives an accurate answer that LDL-C only approximates: “how many ‘things’ are in the bloodstream that can cause plaque?”

    Learn more about ApoB: ApoB vs. LDL-C: What’s More Accurate?

  • Lipoprotein(a): A genetically inherited lipoprotein that increases lifetime risk independent of cholesterol levels. Approximately 20% of people have this genetically-passed risk enhancing factor for an ASCVD event, yet only about 2% of people have had their Lp(a) measured.

    Learn more about Lp(a): High Lipoprotein(a): What Elevated Lp(a) Levels Mean for You

  • Chronic inflammation: Biomarkers such as GlycA or high-sensitivity CRP (hs-CRP) indicate ongoing inflammation that accelerates vascular injury. Low-grade systemic inflammation is an indicator or metabolic dysfunction and a modifiable risk enhancing factor for future ASCVD events.

    📖 Journal of the American College of Cardiology (JACC): Inflammation and Atherosclerosis
    Learn more about GlycA: Quantifying Systemic Inflammation using the biomarker GlycA

  • Chronic kidney disease and insulin resistance: Conditions that amplify vascular and metabolic stress.

  • Noninvasive imaging: Tests such as coronary artery calcium (CAC) scoring or carotid ultrasound reveal early plaque formation.

    Need to find a noninvasive imaging center in your area? Find Noninvasive Imaging Centers Near You

Considering these factors allows for a far more accurate and individualized picture of cardiometabolic risk. The Cardiometabolic Risk Assessment considers over 30 risk-enhancing factors that are often missed in standard lipid panels and basic calculators like the commonly used Pooled Cohort Equation.

The PREVENT Model: A Smarter Starting Point

In 2023, the American Heart Association introduced the PREVENT calculator, a major step forward in individualized risk estimation.

📖 AHA Scientific Statement: The PREVENT Risk Calculator (2023)

PREVENT expands on earlier models by incorporating the following:

  • Hemoglobin A1c to reflect long-term glucose control

  • Kidney function for early detection of metabolic stress

  • More granular demographic data

  • 10-year and 30-year outcomes to guide both short- and long-term decisions

By integrating these cardiometabolic variables, PREVENT reduces the overestimation seen with older tools and creates a stronger foundation for shared decision-making between clinician and patient.

Learn more about Why Measure Cardiometabolic Risk?

Turning Insight Into Action

Understanding risk is only valuable when it leads to action.

At Precision Health Reports, our Cardiometabolic Risk Assessment combines modern risk equations like PREVENT with advanced biomarkers and personalized thresholds for age, gender, and ethnicity. Each report translates complex data into a clear, guideline-based plan for reducing risk through both lifestyle and clinical interventions. Most importantly, the Cardiometabolic Risk Assessment is the only guideline-based clinical-grade tool for individuals and clinicians to identify individual risk factors, indicate risk on a scale, then provide personalized threshold goals for the individual that reflect individual-specific targets for future risk reduction.

The Future of Prevention Is Cardiometabolic

Heart disease, stroke, and diabetes share common pathways rooted in metabolic health and insulin resistance. Recognizing that connection enables earlier identification and more targeted prevention.

By uniting decades of epidemiology, emerging biomarkers, and individualized modeling, cardiometabolic prevention represents the next chapter in how clinicians and patients work together to reduce risk, not just estimate it.

Take the Next Step

Learning about the history of cardiometabolic risk is an important foundation, but don’t stop there. Our Cardiometabolic Risk Assessment gives you a complete picture of your risk for metabolic and cardiovascular disease events with outcome-proven biomarkers and guideline-driven recommendations to give you a clear path forward.

Get Your Own Assessment

Frequently Asked Questions

  • Cardiometabolic risk refers to the combination of factors that increase your chances of developing heart disease, stroke, and metabolic conditions like type 2 diabetes. It reflects how your cardiovascular and metabolic systems interact. Some of the parts of risk include blood pressure, cholesterol, glucose control, body composition, and inflammation.

  • The PREVENT calculator, introduced by the American Heart Association in 2023, incorporates modern cardiometabolic factors such as kidney function and hemoglobin A1c. It provides 10-year and 30-year risk estimates that are more personalized and less likely to overestimate risk compared with earlier models.

  • ApoB measures the number of cholesterol-carrying particles that cause plaque buildup, while Lipoprotein(a) identifies inherited risk not captured by standard cholesterol tests. Including these markers gives a more accurate picture of individual risk for heart disease risk.

  • Improving lifestyle factors such as diet, physical activity, sleep, and weight management is essential. Your doctor may also recommend further testing for biomarkers, imaging, or targeted therapies based on your Cardiometabolic Risk Assessment.

  • Precision Health Reports integrates guideline-based equations like PREVENT with advanced outcome-proven biomarkers, relevant clinical history and adjustment for age, gender, and ethnicity to provide the input for a clear, actionable plan for reducing future disease risk.

Want to Read More about Cardiometabolic Risk?

American Heart Association: Cardiovascular Risk Calculators and Tools. A concise overview of the major risk equations and how they guide prevention of cardiovascular disease, including links to the AHA’s latest assessment models.

🔗 Read on the American Heart Association website ›

National Institutes of Health (NIH): Metabolic Syndrome Overview. Explains what metabolic syndrome is, its five diagnostic components, and why early recognition is key to lowering risk for heart disease and diabetes.

🔗 Read on the NIH website ›

Journal of the American College of Cardiology (JACC): Emerging Risk Factors and Prevention. A scientific summary of how new biomarkers, inflammatory markers, and lifestyle factors are reshaping cardiovascular risk prediction and prevention strategies.

🔗 Read in the Journal of the American College of Cardiology ›